Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

Дубров, В.Э.; Shelupaev, Alexey A.; Arutyunov, G. P.; Belov, Mikhail V.; Bogopolskaya, Anna S.; Божкова, С. А.; Boyarkov, A.V.; Vorontsova, T. N.; Гильфанов, С. И.; Губин, А.В.; Zagorodniy, N. V.; Zlobina, Yulia S.; Корячкин, В. А.; Kostyuk, Georgiy; Litvina, E. A; Protsenko, D.N.; Runikhina, N. K.; Solomyannik, Irina A.; Стафеев, Д. В.; Tikhilov, Rashid M.; Tkacheva, О. N.; Цыкунов, М. Б.; Shubnyakov, I. I.

doi:10.17816/vto100763

Cited by 7 publications

(5 citation statements)

References 126 publications

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“…Garden Classifi cation) рекомендуется применение активной хирургической тактики с остеосинтезом костных фрагментов, что и было выполнено в приведенном клиническом [12]. Однако первичное эндопротезирование тазобедренного сустава также может применяться как эффективный метод лечения как при свежих переломах шейки бедренной кости, так и при неудовлетворительных результатах остеосинтеза, но при этом далеко не во всех случаях эндопротез служит до конца жизни [13]. Есть мнения, что для пациентов пожилого и старческого возраста предпочтительнее проводить тотальное эндопротезирование, несмотря на положительные стороны гемиартропластики.…”

Section: Discussionunclassified

Hemiartoplasty of the Hip Joint with a Bipolar Endoprosthesis for Fail Osteosynthesis of the Femoral Neck

Yamshikov,

Emelyanov,

Chumakov

2024

Урал. мед. журнал

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Introduction. Hip replacement in the last century was called the most successful operation in orthopedics. Replacement of the destroyed joint tissues with an implant allows to relieve a person from pain, restore motor activity and ensure a long-term improvement in the quality of life without disability. Endoprosthetics is indicated both for diseases of the hip joint, which according to the literature are affected by about 35 % of the adult population, and for fractures of the femoral neck. As a rule, the age of patients undergoing endoprosthetics is older than 60 years.The purpose of this publication is to demonstrate the successful experience of subtotal hip replacement with bipolar endoprosthesis in a patient with an ungrown fracture of the neck of the left hip in conditions of metalosteosynthesis with screws with migration of metal structures and violation of fracture consolidation.Materials and methods. Description of a clinical case and a brief analysis of the literature on this topic. The experience of subtotal endoprosthetics of the left hip joint with a bipolar endoprosthesis is presented. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as when assessing the function of the limb and the amplitude of movement in the hip joint.Results. As a result of hip replacement with a bipolar endoprosthesis, complete restoration of limb function and activity of the patient was achieved.Discussion. The choice of a bipolar endoprosthesis with acetabular roof plasty was due to the need to restore joint function and the desire to maintain a greater potential for revision arthroplasty of the patient, which is very likely given the age. Along with the use of augments and individual implants, the method showed a good result of treatment with less trauma.Conclusion. Based on the given clinical example, it can be concluded that both preoperative planning for femoral neck fractures with risk assessment and expanding the range of metal structures, including the least traumatic for bone tissue, is important, as well as the need to improve continuity in the treatment of patients and individualize the postoperative plan. management, socialization and activation of the patient

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Section: Discussionunclassified

Hemiartoplasty of the Hip Joint with a Bipolar Endoprosthesis for Fail Osteosynthesis of the Femoral Neck

Yamshikov,

Emelyanov,

Chumakov

2024

Урал. мед. журнал

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“…Обґрунтована стратегія відновлення цілісності вертлюгової ділянки стегна представлена в системі АО [11,17]. У ній реалізується ідея біологічного остеосинтезу.…”

Section: обґрунтування та опис методу хірургічного втручанняunclassified

“…У ній реалізується ідея біологічного остеосинтезу. За рахунок того, що динамічний гвинт, який вводиться в шийку і головку стегнової кістки, жорстко не пов'язаний із діафізарною частиною, після встановлення таких систем сили, що зрізають, на лінії перелому переводяться в сили міжфрагментарної компресії [10][11][12][14][15][16][17]. У нашому дослідженні представлені власні результати остеосинтезу вертлюгових переломів за допомогою системи PFNA.…”

Section: обґрунтування та опис методу хірургічного втручанняunclassified

“…У післяопераційний період ми застосовували ранню активізацію хворих із раннім дозованим осьовим навантаженням у пацієнтів старше 60 років. У пацієнтів молодше 60 років ми використовували статичний тип фіксації і відтерміноване осьове навантаження, адже особливістю консолідації нестабільних вертлюгових переломів є колапс зони перелому та можливе укорочення нижньої кінцівки [17], що не бажано для цієї категорії хворих.…”

Section: обґрунтування та опис методу хірургічного втручанняunclassified

“…Відновлювальний курс після хірургічного лікування включав руховий режим, фізичні вправи, масаж, дозовану ходьбу, тренування за навичками самообслуговування, дотримання дозованого режиму навантаження на кінцівку. Реабілітаційні заходи після операції проводили у 3 етапи [7,13,17].…”

Section: результати та їх обговоренняunclassified

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Surgical Treatment of Fractures of the Trochanteric Zone of the Femur in Older Patients

Naumenko,

Kostrytsia,

Vaskivskyi

2023

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Summary. Treatment of fractures of the trochanteric zone of the femur in the elderly still remains one of the problems that need further study. Objective: to analyze clinical application of internal osteosynthesis for fractures of the trochanteric zone in older and senile patients. Materials and Methods. The results of treatment of 102 older patients with fractures of the trochanteric region of the femur were analyzed. All patients were treated surgically using a proximal femoral nail antirotation (PFNA); the indicators at the inpatient stage of treatment and long-term consequences up to 3 years after treatment were analyzed using improved standards for evaluating the quality of treatment of injuries and diseases of the organs of movement and resistance with modification. Results and Discussion. Analyzing the treatment of 102 patients with fractures of the trochanteric region type A1, A2, A3 according to the AO classification, it was found that surgical treatment with the use of PFNA proves its effectiveness due to minimally invasive access, minimal intraoperative blood loss, a short time of surgical intervention, and the possibility of early activation of patients and provides low rates of postoperative complications and mortality. Conclusions. 1. The conducted clinical study allows us to confirm the effectiveness of the PFNA system in the surgical treatment of older patients with fractures in the trochanteric zone in a trauma hospital. 2. In older patients with fractures of the trochanteric zone of the femur, PFNA osteosynthesis allows restoring the function of the hip joint in 54.6% (55% СІ 85.4-55.8) of cases. 3. PFNA can be recommended as a priority in the treatment of older patients with fractures of the trochanteric region of the femur in a trauma hospital.

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Effect of various anesthesia methods on surgical treatment outcomes in patients with proximal femur fracture: a narrative review

Teterina,

Silantyeva,

Sakhibullin

et al. 2024

Regional Anesthesia and Acute Pain Management

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Fractures of the proximal femur (FPF) is an unclassified condition that involves fractures of the femoral head and femoral neck and transvertebral, intervertebral, and subvertebral femoral fractures. To date, the number of patients with FPF in Russia is continuously increasing. Most often, patients with FPF have several concomitant diseases that can have a noticeable effect on the choice of anesthesia method. This review aimed to analyze current literature data on the advantages, risks, and contraindications of traditional and novel approaches to anesthesia in surgeries for FPF and assess the impact of these approaches on postoperative outcomes. A search for publications in the electronic databases PubMed and eLibrary was conducted. It revealed 6 324 publications in PubMed and 520 in eLibrary. After selecting publications, 60 studies meeting the inclusion criteria were included in the review. Studies have shown that regional blockades are highly effective; however, the evidence requires additional confirmation. New local anesthesia methods, such as MAC-STILA, can reduce mortality, especially in patients with a burdened medical history. Although the results of the single-center pilot studies of MAC-STILA are promising, multicenter randomized trials are required to test the reproducibility of this approach and evaluate its effectiveness with respect to outcomes that are crucial for the elderly and their family members.

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Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

Cited by 7 publications

References 126 publications

Hemiartoplasty of the Hip Joint with a Bipolar Endoprosthesis for Fail Osteosynthesis of the Femoral Neck

Hemiartoplasty of the Hip Joint with a Bipolar Endoprosthesis for Fail Osteosynthesis of the Femoral Neck

Surgical Treatment of Fractures of the Trochanteric Zone of the Femur in Older Patients

Effect of various anesthesia methods on surgical treatment outcomes in patients with proximal femur fracture: a narrative review

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