The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis.

Talha Ahmed,Ayesha Safdar

doi:10.7759/cureus.7527

Abstract

Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

Highlights

BackgroundA major health concern in elderly patient population is acute hip fracture (AHF)
These results reported by Keswani et al urged the clinicians to be more vigilant in their management of moderate to severe asymptomatic aortic stenosis (AS) in patients undergoing hip fracture surgery [13]
Patients represent a vulnerable group with increased burden of age-related comorbidities

Summary

Introduction

A major health concern in elderly patient population is acute hip fracture (AHF). As the number of elderly patient population is rising, the prevalence of hip fractures is on a rise. Keswani et al in 2016 conducted a similar retrospective case-controlled review (1:2 age-matched groups) of elderly (≥65 years) surgically treated hip fractures from 2011 to 2015 with moderate to severe AS (according to American Heart Association criteria). Unlike the results of that study, the outcomes were worse for the patients included this study These results reported by Keswani et al urged the clinicians to be more vigilant in their management of moderate to severe asymptomatic AS in patients undergoing hip fracture surgery [13]. With the improvement in technique of catheter-based procedures including valve replacement and valvuloplasty, the perioperative management of these patients can be more optimized to improve their outcomes It has always been a management dilemma when a patient presents with AHF and is found to have a severe AS on echocardiogram. Shared decision-making and expert opinions help guide management in such situations

Conclusions

Findings

Disclosures