Slovenská chirurgia 4/2015
Proximal femoral fractures and choise of operative treatment
Fractures of proximal femur have been perceived as a social and economical problem of the senescent population for a long time. It affects mostly older patients with accompanying osteoporosis after a trivial trauma. The increasing number of femur neck‘s fractures is related to demographic development and increasing quality of life. Incidence of proximal femoral fractures in the population of people older than 50 years is, on average, 195 out of 100 000 inhabitants for men and 259 for women. These are low energy injuries that often originate in a minimal force, mostly after a tumble. Diagnostics of femur neck fractures is usually not difficult. The patient is brought to the infirmary immediately after the injury incident. We hinge on the anamnesis of accident. Clinically, at first sight, there is an extrarotation and a several centimetres abbrevation of the stricken extremity, semiflexion in the hip and knee joint and inability to control the extremity as well as to walk. The diagnostics is completed with a radiographs in an AP projection and, if possible, also in axial projection which will show the dislocation that wasn’t visible in the AP projection. The treatment of proximal femoral fracture depends on a number of factors: type of fracture, age and the overall medical condition of patient, quality of the bone, condition of hip joint before the fracture, activity and mobility of patient before the injury. Conservative treatment is usually indicated for stable, wedged femur neck fractures and requires regular radiograph review. Surgical treatment is an optional method. Osteosynthesis is used for all trochanteric and for most of basicervical fractures. Nowadays, two types of implants are used mostly DHS (dynamix hip screw) and PFN (proximal femoral nail). In case we choose endoprosthetic treatment, we have a choice between a total prosthetic implant (TEP) hip replacement or cervicocapital prosthetic implant (CKP) of a hip joint. TEP is indicated for active, biologically younger patients, and for advanced arthrosis of hip joint (in cases of some trochanteric fractures as well). CKP is a less demanding method, it is indicated for patients older than 85 years with minimal functional requirements, provided that acetabulum is not damaged it is therefore contraindicated with advanced arthrosis. In case we choose retainable osteosynthesis, the early intervention is essential, mainly for intracapsular fractures. In other cases, longer preoperative preparation is more essential for reduction of postoperative complications.
Keywords: proximal femur, femoral neck, pertrochanteric, intracapsular
