Multidisciplinary Perioperative Management of Type 2 Diabetes, Respiratory Infection, and Femoral Fracture: A Case Report

Abstract

Perioperative care is complex when diabetes, obesity, hypertension, respiratory symptoms, anaemia, and orthopaedic trauma coexist. A 61-year-old woman with inconsistently treated type 2 diabetes presented after a fall with a right femoral fracture, random glucose of 207 mg/dL, blood pressure of 160/90 mmHg, pulse of 104 beats/min, BMI of 31.2 kg/m2, dyspnoea, and bilateral adventitious breath sounds. SARS-CoV-2 IgG was positive, but later PCR was negative; serology did not establish active COVID-19 or a post-COVID syndrome. Management included glucose monitoring and insulin titration, respiratory treatment, open reduction and internal fixation, transfusion for postoperative anaemia, and anticoagulation in the setting of surgery and elevated D-dimer. Clinical status improved before discharge. The report highlights coordinated metabolic, respiratory, surgical, and thrombosis-risk management while emphasizing that D-dimer alone does not diagnose coagulopathy or venous thromboembolism. Fracture classification, diagnostic tests, medication doses, transfusion details, anticoagulation indication, and consent require verification.