The study was conducted during 2016–2020 at the Department of Traumatology, Anesthesiology and Military Surgery of the Kharkiv Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine.
The tasks of the study were complex, based on a systematic side and their implementation ensured the achievement of the research goal. The study of the research were calculated and provided representative results.
Based on the existing data of modern world and national sources, it was determined that the problem of fractures of the proximal femur is a significant medical and social problem of modern society, one of the most complex and significantly dangerous diseases for the world community due to the existence of significant economical, medical, social and other population losses. Significant global and national medical and epidemiological negative consequences of fractures of the proximal femur have been identified. It is established that the total mortality in this type of fractures reaches 12–15%; and the risk of mortality during the 1st year is about 20–40%, within 6 months. — from 12% to 24% and for the first 4 months. - 20% with a 30-day mortality rate of 5–10%. Inpatient mortality of victims can reach up to 14% and depends on the development of the early pulmonary embolism (2%), bedsores (7%), bleeding (1%), acute cardiovascular failure (10%) and late (false joints) (11.1–51.1%), aseptic necrosis femoral head of the thigh (6.1–43%)) complications, and disability reaches 20–50% and is estimated at 5964 DALY per 1000 people. Literally, high levels of medical and social consequences in the following fractures were noted: full recovery of the ability to full physical activity is 32–97%; 50% of patients after discharge from the hospital do not have opportunities for independent movement and maintenance; and with full recovery, 78% of such patients during the first year and 65% for two need outside help. It is recorded that the treatment level of active and full-life lifestyle after injury reaches only 20–50% of patients. At the same time, the modern literature states a significant effect of comorbid diseases on the length of stay of patients with fractures of the proximal femur in the hospital, the development of complications, treatment outcomes, prognosis for active life and functioning, the likelihood of death. The structure of comorbid pathology was also established: it is a disease of the cardiovascular system (70%); respiratory organs and cerebrovascular disorders (23%); diseases of the urinary system (3%); diseases of the endocrine system and gastrointestinal tract (13% each); diabetes mellitus (7.7%); mental disorders (27.2%) and others.
Criteria for inclusion in our study were: adulthood at the time of the study (reaching 18 years), a history of officially confirmed treatment of at least one fracture, which was localized at the level of the proximal femur and according to the generally accepted coding of the International Statistical Classification of Diseases and Problems. Health-related 10 revisions related to fractures: femoral neck — S72.0, through vertlug fracture of the femur — S72.1, through vertlug fracture of the femur — S72.2.
A retrospective study examined that there were patients with fractures of the proximal femur of female patients (65.4%) compared to men (34.6%) (p <0.05) and a significant advantage of persons aged 71–80 years 32.06%) and older than 80 years (27.02%) compared with patients younger than 60 years (9.82%) (p <0.01). Retrospectively, the predominance of patients living in urban areas (86.35%) compared to rural residents (13.29%) (p = 0.004) and persons without permanent residence (0.37%) was determined (p < 0.001). The privilege of patients admitted to trauma departments in the direction of ambulance and emergency care (66.83%) compared with admission in self-treatment (22.17%) (p < 0.01) and in the direction of outpatient and inpatient facilities Kharkiv and the region (10.07%) (p < 0.01) and planned hospitalization (0.93%) (p < 0.001). It was stated that the vast majority of subjects received medical care in the first six hours after injury (80.35%) compared with patients who received care after six to twenty-four hours (10.24%) (p < 0.001), twenty-four – seventy-two hours (4.46%) (p < 0.001) and more than seventy-two hours (4.95%) (p < 0.001).
