Significance of Choosing Fixators for Osteosynthesis in the Treatment of Patients With Fractures of Proximal Femoral Part

Abstract

Introduction. Fracture of the proximal part of the femur is one of the most common and most life-threatening injuries in the elderly patients. At the current stage, the surgical method has taken the leading place in the treatment of these patients. The growing number of surgical interventions, along with the increase in the elderly population globally, has led to a corresponding increase in the number of complications related to both the biological and mechanical properties of the fixator used. The optimal location of the fixing elements in relation to the center and edge of the femoral head, the value of the cervical-diaphyseal angle, and the technical characteristics of the implants remains a relevant issue today.
 The purpose of this study was to analyze the cause of complications after surgical treatment in patients with fractures of the femoral proximal part taking into account the biomechanical properties of the fixators.
 Material and methods. Staged results of surgical treatment of 60 patients with fractures of the proximal part of the thigh, who were hospitalized due to complications related to imperfect mechanical fixation of bone fractures, were studied. Patients were divided into 2 groups depending on the type of fixator used.
 Results. Migration of fixators with a low level of stability occurs even with the initial correct placement of the implant. Notably, a relatively higher frequency of migration occurred when the fixator was applied to the left limb (23:37). Analysis of immediate post-implantation frontal and axial radiographs revealed that, in all instances of medial migration (cutout effect) and lateral migration (outout effect), the Tip-Apex Distance exceeded 25 mm. The positioning of the cervical component of the fixator did not align with its optimal placement as per the Cleveland zones in 84.6% of cases. A notable incidence of complications in extramedullary osteosynthesis was diagnosed during the early postoperative period. This observation may be attributed to an imperfect plan of the staged rehabilitation functional regime.
 Conclusions. The use of fixators with a low level of stability does not provide high-quality prediction of the course of the postoperative period in patients with femoral proximal fractures. Placing implants for osteosynthesis of the femoral proximal part should ensure reliable fixation of fragments for successful postoperative rehabilitation by taking into account the number of fixators and the features of their location in the proximal fragment of the fracture.