Litvak V. Diagnosis and treatment of osteoporotic hip fracture in elderly and senile.

It was established that osteoporotic disturbances in the femoral neck were accompanied the decrease elastic modulus of cortical and trabecular bone, while the increased load was redistributed on the greater trochanter and the upper third of the femoral shaft. For the first time on the basis of numerical modeling of stress-strain state of proximal part of a human femur with osteoporotic disorders the reduction of physical and mechanical properties of bone, namely its strength, has been found. Thus it was shown that osteosynthesis unloads parts of the femur and reduces the level of stress at osteoporotic disorders. Data on the status of bone mineral density of the proximal femur in patients of different ages with femoral neck fractures were supplemented. During biochemical studies it was revealed that patients with proximal femur fractures had changed the markers of bone metabolism (alkaline and acid phosphatase), acute phase proteins (glycoproteins, haptoglobin) and their components - sialic acids, indicators of degradation of the organic bone matrix (chondroitin sulfate, uronic acids, oxyproline) and mineral metabolism (calcium, magnesium and phosphorus). It was shown that the severity of changes in these indicators depends on the physical condition of patients - compensationб subcompensation, decompensation. Important facts about the level of vitamin D in serum of patients with fractures were obtained. It was proved that this parameter can be one of laboratory criteria which indicate risk of osteoporosis. This is reflected in the disorder of metabolism of organic and inorganic matrix of bone tissue. The study of bone mineral density of the proximal femur in conjunction with the methods of mathematical modeling can be used to develop approaches to the treatment of patients with osteoporotic fractures. The developed treatment algorithm for elderly and senile patients with osteoporotic femoral neck fractures allows a differentiated approach to the choice of surgery methods (osteosynthesis and hip arthroplasty), depending on the type of fracture, degree of osteoporosis and physical condition of patients, as well as apply antiresorptive therapy and correction of vitamin D level. Results of the study are introduced into the clinical practice of KU "Irshava district hospital", Mizhgirya District Hospital, Transcarpathian regional clinical hospital named after Andrei Novak, Uzhgorod central city hospital, Khust district hospital, Vynohradiv regional hospital, the Lviv city clinical hospital № 8 in the educational process of profile departments of the Lviv national medical University named Daniel Galicki and DVNZ "Uzhhorod national University" Ministry of Education and Science of Ukraine. Traumatology and orthopedics.