Sometimes the drop is so severe that a blood transfusion is necessary to increase the RBC level. The RBC level is anticipated to drop after a fracture and subsequent surgery. Red blood cells (RBC) carry oxygen to tissues and bone (a living tissue) which must stay alive and viable to heal. IV antibiotics are delivered to the tissue and hopefully prevent infection. The fracture fragments then are held in that position by inserting metal hardware (typically screws, plates, cables or a rod). The fracture is “reduced” which means we position the fracture fragments in as “stable” and close to “anatomic” position as possible. What a surgeon tries to do is optimize the alignment of the fracture and conditions to encourage healing. Previously I explained that the body ultimately must heal broken bones. Infection: must always be considered (and will be discussed in a subsequent blog).Nerve compromise: from trauma that caused the fracture and/or from treatment of the fracture.Malunion: the fracture healed but with shortening or malrotation of the lower leg.This often is associated with a diminished range of motion. Malunion: the fracture healed but in such a way that pain results with movement due to impingement between the healed bone or hardware and soft tissue.Painful hardware: hardware is irritating overlying tissue or sticking into the hip joint socket.Implant problem: pain in the hip and/or thigh from the implanted endoprosthesis.Post-traumatic arthritis of the hip: the forces that lead to fracture and/or the treatment resulted in injury of articular cartilage, which deteriorates over time.This results in joint space destruction with secondary arthritis. AVN (avascular necrosis or osteonecrosis): part of the femoral head losses its blood supply and bone dies, later collapsing.Below I’ve listed some of the more common reasons for continued pain and/or failure after hip fracture repairs: However, this isn’t the case for everyone and there are a variety of reasons for poor outcomes. Fortunately, most people who break hips and are treated surgically do well. The strategies for treatment and prognosis often are very different. In my last blog post, I described treatment of hip fractures that occur within the hip joint capsule (intra-capsular) and those that occur outside the capsule (extra-capsular).
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