{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:19:11Z","timestamp":1773926351975,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health, Czech Republic\u2013conceptual development of research organization","award":["FNOs\/2026 (MH CZ\u2013DRO-FNOs\/2026)"],"award-info":[{"award-number":["FNOs\/2026 (MH CZ\u2013DRO-FNOs\/2026)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways. Case presentation: We present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO\/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission. Conclusions: This case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed.<\/jats:p>","DOI":"10.3390\/jcdd13030132","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:00:37Z","timestamp":1773219637000},"page":"132","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Co-Occurrence of Pertrochanteric Fracture and Acute Coronary Syndrome in a Geriatric Patient: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3537-0342","authenticated-orcid":false,"given":"Jozef","family":"Dodul\u00edk","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Cardiology, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3385-2974","authenticated-orcid":false,"given":"Ji\u0159\u00ed","family":"Demel","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopedics, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Institute of Disaster Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Mr\u00f3zek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8700-2395","authenticated-orcid":false,"given":"Ji\u0159\u00ed","family":"Vrtal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji\u0159\u00ed","family":"Pl\u00e1\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"V\u00e1clav\u00edk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, University Hospital Ostrava, 70800 Ostrava, Czech Republic"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/BF01623184","article-title":"Hip fractures in the elderly: A world-wide projection","volume":"2","author":"Cooper","year":"1992","journal-title":"Osteoporos. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5371\/hp.2020.32.1.11","article-title":"Timing of Hip-fracture Surgery in Elderly Patients: Literature Review and Recommendations","volume":"32","author":"Seong","year":"2020","journal-title":"Hip Pelvis"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1291","DOI":"10.5435\/JAAOS-D-22-00273","article-title":"AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults","volume":"30","author":"Switzer","year":"2022","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Andaloro, S., Cacciatore, S., Risoli, A., Comodo, R.M., Brancaccio, V., Calvani, R., Giusti, S., Schl\u00f6gl, M., D\u2019angelo, E., and Tosato, M. (2025). Hip Fracture as a Systemic Disease in Older Adults: A Narrative Review on Multisystem Implications and Management. Med. Sci., 13.","DOI":"10.3390\/medsci13030089"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.12688\/f1000research.11064.1","article-title":"Acute Coronary Syndromes in the Elderly","volume":"6","author":"Engberding","year":"2017","journal-title":"F1000Research"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3826","DOI":"10.1093\/eurheartj\/ehac270","article-title":"2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery","volume":"43","author":"Halvorsen","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bui, M., Groothuis-Oudshoorn, C.G.M., Witteveen, A., and Hegeman, J.H. (2024). Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061594"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1080\/17453674.2021.1959155","article-title":"Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning","volume":"92","author":"Wijnen","year":"2021","journal-title":"Acta Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1001\/jama.2010.1013","article-title":"Delirium in Elderly Patients and the Risk of Postdischarge Mortality, Institutionalization, and Dementia","volume":"304","author":"Witlox","year":"2010","journal-title":"JAMA"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/132\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:43:51Z","timestamp":1773913431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcdd13030132"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13030132","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}