Perioperative Management In Hemiarthroplasty In Femoral Neck Fractures Secondary To End Stage Renal Disease

【Objecetive】Conclude the perioperative management experiences when acting hemiarthroplasty in patients of femoral neck fractures secondary to end stage renal diseases.【Methods】From 2006.9 to 2010.2 there were 6 uremic patients undergoing hemodialysis were admitted to orthopaedics department for single femoral neck fractures and were treated with cemented hemiarthoplasty.Those patients,four males and two females, aging from 65 to 79,were all accepting hemodialysis in the blood purification centre of our hospital.They had accept hemodialysis for 6 months to 5 years and all could take care of themselves. The cause of the injury:5 falling down when walking and 1 injured in a vehicle accident,and they were not accompanied with osteoarthritis or femoral head ischemic necrosis.They all accompanied with one or several diseases like mellitus diabetes,hypertension or anemia.Before the operation,they were all in the blood purification centre accepting hemodialysis and therapy of the complications, and calcitionin injection.The injured legs were given skin traction.After those therapy they were sent to our department to accept hemiarthroplaty. In orthopaedics department we went on keep the water and solution banlace and keep the Bun,Cr normal.When the blood pressure and blood glucose were normal,we began the operation.In the operation,we tried to injury less and reduce bleeding.Monitoring the blood pressure and electrolyte levels during the operation.After the operation,use antibiotics routinely for at least one week and stop it according to the observation of the incision.Began the hemodialysis as soon as possible.The first hemodialysis should be done at about 24 hours after the operation,and use the hemodialysis without heparin technique.Monitoring the Bun Cr and electrolytes to decide the frequency of dialysis.Use heparin to prevent the formation of DVT,and this should began at about 24 hours after the operation.Add calcium and VitD in the diet and kept the injection of the calcitionin.Teach the patients to do more exercise and get up from bed at about one week.They were all stitched in 12 to 14 days.【Result】All the patients were stitched 12-14 days after the operation.The incision cured completely,with no infection or DVT complications.After the patients were out of hospital,they were all followed-up for three months to three years and a half.Generally they could basically take care of themselves in three to five months.No lessening prosthesis, prosthesis dislocation, postoperative infection or periprosthesis fractures occurred.One patient were operated recently,and 1.5 months passed no obvious complications were observed. One patient died of heart attack 6 months after the operation.In the perioperative period no patient died.【Conclusion】Patients of femoral neck fractures can get through the perioperative period safely as a result of careful plan,reasonable preoperative dialysis,careful operation,rational use of drugs and definitely control of the Bun Cr and the electrolytes.As there were only six patients,we can't make strictly statistic analysis,so there is still a lot of work to do.