Object: fractures of the proximal femur in elderly and old people. Aim: to improve the results of treatment of elderly and senile patients with fractures of the proximal femur by substantiating, developing and clinical application of the methodology for choosing the optimal treatment tactics for elderly patients with impaired somatic and cognitive status. Methods: systemic analysis, prospective-retrospective, clinical, genetic, immunological, psychodiagnostic, experimental, mathematical modeling and forecasting, biomechanical, statistical analysis. Based on a clinical and experimental study, the connection between lactase deficiency and bone mineral density disorders, the risk of fractures of the proximal femur, especially among the elderly and senile, was determined for the first time. For the first time, as an informative criterion for assessing the course of reparative osteogenesis in patients with femoral fractures, probable immunological cytokine markers of bone metabolism in the process of bone remodeling (decreased serum levels of OPG; low levels of IL-6; increased serum TGF; correlation between OPG and RANKL levels, between TGF-β1 and OPG / RANKL and between IL-6 and RANKL and vice versa - between RANKL level and OPG / RANKL ratio), which allows for timely correction of disorders and development of individual treatment tactics a particular patient, taking into account the peculiarities of his bone metabolism. It was proved for the first time that the comorbid condition of victims with fractures of the proximal thigh is mainly represented by diseases of the cardiovascular system and gastroduodenal tract. By using the model object Rattus norvegicus (gray rat) for the first time in the experiment, the argumentation of the scheme of treatment of fractures of the proximal femur in hypertension, which provides mandatory medical correction of hypertension. For the first time, the main psychoneurological and psychopathological manifestations of the anxiety-depressive spectrum among the elderly and senile with fractures of the proximal femur have been singled out; criteria for their development and strengthening in the process of surgical treatment of hip fractures and pharmacological prophylactic mechanisms of their prevention and correction are established. Scientific data on six-month and three-year causal rates of cumulative mortality and survival rates of patients with proximal hip fractures and their relationship to the method of surgical treatment (statistical or dynamic) have been supplemented. For the first time, finite-element models of trochanteric fractures of the proximal thigh were created, and oblique and intramedullary types of osteosynthesis and endoprosthesis were mathematically modeled. For the first time a comparative analysis of the stress-strain state of models of osteosynthesis (use of plate and modular system) and endoprosthesis (use of endoprosthesis and modular system) in the treatment of trochanteric parts femur fractures of the femur by types of Evans fractures with determination of stress distribution in models, bone marrow the outer surface and in the areas of fractures and entry points of screws and spokes or elements of metal structures. For the first time, a method for selecting the optimal treatment tactics for elderly patients with impaired somatic and cognitive status was substantiated, developed and clinically tested. Based on the received clinical-experimental and theoretical-practical data, algorithms for medical rehabilitation of elderly and senile patients with trochanteric fractures of the proximal femur and effective methods of endoprosthesis of the hip joint in elderly patients with the status of patients with the status of kittens with the status of patients with the status of kittens a type of Evans classification fracture that will allow you to tailor individual patient-specific treatment tactics It is important to improve the results of surgical treatment and quality of life of such patients, and to actively and promptly introduce corrective mechanisms of possible disorders. A method for selecting the optimal treatment tactics for elderly patients with impaired somatic and cognitive status has been developed and clinically tested. The results of the study are introduced in the clinical practice of the Municipal Non-profit Enterprise "City Clinical Multidisciplinary Hospital №17" of the Kharkiv City Council, Communal Non-profit Enterprise of the Kharkiv Regional Council "Regional clinical traumatological hospital", Communal Non-profit Enterprise "Zmiiv central district hospital" of the Zmiiv district council of the Kharkiv region. Traumatology and orthopaedics.
