Kalchenko A. Surgical treatment of trochanteric femoral fractures in elderly and senile individuals.

Object: the process of restoring an injured lower limb after a trochanteric femoral fractures under conditions of osteosynthesis or endoprosthetics in elderly and senile people. Aim: improve the results of treatment of elderly and senile people with trochanteric femoral fractures by rational choice of treatment method - osteosynthesis or hip arthroplasty. Methods: clinical, radiological, biomechanical (mathematical modeling by the finite element method), statistical. For the first time the developed mathematical models have been used to calculate the stress-deformed state in the structures of the "fragment – periosteal fixator" and the "femur – endoprosthesis stem", occurring during the treatment of type 2-5 fractures of the trochanter region of the femur according to Evans-Jensen classification. It has been established that endoprosthesis after trochanter fractures promotes uniform stress along the contact surface of the endoprosthesis stem with the bone, unlike osteosynthesis with screws, where the stress is concentrated on the screws and exceeds the limit of destruction of the spongeous bone. For the first time, based on the retrospective analysis, the frequency and nature of a concomitant pathology in elderly and senile patients with trochanteric fractures of the femur was studied and their influence on the choice of treatment tactics was proved. New knowledge about the higher rate of recovery of the motor activity and the lower incidence of complications from concomitant pathology in elderly and senile patients with trochanteric fractures of the femur when performing total hip arthroplasty as compared to osteosynthesis was obtained. It is proved that in case of impaired motor activity of the patient, provoked by inconsistent osteosynthesis, concomitant somatic pathology is enhanced and can lead to death. Indications for surgery in type II–V trochanter fractures of the femur in the elderly and senile according to Evans-Jensen classification have been developed, providing a differentiated approach to the choice of treatment method for patients. The possibility of endoprosthesis in case of fragmented trochanter fractures of the femur has been substantiated. The developed method for the treatment of fragments of trochanteric trochanteric fractures of the proximal femur (Patent No. 101594UA) enables earlier restoration of limb function. The finite element mathematical models of the proximal femur in type II–V trochanter fractures according to Evans-Jensen classification allow to study the stress-deformed state in the system under the conditions of modeling different types of fixation of bone fragments. The results of the dissertation research were introduced into the practical work of the trauma department of the Municipal Non-profit Enterprise "City Clinical Hospital No. 17" of the Kharkiv City Council, the Communal Health Care Institution "Merefyanskaya Central District Hospital", the Communal Non-profit Enterprise "Zmievskaya Central District Hospital" of the Zmievsky District Council of the Kharkiv Region. Тraumatology and Orthopaedics.