Treatment of proximal metaepiphyseal femoral fractures in senile patients
Background. The incidence of femoral neck fractures, one of the leading causes of death in elderly patients, is increasing as an average life duration and prevalence of osteoporosis continue to rise. Fracture site displacement, patients’ age, comorbid disorders, pre-fracture activity level are some of the critical factors in determining the management of femoral neck fractures. The purpose of the study was to evaluate the advantages and disadvantages in the treatment of proximal femoral fractures in elderly patients based on a retrospective material. Materials and methods. An analysis was performed of 155 medical records of patients with proximal femoral fractures who underwent treatment at the orthopedic and trauma department of Lviv Municipal Clinical Hospital N 8 from 2010 to 2016. The classification of Association for Osteosynthesis/Association for the Study of Internal Fixation was used to detail the fractures of the proximal femur. For further study, patients were divided into two groups. Results. The long-term observation lasted from 3 months to 1 year. In the vast majority, the verticalization of patients began 12 hours after surgery. In patients who were operated in the first 24 hours, the average length of hospital stay was from 7 to 10 days. Patients from the control group did not experience problems caused by hypodynamia, namely: hypostasis, genitourinary inflammation or other diseases. Conclusions. The results obtained after osteosynthesis in most cases were unsatisfactory. Osteosynthesis in the patients of the observed age group does not allow activating patients in the early stages, which in turn leads to the progression of concomitant diseases. The use of early surgical intervention such as the primary hip joint replacement makes it possible to achieve better results and to prevent aggravation of concomitant pathology.
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Holt G., Smith R., Duncan K., Finlayson D.F., Gregori A. Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit // J. Bone Joint Surg. Br. — 2008. — 90. — 1357-63.
Sikand M., Wenn R., Moran C.G. Mortality following surgery for undisplaced intracapsular hip fractures // Injury. — 2004. — 35. — 1015-9.
Shah A.K., Eissler J., Radomisli T. Algorithms for the treatment of femoral neck fractures // Clin. Orthop. Relat. Res. — 2002. — 399. — 28-34.
Waaler Bjørnelv G.M., Frihagen F., Madsen J.E., Nordsletten L., Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial // Osteoporos. Int. — 2012. — 23. — 1711-9.
Gjertsen J.E., Vinje T., Engesaeter L.B. et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients // J. Bone Joint Surg. Am. — 2010. — 92. — 619-28.
Leighton R.K., Schmidt A.H., Collier P., Trask K. Advances in the treatment of intracapsular hip fractures in the elderly // Injury. — 2007. — 38 (Suppl. 3). — S24-34.
Bhandari M., Devereaux P.J., Tornetta P. 3rd et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey // J. Bone Joint Surg. Am. — 2005. — 87. — 2122-30.
Sendtner E., Renkawitz T., Kramny P., Wenzl M., Grifka J. Fractured neck of femur-internal fixation versus arthroplasty // Dtsch. Arztebl. Int. — 2010 Jun. — 107(23). — 401-7.
Mossey M., Murtan E., Knott K., Graik R. Determinants of recovery 12 months after hip fracture: the importance of psychological factors // Am. J. Public Health. — 1989. — 79. — 279-286.
Su H., Aharonoff G.B., Hiebert R., Zuckerman J.D., Koval K.J. In-hospital mortality after femoral neck fracture: do internal fixation and hemiarthroplasty differ? // Am. J. Orthop. (Belle Mead NJ). — 2003. — 32. — 151-155.
Tidermark J., Ponzer S., Svensson O., Söderqvist A., Törnkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly; a randomized controlled trial // J. Bone Joint Surg. [Br]. — 2003. — 85. — 380-388.
Lu-Yao G.L., Keller R.B., Littenberg B., Wennberg J. Outcomes after displaced fractures of the femoral neck. A metaanalysis of one hundred and six published reports // J. Bone Jt Surg. Am. — 1994. — 76. — 15-25.
Mouzopoulos G., Stamatakos M., Arabatzi H., Vasiliadis G., Batanis G. et al. The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options // International Orthopaedics (SICOT). — 2008. — 32. — 367-373.
Taine W.H., Armour P.C. Primary total hip replacement for displaced subcapital fractures of the femur // J. Bone Joint Surg. Br. — 1985. — 67. — 214-217.
Barnes R., Brown J.T., Garden R.S., Nicoll E.A. Subcapital fractures of the femur. A prospective review // J. Bone Joint Surg. Br. — 1976. — 58. — 2-24.
Skinner P.W., Powles D. Compression screw fixation for displaced subcapital fracture of the femur. Success or failure? // J. Bone Joint Surg. Br. — 1986. — 68. — 78-82.
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