case of hip fracture in patient with diabetes mellitus type 2

Introduction

A 78 yo woman presents to the emergency department for left hip pain after a fall. She reports stepping off a curb unexpectedly & did not loose consciousness before or after the fall. She reports the pain as moderate-severe & is unable to bear weight.

History

• hypertension
• diabetes mellitus type 2
• osteoporosis

Physical examination

• temperature: 37.0 C
• heart rate: 70/min
• respiratory rate: 20/min
• blood pressure: 145/70
• lungs: clear
• heart regular rate & rhythm without murmurs
• abdomen: benign
• ecchymosis over left hip
• leg leg is externally rotated
• no peripheral edema

Dosage

• aspirin 81 mg PO QD
• simvastatin 20 mg PO QD
• lisinopril 10 mg PO QD
• hydrochlorothiazide 12.5 mg PO QD
• metformin 1000 mg PO BID
• insulin glargine 10 mg SQ QHS
• insulin lispro 8 units with each meal
• alendronate 70 mg PO weekly

Laboratory

• serum glucose is 160 mg/dL
• hemoglobin A1c is 8.0%

Diagnostic procedures

• electrocardiogram: normal

Radiology

• X-ray of hip shows left femoral neck fracture, non-displaced

Management

• referral from orthopedics to geriatrics service reduces risk of postoperative delirium
• arthroplasty under spinal anesthesia planned for next morning
• stop metformin
• continue insulin glargine the night prior to surgery
• discontinue insulin lispro while NPO for surgery
• Immunizations:
  • Herpes zoster vaccine
  • PCV13 & PPSV23
  • Tdap
  • influenza vaccine annually

More general terms

• case presentation