HEALTH MATTERS: Hip surgery recommended even in higher risk patientsQ. My elderly mother just suffered a hip fracture. The orthopedic surgeon is recommending surgery, but because of her multiple medical problems, the risk of complications from the stress of surgery is felt to be high. What should we do?
By: Dr. Joshua Wynne , Grand Forks Herald
Q. My elderly mother just suffered a hip fracture. The orthopedic surgeon is recommending surgery, but because of her multiple medical problems, the risk of complications from the stress of surgery is felt to be high. What should we do?
A. Hip fractures in the elderly is a major problem in the United States and is a particular problem of elderly females like your mother. Unfortunately, about a quarter of adults die within the first year following the fracture and less than half are able to continue to live independently if they survive the first year.
It is generally agreed that surgery, even in higher risk patients, results in better outcomes than nonsurgical approaches, both from the standpoint of pain management as well as mobility. So in general, we recommend surgery even in higher risk patients. It is often worthwhile to delay surgery for a short time to optimize the medical condition of the patient, but delays beyond five days seem to be associated with more pain, less mobility, longer hospital stays after surgery, more complications, and higher mortality. Thus, unless the surgeon feels that the surgical risk for your mother is inordinate, I’d probably favor a short period of medical stabilization if needed, and then prompt surgery.
Q. My teenage son had a sports physical recently and was told that he had a small amount of blood in his urine. Should we be concerned?
A. First of all, while doing a so-called dipstick test of the urine (using a specially designed strip that can detect blood or protein when dipped in a specimen of urine) used to be a standard part of a routine physical examination, more recently it usually is not performed because of the few abnormal tests in an otherwise healthy population. So it is probably good fortune that the test was performed.
In some cases, there is enough blood that it discolors the urine; in others, the amount is so small that it is undetectable except by the dipstick method or with a microscope. One of the common but benign causes is strenuous exercise; so it is possible that your son has nothing else wrong and is just a good athlete. But he needs to be evaluated to exclude other structural problems. And even if no problem is found, adolescents with blood in their urine are at higher risk of developing chronic kidney disease in their later years, so your son needs periodic follow-up into adulthood.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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