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Is ORIF, WIRE FIXATION in bones safe with DIABETES?

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My father 53years old is a diabetic for 15 years old patient, had TIA 13yrs back, Treadmill test positive for cardiac ischaemia 3yrs back. He is taking metformin, insulin mustard, aspirin regularly. 8 months back he had intertrochanteric fracture right side and DHS fixation was done.
Now yesterday he had a fall and has sustained closed fracture of head of right humerus and right greater trochanter avulsion fracture. His investigations show blood urea-44mg/dl, serum creatinine -2.0mg /dl.
orthopedician has planned for ORIF & K-Wire fixation of both fractures.
Kindly give your expert opinion considering comorbid illnesses, as to go with surgical intervention or try conservative treatment. Thanking you.
Akmal
Pls find enclosed XRay radiograms.


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have read your details with diligence .After looking x ray pictures and other details ,the type of fracture at his arm needs surgery.looking at his risk related to Anesthesia the k wire fixation is appropriate in good hands.Although some other methods are more appropriate for his well functioning but there are increase chances of infection & implant failure with other methods.Also they consume more time & in his case ,time consuming surgery may be risky.I hope this will help you.
With best wishes.


Patient replied :

Thank you doctor for your valuable suggestion. Can you please also suggest for management of greater trochanter avulsion fracture? Orthopedician has planned for ORIF for this fracture also in the same sitting. Is it advisable or only humerus fracture reduction is enough as of now.??


Expert:  Dr. Mukesh Tiwari replied 3 Days.

Greater trochanter fracture should be fixed .Generally we do tension band wire fixation in such cases.
With best wishes.


Patient replied :

Thanks for your valuable suggestions sir. We are proceeding with the procedures today. Being a doctor myself I have found this forum very helpful for valuable opinions . Thank you again.


Expert:  Dr. Mukesh Tiwari replied 2 Days.

We appreciate your opinion.
Regards.


Patient replied :

I am thankful for valuable opinions. Surgery was performed on June 13. ORIF screw fixation was done for humerus head fracture, and ORIF screw fixation with tension band wiring was done for greater trochanter avulsion fracture of femur. Post operative period has been uneventful. I need your valuable suggestions regarding physiotherapy especially of the shoulder. Kindly advice. Thankful to you. Herewith pls find enclosed post op stays.


Expert:  Dr. Mukesh Tiwari replied 1 Day.

IT is good that the post op has been uneventful.
You can go ahead with shoulder physiotherapy. A mimimum recommended period is 2 weeks.
Regards.


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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