StoikaVasyl V. Surgical treatment of patients with trochanteric fractures of the femur amid thyrotoxicity.

Objective: structural and metabolic markers of bone tissue in trochanteric femoral fractures in patients with thyrotoxicity and osteoporosis. Goal: to increase the effectiveness of surgical treatment of patients with trochanteric fractures of the femur amidst thyrotoxicity and to improve rehabilitation methods. Methods: clinical and radiological; mathematic modeling, methods of bone densitometry, biochemical. First, based on mathematical modeling, peculiarities of distribution of the stress-strain state in the system of "femur-fixator" in trochanteric femoral fractures repaired with skeletal osteosynthesis and intramedullary fixation were determined. The study added to the knowledge base pertaining to metabolic bone disturbances in patients with trochanteric fractures of the femur amidst thyrotoxicity, which are characteristic of development of hormonal (thyroid) osteoporosis. Negative changes in mineral bone density have been determined in 93.6% of patients with thyrotoxicity, among which 63.8% had osteoporosis and 29.8% had osteopenia. For the first time, the study concluded that incorporation of interval hypoxic trainings, with the usage of low invasiveness methods of surgical interventions based on biochemical markers, into the scheme of complex treatment of thyrotoxic patients decreases inflammatory and destructive processes, improves metabolism, eliminates hypoxia and tissue ischemia during the rehabilitation period. The study also, for the first time, created an algorithm for choosing the method of surgical treatment of trochanteric femoral fractures in thyrotoxic patients accounting for patients' somatic state, type of fracture, and degree of osteoporosis. This algorithm of treatment of thyrotoxic patients with trochanteric femoral fractures allows to differentiate the choice of metallofixators depending on the type of fracture and on the degree of osteoporosis. The study offers a rehabilitation program with usage of interval hypoxic trainings during the post-operative period for thyrotoxic patients with trochanteric fractures of the femur after low invasiveness surgical treatment methods. The results of the study have been implemented into clinical practice at the Regional Clinical Hospital named after O.F. Gerbachevskiy of Zhytomir Regional Administration, Smila City Hospital named after Taras Shevchenko, Skole District Hospital, Transcarpathian Regional Clinical Hospital named after Andriy Novak, Mizhhiria District Hospital, Tyachiv District Hospital, Vinogradiv District Hospital. Traumatology and Orthopedics.