Comparative analysis of treatment of patients with neck fractures of the femur

Abstract

Purpose of the study. Based on the analysis of case histories to determine ways to improve the results of treatment of patients with hip fracture and reduce duration of rehabilitation period. Material and methods. From 2012 to 2018 in the emergency department of traumatology of the Sklifosovsky Clinical and Research Institute for Emergency Care were treated 865 patients with a hip fracture. For analysis of these patients they were divided into 2 groups. The control group consisted of patients who were treated from 2012 to 2016 - 569 patients. The main group - 296 patients treated from 2017 to 2018. Results. Preoperative hospital stay in the main group was reduced in the 2-fold. The number of non-operated patients was reduced by 2 times. It was increased in the number of hip arthroplasty from 46.3% to 53.0%. It reduces the average time of operation in bipolar arthroplasty from 65 to 48 minutes, in total arthroplasty - from 89 to 63 minutes. It reduces the average blood loss during arthroplasty from 626 ml to 277 ml. The preoperative thrombosis of the lower limbs was detected in 9% of primary and 15% of the control group. Number of bedsores decreased from 2.5% to 1.7% and reduced mortality from 3.3% to 1.3%. Conclusion. All patients with a suspected fracture of the proximal femur, regardless of age, should be admitted and examined. Indications for surgery are vital. The purposes of the examination of the patient are identifying ways to quickly patient's condition compensation. For the prevention of thromboembolic complications is necessary to perform venous ultrasound before and after the operation. Detection of floating thrombus in the veins of the lower extremities before surgery is an indication for surgical prophylaxis of thromboembolism. Diagnosing floating thrombus up to 5 cm in the postoperative period may be an indication for conservative treatment. Such measures as multimodal analgesia with combination of non-steroidal and opioid analgesics before and after operation, patient-controlled analgesia in the postoperative period, high volume surgical wound infiltration with a solution of local anesthetic during surgery allows to activate the operated patients for 1-2 days after hip replacement. Reducing the duration of the operation leads to reduction of blood loss during the arthroplasty by improving the surgical technique and intravenous tranexamic acid infusion.

Keywords

hip fracture / multimodal analgesia / surgical prevention of thromboembolism

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RIGHTS & PERMISSIONS

Physical and rehabilitation medicine, medical rehabilitation