A CLINICAL EXAMPLE OF PROVIDING SPECIALIZED MEDICAL CARE TO AN ELDERLY FEMALE PATIENT WITH A FRACTURE OF THE PROXIMAL FEMUR
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Abstract
At present, there is a continuous demographic increase in the number of elderly people. According to Rosstat data for 2024 and the beginning of 2025, the proportion of people of non-working age was 28.2%. Fractures of the proximal femur (FPF) constitute about 35% of all skeletal injuries, remaining one of the pressing contemporary problems due to severe, life-threatening injuries that have enormous social, medical, and economic consequences and increase mortality in the population, within the first six months after trauma, to 40%.
There are many methods of surgical treatment and varieties of implants, however, the proportion of unsatisfactory results remains high. To date, there is no unanimous opinion regarding fixation devices and indications for osteosynthesis or arthroplasty, the timing of surgical treatment, and aspects of rehabilitation, although most authors recommend operating on patients with FPF without delay to ensure early mobilization and thereby reduce mortality. Solving this problem remains one of the priority tasks of modern traumatology, and the search for new methods of visual diagnosis of trauma, especially in elderly individuals, cognitive post-traumatic brain disorders, and a differentiated selection of the correction method for trochanteric femur fracture, considering the patient's age, appears to be very relevant.
The article presents a clinical example of a comprehensive assessment of cognitive functions (Montreal Cognitive Assessment (MoCA)) and traumatic fat embolism syndrome (FES) using a non-invasive method of bilateral transcranial Doppler monitoring of flows in the middle cerebral arteries with microemboli detection on an ultrasound transcranial Doppler analyzer, prior to performing surgical intramedullary blocking osteosynthesis in a 100-year-old patient with an injury to the right femur.
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Dedov II, Mel’nichenko GA, Belaya ZE, Rozhinskaya LY. Osteoporosis: from a rare symptom of endocrine diseases to the tacit epidemic of XX-XXI centuries. Problems of Endocrinology. 2011; 57(1): 35-45. Russian (Дедов И.И., Мельниченко Г.А., Белая Ж.Е., Рожинская Л.Я. Остеопороз – от редкого симптома эндокринных болезней до безмолвной эпидемии XX-XXI века. Проблемы эндокринологии. 2011. Т. 57. № 1. С. 35-45.) doi: 10.14341/probl201157135-45
Belov MV, Belova KYu. Сontemporary view of medical care of the elderly people with proximal femur fractures. Russian Journal of Geriatric Medicine. 2021; 2(6): 176-185. Russian (Белов М.В., Белова К.Ю. Современный взгляд на оказание медицинской помощи при переломах проксимального отдела бедра у лиц пожилого и старческого возраста //Российский журнал гериатрической медицины. 2021. № 2(6). С. 176-185.) doi: 10.37586/2686-8636-2-2021-176-185
Lazarev AF, Solod EI, Antonov AA, Vychuzhanin DV. Surgical treatment for chronic proximal femur fractures. Vrach. 2020; 31(12): 65-69. Russian (Лазарев А.Ф., Солод Э.И., Антонов А.А., Вычужанин Д.В. Оперативное лечение застарелых переломов проксимального отдела бедренной кости //Врач. 2020. Т. 31, № 12. С. 65-69.) doi: 10.29296/25877305-2020-12-13
Raskina TA, Averkieva YuV. Sociomedical sequels and quality of life in patients of old age group with proximal femoral fractures. Modern Rheumatology Journal. 2014; (3): 51-55. Russian (Раскина Т.А, Аверкиева Ю.В. Медико-социальные последствия и качество жизни у больных старшей возрастной группы с переломами проксимального отдела бедра //Современная ревматология. 2014. № 3. С. 51-55.) doi: 10.14412/2074-2711-2014-3-51-55
Chou R, Gordon D, de Leon-Casasola O, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17(2): 131-157. doi: 10.1016/j.jpain.2015.12.008
Ruedi T, Buckley R, Morgan C. AO – Printsipy lecheniya perelomov. Vtoroe dopolnennoe i pererabotannoe izdanie. Izd-vo Vassa-Media, 2013; T. 2: 468 s. Russian (Рюди Т.П., Бакли Р.Э., Морган К.Г. АО – Принципы лечения переломов. Второе дополненное и переработанное издание. Изд-во Васса-Медиа, 2013; Т. 2: 468 с.) ISBN 978-3-9814118-5-0, 978-3-13-117442-0
Baranov VA, Baranova NA, Voronkin RG. Use of bilateral middle cerebral artery blood flow monitoring with microemboli detection for early verification of fat embolism syndrome in polytrauma. Young Scientist. 2025; 31(582): 19-21. Russian (Баранов В.А., Баранова Н.А., Воронкин Р.Г. Использование метода билатерального мониторирования кровотока в среднемозговых артериях с микроэмболодетенцией с целью ранней верификации синдрома жировой эмболии при политравмах //Молодой ученый. 2025. № 31(582). С. 19-21)
Rodionova SS, Kolondaev AF, Solod EI. Kombinirovannoe lechenie perelomov shejki bedrennoj kosti na fone osteoporoza. RMZh. 2004; 24: 1388-1391. Russian (Родионова С.С., Колондаев А.Ф., Солод Э.И. Комбинированное лечение переломов шейки бедренной кости на фоне остеопороза //РМЖ. 2004. № 24: 1388-1391)
Norris R, Bhattacharjee D, Parker MJ. Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury. 2012; 43(6): 706-711. doi: 10.1016/j.injury.2011.10.027