Nadya Mutiara Viryani, - and Soebagijo Adi Soelistijo, Soebagijo Perioperative management of closed fracture subtrochanteric femur sinistra in type 2 diabetes mellitus with multiple comorbid: A case report. International Journal of Surgery Case Reports, 98. ISSN 2210-2612

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Abstract

Abstract Background Perioperative management aims to reduce surgical complications by controlling blood sugar levels and comorbid factors in type 2 diabetes mellitus. Case presentation An elderly Indonesian female, 60 years old, complained of wounds on the base of both big toes for 3 months, paresthesia, and fever. The patient also had a left femoral close fracture after falling out of bed and feeling pain in the left leg. The patient had a medical history of type 2 diabetes mellitus and hypertension for 15 years. Physical examination revealed hypertension (150/80 mm Hg), pulse rate of 102×/min, fever (38 °C), obesity class III (BMI = 42.6 kg/m2, body height = 147 cm, body weight = 92 kg), wound in both digiti I pedis (right = 2 × 2 cm, left = 3 × 3 cm), ankle-brachial index (ABI) of 1.03 (right) and 1.07 (left), and lower extremity sensory of gloves shocks paresthesia. Laboratory examination showed an HBA1c of 8.2 %, HBsAg reactive, and a left femoral X-ray showed a subtrochanteric fracture sinitra. Patients delayed surgery for >30 days post-fracture because of increased blood glucose levels and hyponatremia. The patient was successfully verified, and the outcomes were excellent (blood glucose and blood pressure expected). Discussion Perioperative management of diabetes includes surgical risk assessment, diabetes management pre-intra-post-surgery with blood glucose target levels of 140–180 mg/dL and surgical anticipation. Conclusion Perioperative management focuses on blood sugar control, insulin dosing accuracy, and managing multiple comorbidities.

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