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Медико-биологический
информационный портал
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Vol. 26, Art. 8 (pp. 170-210) | 2025
Optimization of the trauma care system for elderly, senile and long-lived patients with proximal femur fractures in a multi-speciality hospital
Kucheev I. O.,1,2, Linnik S. A. 1
1St. Petersburg State Budgetary Healthcare Institution Hospital for War Veterans, 193079, St. Petersburg, st. Narodnaya, 21, bldg. 2; 2St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze, 192242, Saint Petersburg, Budapeshtskaya str., 3A
Brief summary
Providing trauma care for elderly patients with proximal femoral fractures (PFF) remains a pertinent and controversial issue. This is due to the demographic growth of elderly and senile patients, when the proportion of the population over 60 years old is growing and according to projections will be doubled by 2050. PFF is the most common cause of hospitalization in the trauma department among people over 60 years old, and in-hospital mortality and mortality rates remain quite high in the first months after injury. The article sets forth original approaches to the strategy and surgical tactics determination based on the objective criteria of treatment option selection and subsequent rehabilitation of the older age groups of patients (elderly, senile age, long-livers according to WHO criteria) with proximal femoral fractures and concomitant diseases, including osteoporosis. Purpose statement. To improve health outcomes for the older age group of patients with PFF by means of trauma care system optimization and development of new methods of treatment. Materials and methods. An analysis of the treatment results of patients with PFF treated in the Hospital for War Veterans from 2013 to 2017 was conducted. These 2129 patients formed a comparison group. Treatment in this group of patients was carried out according to the generally accepted methods and algorithms. Then, osteosynthesis methods for severe osteoporosis and treatment of purulent complications were developed, algorithms and new approaches to the treatment of patients with PFF were provided. At the next stage, a differentiated approach for timing establishment of the surgical intervention and optimization measures of medical care for this group of patients were developed. These 2443 patients formed the main study group. Results. In the work process there were established new methods of osteosynthesis, diagnosis and patient treatment algorithms, including those with postoperative purulent complications. In addition, there were analyzed two groups of patients with proximal femoral fractures for the period 2013-2017 (comparison group) and 2018-2023 (study group). To assess the treatment outcomes, the frequency of general and local complications, hardware migration, purulent inflammation in surgical intervention, as well as anatomical and functional results according to the Leken scale were studied. Conclusion. As a result of the implementation of the proposed optimized system of providing trauma care to this category of patients, it was possible to reliably improve the outcomes of their treatment, to reduce the number of postoperative purulent complications, the duration of hospital stay and the preoperative hospital bed-day. Key words proximal femoral fracture, surgical treatment, osteosynthesis, tactics, technique, purulent complications (The article in PDF format. For preview need Adobe Acrobat Reader)  Open article in new window
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