Pertrochanteric and intertrochanteric fractures constitute from 3% to 6% of all
injuries of musculoskeletal apparatus and up to 52% of a number of patients having
femur fractures. More than 91% of cases of this trauma happen to people over 65 years;
women have fractures of such localization 4-6 times more frequently than men. The
mechanism of injury in elderly and people of senile age is typical – low-energy one as
a result of usual fall at home while doing household duties or outdoors. Although there
is a great choice of metal fixations, the frequency of negative late treatment outcomes
remains rather high. Case fatality rate among this group of patients in accordance with
data from different researches amounts from 12% to 19% and has a steady tendency
towards growth with age. The research paper is based on the results of surgical
treatment of 156 senior age group patients: elderly age and senile age, as well as, longliving people, with pertrochanteric and intertrochanteric fractures of femur during the
period from 2012 to 2016. The age of patients at the time of operative treatment was
from 61 to 94 years. Among the patients having this injury there were 52 (33,3%) men
and 104 (66,6%) women. An experimental group of endoprosthesis replacement (total
cement, subtotal monopolar and bipolar) and a reference group of
osteometallosynthesis (angle plate, LCP, DHS, PFN) were formed from 156 selected
patients.
Having analysed the total values in accordance with Harris scale in the check
sample, we can indicate that the patients after osteometallosynthesis have the best functional result of treatment: PFN – 75,13±10,14 scores and DHS – 72,83±17,36
scores, which is assessed as ‘satisfactory’. In groups of angle plate and LCР the
treatment results were estimated as unsatisfactory – 55,71±19,28 scores and
67,67±19,73 scores correspondingly. In the experimental group the results were as
follows: in the group of total cement endoprosthesis replacement – 93,0±4,33 scores
(excellent), 86,53±9,7 scores (good) were evaluated in the group of subtotal bipolar
and 78,23±7,92 scores (satisfactory) in the group of subtotal monopolar endoprosthesis
replacement. Endoprosthetics of the hip joint with an improved technique with
preservation of the basal cervical unit has a significant (p = 0.000005) better functional
results - 92,68 ± 4,77 points, than without preserving the fractures - 81,19 ± 9,47. Thus,
the hip joint endoprosthesis has better remote functional results of treatment than
osteometallosynthesis.
The advanced endoprosthesis replacement of the hip joint was made in 26
patients of the experimental group in accordance with the patented technique
algorithm. As a result, we will obtain the early activation of patients, renovation of
walking stereotype with full loading on the injured leg during the first days of
postoperative period. The endoprosthesis replacement of the hip joint in the group of
elderly people with pertrochanteric and intertrochanteric fractures of the femur allows
to cancel the negative impact of most factors which have effect on the remote
functional results in the reference group of osteometallosynthesis, such as osteoporosis
(r = 0,06 for index Singh, r = -0,14 for МCІ), complexity fracture (r = -0,03),
coxarthrosis (r = 0,049).
