Analysis of surgical treatment in elderly and senile patients with proximal femur fractures by extracortical plate osteosynthesis
Background. Proximal femur fractures in elderly and senile patients are still a challenge in clinical medicine. Long-term results of surgical treatment by extracortical plate osteosynthesis in elderly and senile patients with fractures of the proximal femur evaluating is the main objective of the article. Materials and methods. The study implied the assessment of 744 medical records of patients treated at the trauma department of Kharkiv City Clinical Multifield Hospital N 17 in the period from 2008 to 2016. The study group included elderly and senile patients with low-energy fractures of the proximal femur. Further research according to the age criteria and type of fractures involved formation of a group of 24 patients with average age of 71–74 years (10 male and 14 female patients). All patients were found to have a concomitant abnormality with a predominance of cardiovascular diseases. All patients underwent osteosynthesis with a proximal femoral plate with angular stability. Assessment of pain syndrome, static and dynamic activity of patients, deformation and range of movements of the operated lower limb was carried out using the Harris evaluation scale. Results. Long-term results of proximal femur fractures treatment by osteosynthesis with extracortical plate were studied on the example of 24 patients with the follow-up period from 9 years to 1 year. Dependence on outside help at discharge was observed in 16 patients, 15 patients used a walking frame. In 14 cases, patients partially loaded the operated lower limb, 3 patients moved with full load, 7 patients did not lean on the operated lower extremity. The term of using external support was from 4 months to the present moment. In the questionnaire, 91.6 % of patients subjectively noted deterioration in the quality of life after surgical treatment of the trauma. Following osteosynthesis with a bone plate, a good result (12.5 %) was detected only in one patient, with no satisfactory results, and unsatisfactory results (87.5 %) in 7 patients. It should be mentioned that a good result (88 points on the Harris scale) was noted in one patient with type 2 fracture, whose age at the time of surgery was 66 years. The causes for unsatisfactory results were secondary displacement of bone fragments (25 %), aseptic necrosis of the femur (12.5 %), suppurative complications (12.5 %), moderate or mild pain (87.5 %). Conclusions. Surgical treatment of proximal femur fractures in elderly and senile patients was associated with a high level of morbidity (66.6 %). Long-term results after osteosynthesis of the fractures in this region in 87.5 % of cases were unsatisfactory, the reasons for which, as a rule, were moderate or mild pain, secondary displacement of bone fragments (25 %). Treatment of elderly and senile patients with osteosynthesis in proximal femur fracture often prevents the activation of patients in the early stages, which subsequently leads to aggravation of chronic comorbidities. The use of osteosynthesis in the treatment of proximal femur fractures in elderly and senile patients is an ineffective method that does not allow achieving good and satisfactory results. It is necessary to elaborate methods for surgical treatment of elderly and senile patients with proximal femur fractures that promote early activation of the patients with full load on the operated lower extremity.
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