The Effect of Comorbid Pathology on the Treatment Tactics of Femoral Neck Fractures in Elderly and Senile Patients

摘要

Injury of the bone structures in the hip joint refers to severe trauma of the musculoskeletal system for the elderly and senile patients leading to an adverse outcome. One of the important problems of geriatric practice is comorbidity which affects the prognosis for life, increases the likelihood of lethal outcome. The frequency analysis of presence and level of comorbidity in 201 patients with fractures of the femoral neck has been conducted. The mean age was 71.4 ± 7.1 years. When evaluating the comorbidity indices, its high indicators were found: the Charlson index averaged 9.12 ± 1.05 points, the Cumulative Illness Rating Scale (CIRS) index madeup 16.2 ± 3.9 points. The main contingent of treated 147 (73.1%) patients were individuals with a high level of physical activity. The analysis showed a direct dependence of the tactics choice and treatment methods on age, somatic status, degree of comorbidity index, level of physical activity, level of operational risk according to ASA, as well as dependence on the type of fractures according to Garden classification. Depending on the treatment tactics, the patients were divided into three groups: conservative treatment - 54 (26.9%); operative treatment (osteosynthesis) - 81 (40.3%) and total hip replacement - 66 (32.8%).The most promising method of treating patients with fractures of the femoral neck in the elderly and senile is hip arthroplastyat the current stage of traumatology development. It should be performed with adequate technical equipment, after preliminary preparation of patients and at the earliest possible time, before the development of complications.