Proximal Femur In Elderly Patients Research Articles

Treatment of local purulent postoperative soft tissue complications in patients of older age groups with fractures of the proximal femur

BACKGROUND: Surgical treatment of fractures of the proximal femur in elderly patients makes it possible to put patients on their feet early and improve their quality of life. Local purulent complications in the postoperative period after hip fractures surgical treatment occur in 5–10% of cases. AIM: To improve the treatment outcomes of patients with local postoperative purulent complications of soft tissues by a comparative analysis of treatment methods with various antibacterial, antiseptic hydrogels and physical methods of wound treatment. MATERIALS AND METHODS: The article presents the nature of local purulent complications, their clinical picture, and diagnostic features. All the patients are divided into 2 groups. The main group included 53 patients, and the control group included 48. The patients of the main group underwent comprehensive treatment of local purulent complications using modern technologies (plasma scalpel) and dressings with hydrogel Argacol. The control group was treated with traditional bandages with dioxomethyltetrahydropyrimidine and chloramphenicol. RESULTS: The use of surgical wound treatment using a plasma scalpel and dressings with multifunctional hydrogel allows to accelerate the wound healing process by 2–3 weeks compared with the use of traditional techniques. CONCLUSIONS: The application of the proposed tactics of providing specialized care to elderly patients with a fracture of the proximal femur allows for a significant (p 0.05) improvement in treatment results.

Анализ летальности пациентов пожилого и старческого возраста с переломом проксимального отдела бедра

Fractures of the proximal femur in elderly patients are one of the most severe complications of osteoporosis, being a serious public health problem, causing significant economic damage, and also lead to a high level of mortality among patients at the inpatient and outpatient levels. The results of treatment and a high mortality rate in this group of victims are directly dependent on the organization of medical care in this category of patients.Research objective: to assess the incidence of death, within 12 months from the moment of injury, in residents of Almaty over the age of 60 who had a fracture of the proximal femur.Materials and methods. To assess mortality rates in elderly patients, we performed an observational longitudinal cohort research that included data from 1283 patients aged 60 years and older with fractures of the proximal femur. Results of the treatment were kept for a year since delivery to the hospital. Results. The overall mortality of 1283 patients who applied to hospitals was 35.9%. 74.9% (722) of patients hospitalized in the hospital were survived, 25.1% (241) were died within a year, 6 (0.62%) patients of which were in the hospital. 324 of patients who were not hospitalized, 32.1% (104) of patients survived within a year after admission to the hospital, 67.9% (220) of patients died within a year.Conclusion. An analysis of mortality in elderly patients with fractures of the proximal femur showed that surgical treatment in this group of patients, carried out as early as possible, leads to a significant decrease in mortality within a 12-month follow-up period.Keywords: fracture of the proximal femur, osteoporosis, mortality, osteosynthesis, fracture of the femoral neck.

Medical and social consequences of fractures of the proximal femur in elderly and senile subjects (literature review)

The medico-social consequences of fractures of the proximal femur in elderly patients, the medical care system for such in­juries in various countries, complications and lethality are ana­lyzed. It was noted that the mortality rates during the first year after the fracture of proximal femur ranges from 21.5 to 40.0 %, in 20–50 % of cases, patients become disabled and even three years after injury the indicators of «physical functioning» and «general health» remain low. Return to the regular way of life fracture of proximal femur, observes in 20–50 % of patients only. It is established that 20–60 % of the injured persons need daily assistance, and more elderly people living in boarding schools and nursing homes, compared to those living in families. Based on the results of the STOP study (system for recording of osteoporotic fractures), Ukraine is classified as a country with a moderate risk of developing osteoporosis and its compli­cations, and the incidence of fractures of proximal femur is simi­lar to that of Romania and Poland. In Sweden and the UK, na­tional programs have been developed for the treatment of pa­tients with fracture of proximal femur, which include surgical intervention within 48 hours after trauma, geriatric consultation within 72 hours after admission, early post-operative mobiliza­tion, bedsore prevention, osteoporosis medication, supervision of a geriatrician. All this allowed to reduce the length of stay of the patient in the hospital, to reduce the number of complica­tions, to reduce the lethality and the cost of treatment by 40 %. Surgical treatment of elderly and senile patients with proximal femur fractures as soon as possible is the «gold standard».

Morphological characteristics of the proximal femur in elderly patients with hip fractures: a case-control study

<b>Introduction</b>: Owing to the diverse design, measurement methods and ethnic differences, the influence of the proximal femur geometry on hip fractures is still unclear. Therefore, this study aimed to investigate morphological characteristics of the proximal femur in senile patients with hip fractures on three-dimensional images.<br /> <b>Material and methods</b>: One hundred and sixteen women and 38 men with hip fractures were included in the fracture group. The control group included 74 women and 63 men. The geometrical parameters of the proximal femur were measured after three-dimensional reconstruction. The femoral neck width (FNW), femoral neck length (FNL), femoral head height (FHH), femoral head diameter (FHD), neck shaft angle (NSA) and offset were measured and statistically analyzed. <br /> <b>Results</b>: The NSA in fracture cases was significantly larger than controls in both men and women (130.18 vs. 126.93, p = 0.001; 131.07 vs. 128.68, p < 0.001, respectively). Moreover, a lower total hip bone mineral density (BMD) in fracture cases was found in both sexes (0.725 vs. 0.812, p = 0.001; 0.743 vs. 0.830, p < 0.001, respectively). In multiple logistic regression analysis, a larger NSA and a lower total hip BMD were independent predictors for hip fractures in both men and women (OR = 1.143 and 1.171, p = 0.010 and 0.016, respectively). However, the FNL was an independent predictor for hip fractures only for women (OR = 1.201, 95% CI: 1.106–1.305, p < 0.001).<br /> <b>Conclusions</b>: A larger NSA and a lower BMD were independent predictors for hip fractures of senile patients in both sexes. Moreover, a longer FNL was an independent risk factor for patients with hip fractures in women. As a result, we hypothesized that the geometrical measurement of the proximal femur on three-dimensional images might be appropriate.

Прочностные характеристики проксимального отдела бедренной кости в условиях внутреннего силового шунтирования

The present research describes a method of surgical prophylactic reinforcement of the proximal femur in elderly patients suffering from various diseases that cause degenerative and dysplastic processes in bone (oncology, osteoporosis, cartilage and fibrous dysplasia, etc). These processes cause pathological fractures. Original reinforcement implants (Russian Federation patents number 91845, 98901, 101351, 121725) are installed in the intact bone of the proximal femur to prevent its fractures in case of low-energy trauma, thereby increasing bone strength. Preventive reinforcement technique has a mathematical and economic feasibility. Increasing of the strength of the proximal femur, reinforced by implants from nanostructured titanium, is proved by bench tests.

Prothèse de hanches à double mobilité comme traitement des fractures déplacées du col du fémur du sujet âgé. Une étude prospective, systématique, multicentrique plus particulièrement focalisée sur le risque de luxation postopératoire

Summary Introduction Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation. Hypothesis Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck. Patiants and method In a multicenter prospective study, conducted in France over an inclusion time of 3 months, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup. Patients had clinical and radiological assessment at 3, 6, and 9 months postoperative. Results Two hundred and fourteen hips in 214 patients with a mean age of 83 years (range, 70–103 years) were included. None of the patients was lost to follow-up. The mortality rate after 9 months was 19%. Two patients (1%) had early postoperative infection successfully treated with lavage and antibiotics. Three patients (1.4%), operated through a posterior approach, presented one postoperative dislocation, all of which were posterior. Reduction was performed through closed external manipulation under general anesthesia. There was no recurrence of dislocation. Discussion This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemi-arthroplasties. Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended. Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure with its potential acetabular complication, and weigh them against the potential benefits. Level of evidence Level III prospective, case study.

Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation

Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation. Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck. In a multicenter prospective study conducted in France over an inclusion time of 3 months, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup. Patients had clinical and radiological assessment at 3, 6, and 9 months postoperative. Two hundred and fourteen hips in 214 patients with a mean age of 83 years (range, 70-103 years) were included. None of the patients was lost to follow-up. The mortality rate after 9 months was 19%. Two patients (1%) had early postoperative infection successfully treated with lavage and antibiotics. Three patients (1.4%), operated through a posterior approach, presented one postoperative dislocation, all of which were posterior. Reduction was performed through closed external manipulation under general anesthesia. There was no recurrence of dislocation. This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties. Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended. Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure with its potential acetabular complication, and weigh them against the potential benefits.

Initially missed occult fractures of the proximal femur in elderly patients: implications for need of operation and their morbidity

Occult fractures of the proximal femur are not evident on radiographs and the diagnoses are often missed or delayed. We tried to determine whether the delay of diagnosis in elderly patients lead to increased morbidity and increased need for operation. We identified 26 elderly patients (> or =65 years of age) who were diagnosed as having an occult fracture of the proximal femur over a 3-year period. In 17 patients (17 hips, non-delayed group), the occult fracture was suspected at the first visit and the diagnosis was made on CT and/or MR images (MRI). In the remaining nine patients (9 hips, 34.6% delayed group), the diagnosis was delayed by a mean of 8.4 days (range 4-25 days). We compared the occurrence of fracture displacement, need for operation, change in activity level, and mortality between the non-delayed and delayed groups. Displacement of fracture occurred in 4 of 9 delayed patients and none of 17 non-delayed patients. Ten non-delayed patients needed operative treatment, whereas eight delayed patients needed operative treatment (p = 0.190). The activity level decreased in 6 of 7 surviving patients of the delayed group, whereas it decreased in 4 of 15 surviving patients of the non-delayed group (p = 0.020). A delayed diagnosis of occult fracture in elderly patients resulted in increased rate of secondary displacement of the fracture and increased morbidity. In patients suspected of having occult hip fractures, additional studies, such as MRI and/or CT scans should be recommended to confirm the presence of hip fracture.

Rehabilitation after minor fractures in elderly patients

A great deal of attention has been devoted to the ever-increasing incidence of fractures of the proximal femur in elderly patients and the impact which this has had upon their life expectancy and quality of life. The condition has also made heavy demands on the Health Service, and much effort has been devoted to increasing hospital throughput by effective programmes of rehabilitation. In these circumstances, it is not surprising that much less has been written about the issues involved in treating elderly patients with less serious forms of fracture. Nonetheless, closer attention to this group reveals that it also makes heavy demands on the Health Service. An example is that, in 1995, out of 1771 elderly patients admitted to the acute orthopaedic wards at Edinburgh Royal Infirmary, only 47% had fractures related to the proximal femur or displacement of a hip prosthesis (Figure 1) (CT Currie, unpublished data, 1996). Most of the remainder had fractures at other sites, while 8% had soft tissue injuries. The percentage of fractures involving more common sites in old people was 2.5% for the neck of humerus, 3% for the shaft of humerus, and 7% for the wrist. The low proportion of vertebral fractures emphasizes that this condition rarely leads to admission to an acute unit, so that the size of the problem is usually underemphasized.

MR imaging of occult traumatic fractures and muscular injuries of the hip and pelvis in elderly patients.

Recent studies have shown the usefulness of T1-weighted MR imaging for identifying fractures of the proximal femur in elderly patients with negative radiographs after acute trauma [1-4]. The advent of fast spin-echo and fast inversion recovery sequences allows for the rapid identification of a variety of other musculoskeletal injuries of the hip and pelvis that may explain a patient's symptoms but that may not be seen on T1-weighted images. This pictorial essay shows the types of lesions encountered. Lesion prevalence is given for 20 consecutive patients examined.

Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.

Proximal Femoral Fractures in the Elderly: Does Operative Delay for Medical Reasons Affect Short-term Outcome?

Forty patients over 65 years of age with fractures of the proximal femur, whose operation was delayed more than 24 hours after admission for medical reasons, were studied. Length of post-operative stay on the orthopaedic wards, mobility after one month and need for continuing supervision by the geriatric services, after discharge from the orthopaedic wards, were compared with a matched group in whom there was no delay. There were no significant differences between the results of the two groups, suggesting that, if medical conditions are adequately treated before operative fixation of fractures of the proximal femur in elderly patients, the short-term outcome is not adversely affected.

Treatment of fractures of the proximal femur in elderly patients

The results of treatment of fractures of the femoral neck in elderly and senile patients have been analyzed. It was found that complex prevention and intensive therapy of concomitant diseases play an important role in reducing mortality. Modern methods of treatment allow to obtain good and satisfactory results in 80% of patients with femoral neck fractures.