Two months after undergoing intramedullary nailing (PFNA) surgery for a fractured femur, 95-year-old Cui experienced swelling and pain in her leg. On 23/7, Dr. Le Van Tuan, Director of the Orthopedic Trauma Center at Tam Anh General Hospital in Ho Chi Minh City, explained that Cui's prolonged immobility led to blood stagnation and the formation of blood clots. Typically, patients with this type of fracture require immediate surgery to facilitate early mobilization and prevent complications from prolonged immobility. Although Cui underwent the initial surgery, her advanced osteoporosis, due to her age, prevented the fracture from healing properly. The implanted nail protruded into her pelvis, causing pain and hindering movement.

Cui also had underlying health conditions including hypertension, diabetes, chronic kidney disease, and severe coronary artery stenosis. Dr. Do Duy Long, from the Cardiology Department at Tam Anh General Hospital, assessed her as high risk for heart failure, arrhythmia, heart attack, and even death during surgery. Doctors prescribed anticoagulants to manage the blood clots, along with medication to stabilize her heart and kidney function. After two weeks of treatment, she was deemed fit for hip replacement surgery.

To minimize risks, doctors performed a pre-operative CT scan of her hip to assess the bone defect. The surgical team then removed the intramedullary nail, grafted bone from her femoral neck, and implanted a long-stem hip prosthesis.

Cui recovered quickly, with her hip pain subsiding. She began physical therapy to prevent further clotting and regain mobility in her leg. A week after surgery, she was able to stand, her health stable, and was discharged. She is expected to walk again in 4-6 weeks and will continue anticoagulants for at least three months, with regular follow-up appointments.

Dr. Long checks on the patient a week after surgery. Photo: Ha Vu

Dr. Long checks on the patient a week after surgery. Photo: Ha Vu

Deep vein thrombosis (DVT) in the lower extremities occurs when blood clots form in the deep veins of the legs. This can be caused by reduced blood flow back to the heart, damage to the blood vessel lining, or excessive blood clotting. Untreated, these clots can travel to the lungs, causing a pulmonary embolism, which can lead to serious circulatory and respiratory problems.

To prevent DVT, doctors recommend maintaining a healthy weight, avoiding prolonged periods of sitting or standing, eating plenty of fruits and vegetables, and staying hydrated to prevent constipation. Regular checkups are crucial, especially for those with risk factors such as nephrotic syndrome, systemic lupus erythematosus, cancer, stroke with hemiplegia, spinal cord injury with quadriplegia, obesity, pregnancy, or prior lower limb surgery like hip replacement.

If you experience symptoms of DVT, such as leg swelling, pain, redness or discoloration, or enlarged veins near the skin's surface, seek immediate medical attention.

Thu Ha