Fractures of the Proximal Femur in the Elderly

Autor: Aljoša Matejčić, Miroslav Bekavac-Bešlin, Ivica Mihovil, Mladen Tomljenović, Ivan Krolo, Borki Vučetić
Jazyk: angličtina
Rok vydání: 2002
Předmět:
Zdroj: Acta clinica Croatica
Volume 41
Issue 1
ISSN: 1333-9451
0353-9466
Popis: Fractures of the proximal femur are a substantial problem in the elderly. These fractures primarily are due to bone fragility in the elderly caused by osteoporosis. This population is burdened with numerous chronic illnesses that aggravate and complicate surgical treatment of the injured. According to latest figures, death rates among patients with these fractures are by 15% higher than in those free from these injuries, and 20% of the injured will never be able to walk independently again. According to our own experience and literature data, surgical treatment significantly reduces the mortality of the injured and improves their quality of life by providing by far better functional results than conservative treatment. Results of operative treatment for proximal femur fractures were compared between two periods of time at a 10-year interval (1988/1989 and 1998/1999). Comparison between these two time periods showed the frequency of hospital admission and operative treatment for this pathology to have increased by more than 100% in 10 years, so that at present this group of patients account for more than 45% of the capacity and operative schedule of the Division of Traumatology, Department of Surgery, Sestre milosrdnice University Hospital in Zagreb. During the latter 2-year period (1998/1999), there were 372 injured in total, 78 (21%) of them male and 294 (79%) female, mean age 73 years (69 in male and 79 in female patients). The mean duration of hospitalization was 15 days with 5-day waiting for the operation. During the same time period, eight (2%) patients were treated conservatively. A 2.5% (n=9) perioperative mortality rate was recorded. Fracture of the neck of femur was found in 152 (41%) patients; 47% of them were treated by use of partial hip prosthesis, 10% with total hip prosthesis, and 42% with a 130-degree angle plate. Out of 205 pertrochanteric fractures, 130-degree angle plate was used in 50%, 95-degree angle plate in 22%, and dynamic hip screw in 28% of cases. Operative treatment combined with a well planned rehabilitation program consistent with the type of surgery and individual patient condition has evident and great advantages, and has been recognized as the treatment of choice for this pathology.
Lom gornjega okrajka natkoljenične kosti u starih osoba uvijek predstavlja aktualan problem. Mnogo je uzroka loma natkoljenične kosti u toj životnoj dobi, ali je u središtu zbivanja ipak osteoporoza i biomehaničko slabljenje kosti. Prema današnjim saznanjima može se ustvrditi da je opća smrtnost ove dobne skupine za 15% niža od unesrećenih koji su slomili proksimalni okrajak bedrene kosti, te su prema suvremenim znanstvenim spoznajama operacijski liječeni. U ovom su radu uspoređene dvije skupine ispitanika u razmaku od deset godina (2000./1999. i 1998./1989.). Najznačajniji je podatak da je u deset godina za 100% povećan broj hospitaliziranih zbog navedene ozljede, te je time oko 45% kapaciteta traumatološkog odjela Klinike za kirurgiju kliničke bolnice “Sestre milosrdnice” zauzet gerijatrijskom traumatologijom. U razdoblju od dvije godine, 2000./1999., bilo je ukupno 372 ozlijeđenika s lomom u navedenoj regiji. Od toga je 21% (n=78) muškaraca i 79%(n=204) žena. prosječna dob je bila 73 godine, i to 69 za muškarce i 79 za žene. Prosječno trajanje boravka u bolnici bilo je 15 dana, s čekanjem na operaciju u prosjeku 5 dana. Svega je 2% bolesnika liječeno konzervativnim postupkom zbog kon¬traindikacija za operaciju. Zabilježena je perioperacijska smrtnost od 2,5% ili devet slučajeva. Od ukupnoga broja ozlijeđenika, 152 (41%) ih je imalo lom vrata bedrene kosti, 205 (55%) pertrohanterni lom, a 15 (4%) subtrohanterni lom. Operacijsko liječenje uz odgovarajući rehabilitacijski postupak ima velike prednosti i predstavlja metodu izbora u liječenju lomova gornjega okrajka natkoljenične kosti u starih osoba.
Databáze: OpenAIRE
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