Hip Fracture With Subdural Bleeding in an Elderly Patient: How a Multidisciplinary Team Made Surgery Possible
One Fall, Two Serious Problems
Henry was in his 80s. After an accidental fall, local hospital examinations found two problems: a hip fracture and a small traumatic subdural hematoma.
The local anesthesiology team considered the anesthesia risk too high. Because of advanced age, perioperative cardiovascular and cerebrovascular risks were already significant. The small intracranial hematoma made the situation even more concerning, as blood pressure fluctuations during anesthesia and surgery could theoretically worsen bleeding.
Two anesthesia evaluations did not approve surgery. The family was advised to wait until the hematoma stabilized or disappeared.
Advanced age · High anesthesia risk · Local hospital declined surgery · Family worried about missing the golden window
The Turning Point — Reassessment by Anesthesiology and Neurology
The family contacted Dr. Xu from Anesthesiology at another hospital. After carefully reviewing the imaging, Dr. Xu noted that the subdural hematoma was small, localized, and stable. Henry had no signs of intracranial hypertension and no symptoms of nerve compression.
Dr. Xu then requested a neurology consultation. Dr. Wang from Neurology confirmed that with strict blood pressure control and avoidance of anticoagulation, the risk of hematoma worsening was controllable.
"Advanced age and high risk are not reasons to give up. The key is whether we can create safe conditions for surgery."
— Dr. Xu
The hospital opened a green channel and admitted Henry for surgery preparation.
The Key Step — Preemptive Analgesia With a 72-Hour Block
After admission, Dr. Sun from Anesthesiology immediately performed an ultrasound-guided fascia iliaca nerve block at the bedside using an ultra-long-acting local anesthetic that could provide analgesia for up to 72 hours.
- Severe hip fracture pain
- Difficulty turning over
- Longer bed rest
- Higher risk of pneumonia, pressure sores, and thrombosis
- Pain-induced blood pressure spikes
- Pain was greatly reduced
- Henry could turn over and cooperate with checks
- Supported intraoperative anesthesia
- Provided post-operative analgesia
- Helped reduce risk from pain-related blood pressure changes
Dr. Sun described the block as achieving three goals at once: preoperative analgesia, intraoperative anesthesia support, and postoperative pain control.
From “Cannot Operate” to Successful Hip Replacement
Because of the preemptive analgesia, Henry could comfortably lie in the side position. Dr. Lu from Anesthesiology successfully performed spinal anesthesia, avoiding tracheal intubation and reducing cardiopulmonary burden compared with general anesthesia.
Dr. Wu from Orthopedics quickly arrived and completed hip replacement surgery. The procedure went smoothly, and Henry returned to the ward awake.
Local hospital considered anesthesia risk too high because of age and intracranial bleeding.
Anesthesiology and neurology confirmed that risk could be controlled under strict conditions.
Preemptive analgesia and spinal anesthesia enabled successful hip replacement.
"From being turned away to successfully leaving the operating room, what changed the outcome was a multidisciplinary anesthesia team willing to create safe conditions."
Henry's story reminds families that hip fracture in older adults is an urgent condition. For high-risk elderly patients, multidisciplinary evaluation, preemptive analgesia, precise anesthesia, and experienced orthopedic care can help protect the surgical window and improve the chance of recovery.