Optimization of treatment of patients of older age groups with osteoporosis and fractures of the proximal femur

Abstract

BACKGROUND: Osteoporosis is mainly found in elderly people, often leading to fractures of the proximal part of the femur, and can worsen the patient’s quality of life. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups (elderly, senile age, and centenarians according to World Health Organization criteria) with fractures of the proximal femur (S72.0, S72.1, S72.2. according to International Classification of Diseases 10th Revision) and with concomitant osteoporosis.

AIM: To improve the treatment results of patients of older age groups with fractures of the proximal femur by modernizing and developing new methods for implant fixation.

MATERIALS AND METHODS: 322 patients with fractures of the proximal femur with the presence of II and III degree of osteoporosis, who were treated at the Hospital for War Veterans in Saint Petersburg from 2017 to 2020 were included for the analysis. All the patients were divided into two groups depending on the methods of the treatment used. The first group consisted of 145 patients treated with the proposed method. The patients of the 2nd group (177 people) were treated using the traditional method. To assess the immediate results, the anatomical and functional result and possible complications (false joint, delayed consolidation of fragments, shortening of the damaged lower limb, dislocation of the endoprosthesis, migration of metal structures, osteomyelitis) were studied. The results were evaluated according to Leken’s functional index, and the quality of life was assessed according to the World Health Organization scale.

RESULTS: In 52.5% of the paients from the first group, good outcomes were obtained after 6 months according to the Leken’s scale, while in group 2 such results were demonstrated only in 21.6% of the patients, and a year later, in 53.7% and 19.1%, respectively. In the first group, 13 patients (12.0%) had unsatisfactory outcomes after a year, 12 (13.5%) — after 3 years, while in the second group 36 patients (31.3%) had unsatisfactory outcomes after a year, and 38 (35.8%) — after 3 years.

CONCLUSIONS: As a result, the use of the proposed method for providing care to patients with fractures of the proximal femur ensures significant improve (p < 0.01) of the treatment outcomes for this category of patients.

Keywords

osteosynthesis / fracture of the proximal femur / comorbid disease / endoprosthetics

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