Perioperative management of closed fracture subtrochanteric femur sinistra in type 2 diabetes mellitus with multiple comorbid: A case report

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/m(2), 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.