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.
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