Treatment of Proximal Femoral Fractures in Patients with COVID-19

Background. In relation with the COVID-19 new coronavirus infection epidemic that began in Russia in the spring of 2020, a completely new group of patients appeared: patients whose coronavirus infection was combined with the proximal femur fractures. In the course of practical work, hospital doctors had to gain experience in treating these complex patients, solve new organizational and medical tasks. The aim of the study was to evaluate the results of treatment of patients with the proximal femur fractures in combination with coronavirus infection in a covid hospital at the hospital stage, 30-day and 6-month terms. Materials and Methods. The retrospective study is based on the collection and generalization of data from 64 patients with the proximal femur fractures in combination with confirmed coronavirus infection who underwent inpatient treatment from 16.03.2020 to 31.05.2021. 38 (59.4%) patients had a femoral neck fracture, 26 (40.6%) had a fracture of the trochanter region. Forty (62.5%) patients underwent surgical treatment (hip replacement was performed in 23 cases, osteosynthesis was performed in 17 cases), 24 (37.5%) patients did not undergo surgery. Results. With conservative treatment, the hospital mortality rate was 41.6%, the 30-day mortality rate was 72.7%, and the 6 month mortality rate was 95.5%. During surgical treatment, the hospital mortality rate was 5.0% (2 patients died). Early postoperative complications were detected in 5 (12.5%) patients. Thirty-one (77.5%) patients walked or stood with a walker on their own at the time of discharge; 7 (17.5%) patients could not be activated. The thirty-day mortality rate in the group of patients who underwent surgical treatment was 8.6%, and the 6-month mortality rate was 32.1%. Conclusion. Surgical treatment of patients with the proximal femur fractures in combination with coronavirus infection is much more difficult than the treatment of patients without infectious pathology. However, despite number of unresolved problems, surgical treatment of such patients is possible with good results and should be actively applied.

Остеосинтез у разі переломів шийки та вертлюгової зони стегнової кістки в дітей

Proximal femur fractures are uncommon injuries in children, accounting for less than 1 % of all fractures per year, but usually result in hospitalization and are at risk of complications. We have designed a device for bone fragments fixation in the case of proximal femur fractures and the method of its application in adults. The device consists of rods that are screwed into the cap of the head, the diaphyseal part and the module, which is located in the subtrochanter area. The rods can be connected to the module at any angle in the frontal plane. The device provides a certain stage of installation of the elements, which allows you to effectively place it with minimal bone destruction. Objective. Share your own experience in the treatment of femoral neck and proximal femur fractures in children. Material. The experience of treatment of 28 children with femoral neck fracture or proximal femur fractures for the period 2005–2020 is presented, 11 of them were treated conservatively with the skeletal traction. Osteosynthesis by the author’s device was performed in 17 patients: 15 closed reduction, 2 in case of intertrochanteric fracture, — open reduction. The method of osteosynthesis and postoperative management of patients is described in detail. Results. In children who were treated conservatively, the fracture consolidation was achieved within 5–7 months, in one of them — in the position of varus deformity. In contrast to conservative treatment, children began to walk with crutches after a few days after surgery, with partial weight-bearing on injured limb. The device was removed in 16 patients after 5–8 months, and complete fracture consolidation of the fragments in their anatomical position was noted. There were no pathological tissue reactions to the metal device. Conclusions. The proposed device and method of closed osteosynthesis with its usage in the case of proximal femur and femoral neck fractures in children can be recommended in the practice of pediatric traumatology.

Concentração de cálcio nas fraturas de fêmur proximal atendidos em um hospital público do extremo sul da Bahia / Calcium concentration in proximal femur fractures treated at a public hospital in the extreme south of Bahia

A osteoporose é um distúrbio comum nos idosos e mais frequente na mulher após a menopausa devido à diminuição dos estrógenos. A fragilidade do esqueleto ósseo predispõe à fraturas, em especial a de quadril por causa do grande impacto sobre os pacientes, maior mortalidade, dependência, risco de institucionalização, com aumento substancial dos custos econômicos e sociais.A baixa massa óssea e a recorrência de quedas são os principais fatores associados às fraturas de fêmur proximal em idosos. A etiologia está relacionada com a diminuição dos níveis séricos de cálcio, menor produção de vitamina D, e aumento da secreção de paratormônio. Os fatores de risco para fraturas patológicas são as causas de quedas em idosos: fratura prévia, sedentarismo, uso de medicamentos que afetam equilíbrios e cognição, desordens neurovegetativas, instabilidade da marcha, baixa acuidade visual e taquicardia ao repouso.Dessa forma, as fraturas de quadril em idosos podem ser fatais, atreladas à morbidade pela imobilização e restrição ao leito, diminuindo consideravelmente a qualidade de vida do idoso. Assim, a prevenção ou tratamento efetivo da osteoporose necessita de uma ingesta de cálcio adequada para manter ou restaurar a saúde do esqueleto ósseo, além de um estilo de vida saudável, com uma alimentação equilibrada e prática regular de atividades físicas que são medidas importantes à prevenção desta doença.