Minimally Invasive Orthopedic Surgery with MDT Collaboration Offers Hope for 97-Year-Old Patient with Femoral Fracture
In orthopedics, femoral fractures in the elderly are widely known as “the last fracture of life”. For patients over 90, such fractures carry extremely high risks of anesthesia complications, intraoperative emergencies and postoperative adverse events.
Recently, the Department of Orthopedics, Taikang Xianlin Drum Tower Hospital Affiliated to Nanjing University Medical School admitted a 97-year-old patient with femoral fracture who had been turned down for surgery at multiple hospitals due to excessive risks. Leveraging in-depth collaboration with the Orthopedics Department of Nanjing Gulou Hospital and the hospital’s multidisciplinary team (MDT) resources, Director Xiong Jin and his team successfully performed minimally invasive intramedullary nailing surgery, breaking through barriers for ultra-elderly surgery. The patient’s family presented a silk banner to Director Xiong Jin.
Fall-induced Femoral Fracture: A Long Journey in Search of Treatment
The elderly patient suffered a femoral fracture after an accidental fall at home. She developed severe thigh swelling and pain, losing the ability to stand or turn over independently and becoming fully dependent on care. Prolonged bed rest for seniors may trigger life-threatening complications including pneumonia, deep vein thrombosis, pressure ulcers and multi-organ decline, with poor outcomes under conservative treatment. To avoid suffering from long-term immobilization, the family brought her to Nanjing for surgical intervention.
Given her advanced age of 97, deteriorated organ function, poor cardiopulmonary reserve and low surgical tolerance, other hospitals deemed anesthesia and surgery too risky and recommended conservative care. Desperate for treatment, the family learned that Director Xiong Jin from Nanjing Gulou Hospital conducted clinics and surgeries at Taikang Xianlin Drum Tower Hospital and travelled there for help.
After admission, Director Xiong Jin carefully reviewed her condition, vital signs and imaging results. Fully aware of the surgical risks, he recognized that prolonged bed rest posed an even greater threat. He decided to admit her: “It is not easy for this family to seek help. Advanced age alone is not a reason to refuse surgery. We will spare no effort as long as there is a chance.”
MDT Consultation & Minimally Invasive Surgery Pave the Way for Recovery
To deliver safe treatment, the orthopedic team immediately launched an MDT consultation with specialists from cardiology, respiratory medicine, anesthesiology, nutrition and other departments. They carried out a comprehensive preoperative assessment covering physical tolerance, osteoporosis and underlying organ risks, repeatedly refining surgical approach, fixation plan, hemostasis, anti-infection and thrombosis prevention strategies to build a personalized perioperative management plan.
Anesthesia is the key challenge for ultra-elderly surgery. To avoid harm to cardiopulmonary function from conventional endotracheal general anesthesia and reduce risks of pneumonia, delayed emergence and cognitive dysfunction, the anesthesiology team adopted ultrasound-guided regional nerve block combined with intravenous sedation. The patient maintained spontaneous breathing without intubation while surgical pain was effectively controlled.
The surgery proceeded smoothly. With sophisticated minimally invasive skills and rich experience in geriatric fracture care, Director Xiong Jin’s team achieved closed reduction and intramedullary nailing fixation. This is a mainstream minimally invasive technique: surgeons make small skin incisions, reduce the fracture under fluoroscopic guidance, and place a custom metal nail inside the femoral medullary canal for stabilization. The patient remained hemodynamically stable throughout the operation. Director Xiong Jin performing minimally invasive orthopedic surgery.
Postoperatively, guided by Enhanced Recovery After Surgery (ERAS) principles, the team delivered holistic care including close monitoring, stepwise analgesia, early mobilization, targeted thromboprophylaxis and respiratory support to prevent common geriatric postoperative complications. The patient is now in good spirits with encouraging recovery, free from the dangers of long-term bed rest.
Compassion drives medical practice. This successful case demonstrates the hospital’s strong capability in managing complex geriatric trauma, MDT care and enhanced recovery. Going forward, the Orthopedics Department of Taikang Xianlin Drum Tower Hospital will continue refining minimally invasive techniques for elderly trauma and optimizing perioperative safety systems, bringing high-quality care to more high-risk senior fracture patients.
#GeriatricOrthopedics #FemoralFracture #MDT #MinimallyInvasiveSurgery #TraumaCare #EnhancedRecovery #AgingHealth
Comments