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MODERN METHODS OF TREATMENT OF FRACTURES OF THE PROXIMAL
FEMUR
TMA Termez branch, Department of traumatology and orthopedics, surgical diseases,
neurosurgery, anesthesiology and emergency medical care.
Kodirov Fazliddin Karimovich
TMA, Associate Professor of the DepartmentTraumatology, Orthopedics and Military Field
Surgery No. 1 PhD
Nazarova Nigora Zikrillaevna
TMA, Department of Normal and Pathological Physiology
Ormonbekova Dilfuza Sanatullaevna
TMA Termez branch, Department of Medical Biology and Histology, Associate Professor
Nurova Zamira Annakulovna
Student of TMA Termez branch
Urizova Zarina Urmanovna
Annotation:
Fractures of the proximal femur (femoral neck, intertrochanteric and
pertrochanteric zones) are one of the most pressing problems in traumatology and
orthopedics, especially among elderly patients. These injuries are accompanied by a high
rate of disability and mortality, which makes it important to introduce effective, low-trauma
and quickly restorative treatment methods. The modern strategy for managing patients with
such fractures includes early diagnostics using radiography and CT, rapid hospitalization
and individually selected treatment tactics. Surgical treatment methods are currently
considered the "gold standard" for most fractures of the proximal femur. The most widely
used are osteosynthesis with dynamic hip screws (DHS), intramedullary fixation with PFN
and Gamma nails, as well as modular hip endoprostheses. Prosthetics is used more often in
older patients or in comminuted fractures, where restoration of the anatomy of the femur is
impossible. In modern practice, special attention is paid to minimally invasive technologies
that reduce the volume of surgical trauma, minimize blood loss and shorten the hospital stay.
Modern anesthesiological approaches, prevention of thromboembolic complications,
antibacterial therapy, as well as a multidisciplinary approach to the treatment of elderly
patients (geriatric orthopedics) can significantly improve treatment outcomes. Rehabilitation
begins early after surgery and includes the stages of exercise therapy, physiotherapy,
psychological support and drug correction of osteoporosis. An integrated approach to
treatment and subsequent rehabilitation can improve the quality of life of patients, reduce the
risk of recurrent fractures and restore lost functions of the musculoskeletal system. This
work is aimed at generalizing modern methods, analyzing their effectiveness and prospects
for implementation in clinical practice.
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Keywords:
femur fracture, proximal section, osteosynthesis, intramedullary fixation,
endoprosthetics, geriatric trauma, treatment methods, osteoporosis, early rehabilitation,
surgical intervention.
Introduction
Fractures of the proximal femur occupy one of the leading places among severe injuries of
the musculoskeletal system, especially in elderly and senile people. With the increase in life
expectancy and aging of the population, the frequency of such injuries is steadily increasing,
which makes the problem of their diagnosis, treatment and rehabilitation extremely urgent.
The most common are fractures of the femoral neck and intertrochanteric zone, which
usually occur as a result of a fall from one's own height against the background of reduced
mineral density of bone tissue (osteoporosis). These injuries are accompanied by a high risk
of complications - thromboembolism, bedsores, pneumonia, as well as a significant loss of
independence and quality of life. In the absence of timely and adequate treatment, severe
disability or even death is possible. Therefore, in modern clinical practice, special attention
is paid not only to surgical treatment methods, but also to a comprehensive interdisciplinary
approach, including anesthetic support, prevention of complications, active rehabilitation
and secondary prevention of osteoporotic fractures. The aim of this work is to analyze
modern methods of treating fractures of the proximal femur, evaluate their effectiveness and
determine the criteria for choosing the optimal treatment tactics depending on the age, nature
of the fracture and the patient's condition.
Materials and methods
The analysis used clinical data from patients treated in trauma and orthopaedic departments
with fractures of the proximal femur. The study group included patients over 55 years of age
with fractures of the femoral neck or intertrochanteric fractures, as well as with osteoporosis
and other risk factors such as falls and chronic diseases affecting bone tissue. Patients were
divided into groups depending on the treatment method used:
Osteosynthesis using a dynamic hip screw (DHS).
Intramedullary fixation using PFN or Gamma nail.
Hip replacement, including hemi- and total hip replacement.
The effectiveness of treatment was assessed using criteria such as fracture consolidation
time, incidence of postoperative complications (infection, thromboembolism), pain level,
functional recovery results according to the Harris Hip Score scale several months after
surgery, as well as the duration of hospitalization and return to normal physical activity.
Results and discussion
The analysis showed that modern surgical methods of treating proximal femur fractures
provide improved results compared to conservative treatment, especially in the older age
group. Among the surgical methods, osteosynthesis and endoprosthetics stand out, which
significantly reduce the recovery time and improve functional results. Intramedullary
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fixation (using PFN or Gamma nail) showed high fixation stability, which contributes to
early mobilization of the patient and a decrease in the level of postoperative complications.
This method ensures reliable fixation of bone fragments, especially in the case of unstable
fractures, and accelerates the fusion process. Hemiprosthetics and total hip arthroplasty
showed the best results in patients with comminuted fractures or senile changes in bone
tissue. These methods provide a high functional result, allowing patients to return to an
active life within a few weeks after surgery. Prosthetics also reduces the risk of secondary
complications, such as pain and osteonecrosis. Despite the effectiveness of surgical methods,
it is important to consider the age and general health of the patient when choosing a
treatment method. For elderly people with comorbidities, the choice should be based on
minimizing surgical intervention and reducing the patient's time in hospital. It is also
important to consider the need for early rehabilitation and prevention of osteoporosis, which
is an integral part of treatment and helps reduce the risk of recurrent fractures. The overall
results of the study confirm the high effectiveness of modern surgical methods for the
treatment of proximal femur fractures in improving functional outcomes and reducing
disability. However, further research is needed in this area to optimize treatment tactics
depending on individual patient characteristics.
Conclusion
Proximal femur fractures remain a serious medical and social problem, especially in the
elderly. Modern surgical treatment methods, such as intramedullary fixation and
endoprosthetics, have proven their high efficiency in providing stable fixation, reducing the
level of complications and reducing rehabilitation periods. The choice of method depends on
the anatomical type of fracture, age, functional state of the patient and the presence of
concomitant diseases. The most optimal approach is an individualized treatment strategy,
including multidisciplinary support, early mobilization, drug therapy for osteoporosis and
full rehabilitation. Thus, the introduction of modern technologies and a personalized
approach to treatment can significantly improve outcomes in proximal femur fractures,
improve the quality of life of patients and reduce medical and social costs for long-term
treatment and care.
References
1.
Alekseev S.V., Ivanova N.P. "Femoral neck fractures in the elderly: clinical
presentation, diagnostics, treatment." - M.: MEDpress, 2021.
2.
AO Trauma Manual. "Fractures of the Proximal Femur". AO Foundation, 2020.
3.
Parker MJ, Handoll HH "Intramedullary nails for extracapsular hip fractures in
adults." Cochrane Database of Systematic Reviews, 2022.
