The purpose of the study is to study the current global clinical and epidemiological features of proximal hip fractures and the risks of their development and spread. The paper identifies the main aspects of the spread and treatment of fractures of the proximal femur; main world modern epidemiological characteristics of hip fractures and levels of risks of their development and spread. The relationship between comorbidities in patients with proximal hip fractures and the risk of various treatment complications is shown. The main types of treatment tactics are identified, the groups of the most common comorbidities in such patients are given. As a result of the work it was established: the percentage of fractures of the proximal thigh is 9.00–45.00 % among all skeletal fractures in the older age group and among all age categories – 17.00–24.00 %; global annual morbidity is 1.7 million people, and mortality – 11.00–23.00 % in 6 months and 22.00–29.00 % in a year; increase in the frequency of these fractures with age with doubling after 50 years every ten years; average age of patients – 75–79 years; predominance of women over men in 2-3 times; the lowest annual age-standardized cases among women are in Nigeria, South Africa, Tunisia and Ecuador, and the highest are in Denmark, Norway, Sweden and Austria, which is also typical for men; significant economic burden of treatment and high levels of fractures with osteoporosis, cardiovascular disease, diabetes, chronic obstructive pulmonary disease and more; the advantage of surgical treatment over conservative.
The paper shows the results of a study related to the possibilities of predicting the outcome in patients with fractures of the proximal femur depending on the medical-epidemiological and anamnestic characteristics. It was determined that fractures of the proximal femur are among the most common types of fractures and rank third among the most common types of fractures; they have high relevance and medical and social significance. Objective: study the possibilities of predicting treatment outcomes in patients with fractures of the proximal femur depending on the medical-epidemiological and anamnestic characteristics. In order to achieve this purpose, a retrospective study of the treatment outcome in patients with fractures of the proximal femur was conducted using the data of seven medical institutions in Kharkiv for six years (from January 01, 2011 to December 31, 2016). According to the results of the study, a significant direct correlation of healed fractures and healing fractures with a likelihood of surgical treatment was determined: they were 2.40 and 4.15 times higher, respectively, versus the comparison group. A significant inverse correlation with the conservative treatment of pseudarthrosis and other types of lesions, together with fractures of the proximal femur (reduced likelihood of surgical treatment by 79.50% and 66.90%, respectively) was found. There was a significant inverse correlation between age characteristics and the conservative treatment, with 23.10% increase by every 10 years and a direct correlation between functional characteristics according to the ASA classification and surgical treatment. A significant direct correlation of increased likelihood for operative treatment of fractures of all types according to AO classification in comparison with type 31A1 was defined. Significant correlation with the place of residence was established: increased likelihood of conservative treatment (by 75.00% in patients from other cities of Kharkiv region); increased likelihood of surgical treatment (residents of villages of Kharkiv region – 12.78 times, residents of villages of other regions – 5.20 times, residents of cities of other regions – 7.87 times, persons of no fixed abode – 5.11 times). A significant correlation between the characteristics of patients' admission to the clinic and the use of surgical treatment were recorded: in self-treatment (2.29 times) and in referral to outpatient and inpatient facilities (2.44 times). Keywords proximal femur fractures, clinical and epidemiological characteristics, concomitant pathology, comorbid burden, age-sexual characteristics, functional status, odds ratio, confidence intervals.
The aim of the research: correlation levels of the psychological component of quality of life and medical-epidemiological characteristics of patients with fractures of the proximal thigh. Solved problem: to determine the possibility of predicting the impact of medical-epidemiological and anamnestic characteristics of patients with fractures of the proximal thigh on their quality of life after treatment of fractures of the proximal thigh. Main scientific results: natural increase in comorbidity in the presence of comorbidities, low functional status and an increase in age characteristics were established. The probable influence of comorbidity on the decrease of the functional state according to the ASA classification also stated. An increase in the duration of treatment of patients with surgical treatment and a longer period of injury marked. The decrease in the quality of life of patients with increasing age characteristics, increasing comorbidity and reducing the indicators of functional status according to the ASA classification have been established. Area of practical use of research results: medical institutions of traumatological profile. Innovative technological product: determining the ability to predict the quality of life of patients after treatment of fractures of the proximal thigh, which allows you to predict the results of treatment such patients. Scope of application of the innovative technological product: clinical medical traumatological practice of use of possibilities of forecasting of results of treatment of fractures of proximal hip department.
Regional clinical and epidemiological characteristics of the patients with the proximal femur fractures have been determined. To perform the research, the following tasks were solved: to establish the prevalence of fractures of the proximal femur depending on age and sex characteristics, place of residence, lesion, features of admission to the clinic, mechanisms of referral, timing of admission, concomitant pathology and comorbid burden, functional level, type of fracture and treatment tactics. The regional epidemiological characteristics of patients with these fractures were retrospectively studied using the date of seven medical institutions of the city of Kharkiv during 2011−2016. The predominance of women with a total average age of all the patients of 70.36±0.20 years and the one of the contingent of the patients aged 71−80 years and older 80 years and older were found. There was a significant prevalence of urban dwellers among the patients. The predominance of patients admitted to trauma departments by ambulance crews was determined. It was stated that the vast majority of respondents received medical care in the first 6 hours after injury. A significant proportion of comorbidly burdened patients with a predominance of the patients with one or two concomitant diseases was identified. Almost identical injuries of both the right and left extremities with a significant predominance of closed fractures and those of type 31A1 and 31B1 according to the classification of the Society for the Study of Osteosynthesis. A certain decrease in functional status was determined according to the classification of the American Society of Anesthesiologists. Conservative treatment was used more often than surgical treatment. Key words: proximal femur fractures, clinical and epidemiological characteristics, concomitant pathology, comorbid burden, age−sexual characteristics, functional status.
Many studies have confirmed that the incidence of fractures of the proximal femur increases significantly with age and doubles every ten years after the age of 50. It was found out that these patients average age increases by one year every five years, and more than 50.00% with damage to this location are over 60 years old. The purpose of the study was to determine the regional correlation features of the interdependence of medical-epidemiological and anamnestic characteristics of patients with proximal femur fractures. Material and methods. To achieve the main goal, we conducted a retrospective study of patients with such fractures according to seven medical institutions in Kharkiv. Results and discussion. When studying the correlation levels of interdependence between various medical-epidemiological and anamnestic characteristics of the examined patients we stated that the female sex correlated with all age periods, which confirmed the predominance of females among the examined all age categories: the sex of patients determined reliable (average <0.001); forces correlation with age characteristics: k = 0.349; the possible influence of gender characteristics on the choice of treatment tactics was stated reliable (p = 0.003); the inverse weak correlation with the type of treatment was recorded: k = -0.041; the possibilities of the influence of age characteristics on comorbid burden; the presence of concomitant pathology and the choice of treatment tactics were clarified: it was determined that the age of the examined patients was significantly (p = 0.014) inversely weakly correlated with the presence of comorbidities and comorbid burden (respectively k = -0.050 (p < 0.001) and k = -0.047 (p <0.001)) and the type of treatment: k = -0.193 (p <0.001); possibilities of influence of more significant comorbid burden on indicators of levels of functional condition and increase in duration of terms of receipt to traumatological departments and reception of qualitative medical care were established: reliable (p <0.001) direct weak correlation was received between indicators of age of trauma and presence of concomitant diseases k = 0.081), comorbid load (k = 0.087) and functional state according to the ASA classification (k = 0.084); determined the stable effect of the existing concomitant pathology and comorbid burden at the level of functional status and its possible impact on using conservative treatment: the presence of comorbidities correlated strongly with comorbid burden (k = 0.989, p <0.001); functional state was evaluated according to ASA classification k = 0.985, p <0.001) and directly weak with the type of treatment (k = 0.228, p <0.001); a direct strong correlation was found between the comorbid burden and functional status according to the ASA classification and the type of treatment performed (respectively k = 0.979 and k = 0.226; p <0.001); the possible influence of low functional state on the choice of treatment tactics was stated: it was proved that the functional state significantly weakly correlated with the type of treatment: k = 0.229, p <0.001. Further research is planned to establish the possibility of predicting the use of treatment tactics and the development of reliable prognostic statistical models of the dependence of the results of different treatment methods on the medical-epidemiological and anamnestic characteristics of patients
Стаття надійшла до редакції 21.06.2019 ДО УВАГИ СПЕЦІАЛІСТІВ ДУ «Інститут патології хребта та суглобів ім. проф. М. І. Ситенка НАМН України» проводить післядипломну підготовку фахівців на курсах інформації та стажування з актуальних питань ортопедії та травматології (ліцензія Міністерства освіти і науки України АЕ № 285527 від 27.11.2013
Харківська медична академія післядипломної освіти. Україна 2 Харківська міська клінічна багатопрофільна лікарня № 17. Україна
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