An 87-Year-Old, a Hip Fracture and a Blood Clot

An accidental fall put an 87-year-old patient into several crises at once.

The diagnosis was a comminuted left femoral intertrochanteric fracture with obvious displacement — a typically irreducible fracture that would normally call for open reduction. Examination then found acute deep vein thrombosis (DVT) of the left lower limb, and persistent hypoxaemia caused by underlying interstitial lung disease. Three hard problems converging on one operating table.

The patient's children live abroad. They heard the news and could not get back to China in time.

What followed was a piece of high-risk "bomb disposal" carried out by a multidisciplinary team at Shanghai SinoUnited Health. Afterwards the lead surgeon, Dr. Yuqi Dong, his orthopaedic team, the nursing team and the patient-services team received three pennants from the family.

Three risks arriving together

For a very elderly patient, a comminuted intertrochanteric fracture is never just a broken bone.

The patient also had a history of lymphoma, which creates a tumour-related hypercoagulable state: malignancy raises the risk of venous thromboembolism (VTE) by roughly four to seven times compared with the general population. A central-type DVT in the injured limb then pushed the perioperative risk of fatal pulmonary embolism considerably higher.

Meanwhile the interstitial lung disease had reduced the patient's oxygen reserve, placing heavier demands on anaesthesia and on postoperative respiratory management. Fracture, thrombosis and respiratory compromise together made the conventional surgical pathway far harder to follow.

Control the risks first, then find the safe window

SinoUnited Health immediately convened a multidisciplinary team (MDT) consultation. Specialists from orthopaedics, vascular surgery, pulmonology, anaesthesiology and the intensive care unit took part, identifying perioperative risks early and building individual countermeasures for each one.

• Defending against the clot. Following the 2016 antithrombotic guidelines of the American College of Chest Physicians (ACCP) and the relevant expert consensus, the vascular surgery team treated this as a high-risk patient with proximal DVT who had contraindications to, or had failed, anticoagulation. A retrievable inferior vena cava (IVC) filter was placed before surgery, putting a barrier between the thrombus and the cardiopulmonary circulation and lowering the perioperative risk of pulmonary embolism.
• Optimising the lungs. Pulmonology assessed surgical tolerance in the context of hypoxaemia, adjusted the oxygen regimen and set explicit perioperative respiratory-support targets.
• Anaesthesia and monitoring. The anaesthesiology team planned general anaesthesia with endotracheal intubation, invasive arterial blood-pressure monitoring and individualised fluid management. The ICU reserved a bed so that respiratory support and dynamic monitoring of thrombotic risk could continue without interruption after surgery.
• The surgical decision. Dr. Dong's orthopaedic team planned closed reduction and internal fixation of the left intertrochanteric fracture — minimising surgical trauma, shortening operating time and reducing complications. Because the fracture was difficult to reduce, the team rehearsed the likely difficulties of minimally invasive closed reduction beforehand and prepared contingency plans.

After the MDT discussion, the patient first underwent IVC filter implantation. With the "ticking time bomb" of pulmonary embolism contained, surgery went ahead promptly. Early risk identification, pre-emptive management and close collaboration in theatre allowed the closed reduction and internal fixation to be completed with the implants placed exactly as planned. The patient then moved to the ICU for continued anticoagulation and respiratory support.

"Filter protection — standardised surgery — monitored closed loop": that sequence is the core logic of safe care for the highest-risk patients.

All surgical and therapeutic interventions were completed within three days of admission for the fracture — cutting the risk of perioperative complications and creating the conditions for a good outcome.

Across the ocean, the family kept beside the bed

What moved the family was not only the layers of technical protection, but the warmth of the service around it.

The children, working overseas and unable to return in time, began in a state of helplessness. From admission, the patient-services team acted as a bridge across time zones — sending the preoperative plan, daily updates on the patient's condition and progress in rehabilitation, clearly and promptly, to the family abroad. The nursing team looked after every detail: repositioning, back percussion to help clear sputum, pressure-injury prevention. Dr. Dong and the orthopaedic team made regular postoperative rounds and answered every question from the patient and the family patiently.

The family later ordered three pennants, presented separately to Dr. Dong and the orthopaedic team, to the nursing team, and to the patient-services team. Their message: "We appreciate the communication and coordination during this admission. The team kept us updated, which helped us stay informed while we were abroad."

A closed loop, and a different definition of reassurance

In orthopaedic surgery for elderly patients with multiple high-risk comorbidities, safety does not come from excellence at any single step. It comes from systematic risk identification and whole-chain management.

SinoUnited Health combines multidisciplinary collaboration (MDT), standardised management of the key perioperative checkpoints and comprehensive patient services into one closed loop: anticipate risk before surgery — follow the protocol in theatre — monitor closely afterwards — communicate seamlessly throughout.

For families living overseas, timely updates and coordinated communication keep them informed and involved in the patient's care. That is what patient-centred communication and whole-process coordination mean in practice: treating not only the condition, but also a family's need to know, and to be part of it.

References

1. Gong Y, Zhang K, Chen W, Yang Q, Shi M, Dong Z, Yin Z, Zhang Y, Ge W. Development and temporal external validation of a novel nomogram for predicting one-year mortality in the older adult with hip fracture. Front Med (Lausanne). 2025 May 22;12:1532196. doi: 10.3389/fmed.2025.1532196.
2. Chai SS, Hu JW, Han L. Risk factors for postoperative mortality within one year in patients over 90 with hip fractures. Zhongguo Gu Shang. 2024 Aug 25;37(8):833–37. doi: 10.12200/j.issn.1003-0034.20231225.
3. Zhang JZ, Wang XW, Liu Z, Sun TS. Pay attention to the high mortality rate of hip fractures in the elderly. Chinese Journal of Bone and Joint. 2018;7(7):481–483.

This article describes an individual clinical case for the education of international patients and their families. It does not replace an individual consultation, examination or diagnosis. Treatment decisions depend on the circumstances of each patient.