DOI: https://doi.org/10.22141/1608-1706.3.20.2019.172092

Our experience of application of single-pole endoprosthesis in the proximal femur fractures in the elderly and senile patients

A.V. Kalchenko

Abstract


Background. Proximal femur fractures are closely dependent on patient’s age. Most commonly, they are diagnosed in elderly and senile patients. To 2050 the number of people beyond 65 years in the developed countries will increase twice and account for 2 billion. That is why the importance of treatment of proximal femur fractures will rise even more than nowadays. The purpose was to improve outcomes in elderly patients with proximal femur fractures using bipolar hemiarthroplasty of hip joint. Materials and methods. Forty-three patients with proximal femur fractures were undergone surgery. Among them there are 14 men and 29 women. Twenty-nine patients were of senile age and 14 patients of eldery age. Pain, stato-dynamic activity, deformity and movement amplitude assessed using Harris Hip Score. The open reduction and internal fixation of proximal femur fracture with plate was chosen for 23 patients. Average duration of stay in hospital was from 17 to 21 days. Following, the patients were observed on outpatient basis. Control radiographs were conducted in 2 and 4–6 months after the fracture. Unipolar bipolar endoprosthe-tics was used for 20 patients with proximal femur fracture. Bone fragments were additionally fixed with K-wires (patent, Ukraine, «Method of treatment of comminuted proximal femur fractures No 101594 dated 25.09.2015»). Results. After hip endoprosthetics excellent and good results were obtained in 95 % of cases. Unsa-tisfactory results were obtained in 5 % of cases. After bone plate osteosynthesis good result was obtained in 1 case and bad results were obtained in 7 patients. The bad results in bone plate osteosynthesis were associated with pain complains, lower limb shortening to 1–1.5 cm, lameness, use of walkers and crutches, bone fragments secondary bias (25 %), aseptic femoral neck necrosis (12.5 %). Conclusions. It is better to perform endoprosthetics for elderly and senile patients with proximal femur fractures type 3, 4 and 5 according to Evans classification. We offer a fixation of intertrochanteric fragment to endoprosthetics shaft using the wires to avoid the lower limb shortening. The results demonstrate that patients who had undergone hip endoprosthetics after proximal femoral fractures type 3, 4 and 5 according to Evans classification locomotive function was restored to the initial level after 1.5–2 months and more. After bone plate osteosynthesis, the long-term movement restrictions, pain and locomotive function impairment were observed.

Keywords


proximal femur fractures; elderly and senile age; bone plate osteosynthesis; long term postoperative results

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