title: Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report.
abstract: Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA, paolo.mazzola@unimib.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzola
authors.forename: Alessandra
authors.initials: A
authors.lastname: Anzuini
authors.forename: Domenico
authors.initials: D
authors.lastname: Picone
authors.forename: Francesco
authors.initials: F
authors.lastname: De Filippi
authors.forename: Lauren
authors.initials: L
authors.lastname: Dubner
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zatti
authors.forename: Giulio M
authors.initials: GM
authors.lastname: Pasinetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Annoni
mesh_terms: D000368:Aged; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D000069076:Fractures, Multiple / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D015577:Geriatric Assessment; D062785:Hemiarthroplasty / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D010347:Patient Care Planning; D010348:Patient Care Team; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D011859:Radiography; D006435:Renal Dialysis; D020379:Risk Adjustment; D016896:Treatment Outcome