Surgical treatment of proximal femur osteoporotic fractures (literature review)
Keywords:proximal femur, osteoporosis, trochanteric fracture, osteosynthesis, joint replacement, monopolar joint replacement
Proximal femur fractures is the complex medical-social problem because of prevalence in the elderly patients and is related to the most dangerous complications of osteoporosis. Difficulties in the treatment of trochanteric fractures in the patients of this category not related only to osteoporotic changes, but to comorbities. Epidimeology, classification, treatment principles of proximal femur in the elderly patients are presented in this work. It is noted, that determination of the bone density is the main volume for the fracture risk prediction in the elderly patients, decreasing of the bone mass burdens the course of traumatological and orthopedic pathology. As the result of scientific publications analyses, we revealed debatable questions in the treatment of the elderly patients. At present, active surgical tactic is the most recognized, however, in spite of the implants manifold, precise indications for the definitive implant application and osteosynthesis methods are not well defined, especially in the light of the age aspect. Problems of the early rehabilitation for the weight bearing and motion, improving and preservation of the somatic status, lethality decreasing, demand further specification. In-depth studies are necessary for the determination of the differentiated osteosynthesis choice and treatment technology optimization for the improving of the surgical treatment in elderly patients with extraarticular proximal femur fractures. Perspective directions in the treatment of the extraarticular proximal femur fractures in the elderly patients are extracted.
The audit of the status of osteoporosis in Eastern Europe and Central Asia 2010 [Electronic resource]. — Access mode: http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Eastern%20Europe_Central%20Asia/Eastern_European_Central_Asian_Audit_2010–RU.pdf.
Belousov BYu. The dynamics of X-ray data changes in monopolar endoprosthetics of the hip. Medical Almanac. 2012;1:147–8.
Bitchuk DD, Khimenko MPh, Sukhovetskiy VV. Our opinion on the treatment of trochanteric fractures in the middle-aged and elderly patients. Visnik orthopedii, traumatologii i protezuvannya. 2004;(3):37–40.
Boyko IV, Sabsai AV, Makarov VB. Primary monopolar cemental endoprosthetics in transtrochanteric fractures of the femur by means of «double-cup» system in the elderly patients. Problemi traumatologii ta osteosyntezu. 2015;(1):43.
Borovkov VN, Khrupalov AA, Sorokin GV. The experience of using the PFN fixator in treatment of proximal femoral fractures in the middle-aged and elderly patients. Traumatologiya i ortopediya Rossii. 2010;(2):27–31.
Brusko AT, Gaiko GV. Functional bone remodeling and its clinical relevance. Lugansk, 2005. 14 p.
Bystrov SV, Federyakin DV. The attempt of total endoprosthetics and hemiarthroplastics of the hip in operative treatment of hip fracture in the middle-aged and elderly patients in Tver Oblast. Verkhnevolzhie medical journal. 2014;2;26–30.
Bystrov SV, Federyakin DV. Total endoprosthetics and hemiarthroplastics of the hip in operative treatment of the hip fracture in the middle-aged and elderly patients. Tver medical journal. 2014;(4):21–5.
Vaida VM. Epidemiology of femoral fractures in the population of the Zakarpattia Oblast. Medication of Ukraine. 2011;(2):45–7.
Gilfanov SI. Proximal femoral fractures treatment: abstract dis. the doctor of medical sciences. 2010. 32 p.
Gorodnichenko AI, Uskov ON, Platonov II. Intramedullary osteosynthesis of trochanteric fractures in the patients of older age groups. Surgery. Journal named after N. I. Pirogov. 2013;6:55–58.
Gaiko GV, Kukurudza LP, Torchinskiy VP, et al. Endoprosthetics of hip region in the aged patients with proximal femoral fractures: the materials of research and training conference with international participation. Kyiv-Lviv, 2003. pp.11–5.
Zagorodniy NV, Zharmukhambetov EA. Surgical treatment of trochanteric fractures. Russian medical journal. 2006;(2):18–9.
Zagorodniy NV. Endoprosthetics of the hip. Fundamentals and practice: manual. GEOTAR-Media, 2012. 704 p.
Ivanov VI, Basov SV, Zorkin GD. Practicing endoprosthetics in hip injuries and diseases. The Chief Medical Officer of the Southern Russia. 2005;2:7–9.
Ismailov SI, Khodjamberdiieva DSh, Rikhsieva NT. Osteoporosis and low-impact fractures of the hip as a complication of different endocrine diseases. International endocrine journal. 2013;(5);113–20.
Ivchenko AV, Samoilenko АА, Shvets AI, et al. The use of proximal hip locking plate for tension-band osteosynthesis of trochanteric fractures. Trauma. 2013;(5):51–4.
Kaplan AV. Nonpenetrative bones and joints injuries.1967. 512 p.
Kaplun VA. Extramedullary osteosynthesis of bones of lower limbs. Novosibirsk National University bulletin. 2010;(2):124–8.
Karev DB, Karev BA, Boltrukevitch SI. Monopolar endoprosthetics of the hip in medial fractures in the old age groups of patients. News of surgery. 2010;(2):76–81.
Klimovitskiy VG, Borodin DV. Minimally invasive osteosynthesis in proximal femoral fractures in the elderly patients. Trauma. 2013;(1):6–8.
Kluchenskiy V.V. Skeletal traction. Medicine, 1991. 160 p.
Kovalenko VN, Bortkevich OP. Study of osteoporosis risk factors incidence and search for optimal prophylaxis of fractures in women over 50. Ukrainian Rheumatology journal. 2010;(3):15–20.
Korzh NA, Dedukh NV. Osteoporosis risk factors. International medical journal. 2007;(2):70–4.
Kuzmin II, Kislitsyn MA. Endoprosthetics of the hip in comminuted proximal femoral fractures XIVth Russian National Congress The human and his health, 2009. р. 29.
Lazarev AF, Solod EI, Lazarev AA. The patterns of treatment of fractures of different bones in systemic osteoporosis. The pain. The joints. The spinal column. 2013;(1):98.
Rusanov AG, Barabash AP, Kauts OA, et al. The treatment of the middle-aged and elderly patients with trochanteric fractures of proximal femur. Medical almanac. 2012;(5):157–60.
Gorodnichenko AI, Uskov ON, Gorbatov VI, Minaev AN. Treatment of trochanteric fractures by means of modern fixators. Surgery. Journal named after N.I. Pirogov. 2008;(6):67–72.
Litovchenko VO, Bondarchuk GV, Garyachiy EV. Treatment of proximal femoral fractures in the elderly patients with polytrauma. Medicine today and tomorrow. 2012;(1):104–7.
Loskutov AE, Oleynik AE. Achievements and perspectives of endoprosthetics of the hip. Health in Ukraine. 2010;(5):29–31.
Markin VA. Review of literature on the modern methods of operative treatment of fractures of proximal region of the humerus. Osteosynthesis. 2008;(2):33–40.
Shimon MA, Litvak VV, Sheregiy AA, et al. Modeling of operative treatment of osteoporosis in the elderly patients after primary hip endoprosthetics. KhPI National Technical University bulletin. 2014;(29):177–82.
Zorya VI, Novikov SV, Karchebniy NN, et al. Extramedullary dynamic compression osteosynthesis in treatment of shaft fractures of the hip. Surgery. 2009;(5):52–7.
Shulika EI, Chebukin VM, Gaponiuk SP, Ochman PP. Our experience of treating patients with injuries and diseases of the hip. Medicine of Transport of Ukraine. 2012;(2):59–61.
Piontkovskiy VK, Denisiuk BS, Malevich YuM, et al. Our experience in minimally invasive osteosynthesis in transtrochanteric femoral fractures. Trauma. 2012;(4):140–2.
Ahtyamov IF, Garifullov GG, Kovalenko AN, et al. New methods of preventing intraoperative and early postoperative complications in endoprosthetics of the hip. Vestnik traumatologii i ortopedii imeni NN Priorov. 2010;(1):25–8.
Golubev VG, Starostenkov AN, Vorontsov AP, et al. The experience of treating the elderly patients with proximal femoral fractures in CCH RAS: abstracts of the Russian research and training conference with international participation Problems of diagnosis and treatment of injuries and diseases of the hip. Kazan, 2013. рр.27–35.
Kluchevskiy VV, Belov MV, Bystrov SV, Serov IA. Organization of the proper treatment of the patients with proximal femoral fractures. Traumatologiya i ortopediya Rossii. 2014;(2):107–11.
Ivchenko VK, Shvets AI, Gavrilov II, et al. Complications of the buried metal osteosynthesis of proximal femoral fractures. Ukrainian journal of extreme medicine named after GO Mozhaev. 2009;(2):82–6.
Petrov NV, Silin LL, Kalashnik AD, et al. The patterns of operative treatment of trochanteric fractures in the middle-aged and elderly patients: abstracts of the VIIIth congress of traumatologists-orthopedists of Russia, Samara. 2006;1:292.
Gavrilov II, Basil AP, Brysiuk GP, Samoilenko AA. Osteosynthesis of proximal femoral fractures by means of DHS construction. Ukrainian journal of extreme medicine named after GO Mozhaev. 2009;(2):79–82.
Morgun MI, Vinnyk OO, Golovko EV, et al. Comparative analysis of the results of the proximal femoral fractures. Trauma. 2014;(3):33–6.
Shapovalov VM, Mykhailov SV, Hominets VV, et al. Revision operations in case of errors and noninfectious complications of stable functional osteosynthesis. Traumatologiya i ortopediya Rossii. 2009;(4):73–9.
Müller ME, Allgöwer M, Schneider R, Willinegger H. Manual on the internal osteosynthesis: methods, recommendations of the AO group (Switzerland): transl. from German. Berlin; Moscow: Springer, 1996. 750 p.
Rudi TP, Bakley RE, Moran KG. AO-principles of fractures treatment. Vassamedia, 2013. 1103 p.
Sakalov DA, Skorogliadov AV. Treatment of trochanteric fractures in the middle-aged and elderly patients. Russian Medical University bulletin. 2003;(5):24–9.
Skorogliadov AV, Sakalov DA, Tretiakov AV. Operative treatment of subtrochanteric fractures. Kazan medical journal. 2006;(5):361–3.
Sergeev SV, Zagorodniy NV, Abdulkhabirov MA, et al. Modern methods of osteosynthesis of bones in acute trauma of musculo-skeletal system: training guide. 2008. 222 p.
Pinchuk LS, Karev DB, Cherniuk NV, Boltrukevitch SI. Modern tendencies in monopolar endoprosthetics of joints. GrNMU journal. 2010;(2):100–4.
Soldatov YuP, Ushakov SA. Errors and complications in treatment of the patients with trochanteric fractures by means of intramedullary osteosynthesis. Bulletin of Siberian department of Russian Academy of Medical Sciences. 2009;(6):10–4.
Shvets AI, Gavrilov II, Samoilenko AA, et al. Stabilizing operations on the proximal femur in the complex of rehabilitation of the patients of the old age group. Trauma. 2008;(1):20–9.
Vakulenko VM, Vakulenko AV, Nedelko AA. Structure of proximal femoral fractures. Ukrainian medical almanac. 2010;3:35–36.
Traumatology and orthopedics: in 3 volumes. Vol. 2: manual for doctors / edited by YuG Shaposhnikov. — Moskow: Medicine, 1997. 592 p.
Gertsen GI, Pronik AI, Ostapchuk MP, Amir M. Traumatology of the old age Kyiv: Stal, 2003. 170 p.
Firulin SV, Klukvin IYu. Study of the load bearing capacity of the fixators, used for the osteosynthesis of the transtrochanteric fractures of the hip and the search for the means of their improvement. Vestnik traumatologii i ortopedii imeni NN Priorov. 2008;(3);30–2.
Firulin S, Klukvin I, Gavriushenko N. Modified fixators in trochanteric fractures. Doctor. 2008;5:76–77.
Romanenko KK, Belostotskiy AI,. Prozorovskiy DV, Golka GG. Functions and kinds of plates and screws in modern osteosynthesis. Orthopedics, traumatology and prosthetics. 2010;(1):68–75. DOI: http://dx.doi.org/10.15674/0030-59872010168-75.
Khvostova SA. Psychological state of the patients with osteoporosis and fractures during the rehabilitation. Fundamental studies. 2012;(2):152–5.
Rusanov AG, Barabash AP,. Barabash YuA, Kauts OA. Surgical rehabilitation of the middle-aged and elderly patients with periarticular fractures of the proximal femur: collected papers Innovative implants in surgery. 2014;(3):206–14.
Korzun OA, Beletskiy AV, Sitnik AA, et al. Surgical treatment of trochanteric fractures of the proximal femur: analysis of the short-term results in 62 patients. Medical journal. 2013;(4):12–6.
Mironov SP, Gorodnichenko AI, Uskov ON, Sorokin GV. Transosseous osteosynthesis in trochanteric fractures. Vestnik traumatologii i ortopedii imeni NN Priorov. 2002;(4):13–7.
Peyser A, Weil YA, Brocke L, Sela Y, Mosheiff R, Mattan Y, Manor O, Liebergall M. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2007;89(9):1210-7.
Ahrengart L, Törnkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlström P, Honkonen S, Lindgren U. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop. 2002;401:209–22.
Anoop K, Mam MK, Rajesh P. Ipsilateral fracture of femur and tibia, treatment and functional outcome. J K. Science. Journal of Medical Education. 2006;8 (1):42–4.
Yang B, Lin X, Yin XM, Wen XZ. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol. 2015;25(3):425–33, doi: 10.1007/s00590-014-1565-2.
Boltrukevich SI, Karev BA. Our experience of hip joint replacement, Atik Salekh: abstract book of the 13th SICOT Trainees Meeting, May 23–25, St.-Petersburg, 2002. рр.194–5.
Siris E, Miller P, Barrett-Connor E, Abbott T, Sherwood L, Berger M. Design of NORA, the National Osteoporosis Risk Assessment Program: a longitudinal US registry of postmenopausal women. Osteoporos Int. 1998;8(1):62–S69.
Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of trochanteric fractures of the femur. A randomized prospective comparison of the Gamma nail and the dynamic hip system. J Bone Joint. Surg. Br. 1991;73-B(2):330–4.
Ekström W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA. Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop. Trauma. 2007;21 (1):18–25.
Hack BH, Mattchen TM. Method of applying an active compressive force continuously across a fracture. Patent 6.589. 8.07.03;246 B1 (US).
Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg. Am. 2003;85-A(5):899–904.
Iki M. Epidemiology of osteoporosis in Japan. Clin Calcium. 2012;22(6):797–803, doi: CliCa1206797803.
Lübbeke A, Garavaglia G, Barea C, Roussos C, Stern R, Hoffmeyer P. Influence of obesity on femoral osteolysis five and ten years following total hip arthroplasty. J Bone Joint Surg Am. 2010;92(10):1964–72, doi: 10.2106/JBJS.I.00749.
Harrington P, Nihal A, Singhania AK, Howell FR. Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury. 2002;33(1):23–8.
Matre K, Havelin LI, Gjertsen JE, Espehaug B, Fevang JM. Intramedullary nails result in more reoperations than sliding hip screws in two-partintertrochanteric fractures. Clin Orthop Relat Res. 2013;471(4):1379–86, doi: 10.1007/s11999-012-2728-2.
Lau AC, Neo GH, Lee HC. Risk factors of surgical site infections in hip hemiarthroplasty: a single-institution experience over nine years. Singapore Med J 2014:55(10):535–8.
Little EA, Eccles MP. A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis. Implementation Science. 2010;5:80, doi: 10.1186/1748-5908-5-80.
Anil M. The use of an Intramedullary Nail vs. Dynamic Hip Screw in the treatment of Intertrochantric fractures; a case cohort study. Kerala Journal of Orthopaedics. 2012;25(1):6–13.
Lakatos P, Balogh A, Czerwinski E, Dimai HP, Hans D, Holzer G, Lorenc RS, Palicka V, Obermayer-Pietsch B, Stepan J, Takács I, Resch H; Members of the 3rd Summit on Osteoporosis — Central and Eastern Europe (CEE). New considerations on the management of osteo porosis in Central and Eastern Europe (CEE): summary of the 3rd Summit on Osteoporosis — CEE (November 2009, Budapest, Hungary). Arch. Osteoporos. 2011;6 (1/2):1–12. doi: 10.1007/s11657-010-0048-2
Putz Ph, Coussaert E, Delvaux D, et al. Osteosynthese des lesions proximales du femur par visplaquedynamisee. Int. Orthop. 1990;14(3):285–92.
Patel SH, Murphy KP. Fractures of the proximal femur: correlates of radiological evidence of osteoporosis. Skeletal Radiol. 2006;35(4):202–11.
Fritz T, Hiersemann K, Krienglstein C, Friedl W. Prospective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fracture. Arch. Orthop Trauma Surg. 1999;119:1–6.
Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J, Luan HX, Yang F, Zheng H, He SJ. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation ofintertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol. Surg. Res. 2014;100(8):859–66, doi: 10.1016/j.otsr.2014.07.023.
Geiger F, Schreiner K, Schneider S, Pauschert R, Thomsen M. Proximal fracture of the femur in elderly patients. The influence of surgical care and patient characteristics on post-operative mortality. Der Orthopede. 2006;35(6):651–7.
Kido K, Fujioka M, Takahashi K, Ueshima K, Goto T, Kubo T. Short-term results of the S-ROM-A femoral prosthesis operative strategies for Asian patients with osteoarthritis. J Arthroplasty. 2009;24(8):1193–9, doi: 10.1016/j.arth.2009.03.009.
Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013;44(6):735–42, doi: 10.1016/j.injury.2012.12.010.
Callaghan JJ, Rosenberg AG, Rubash HE. The Adult Hip. 2nd ed. Lippincott Williams & Wilkins, 2007. 1569 р.
Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of the long bones. Berlin Heidelberg: Springer-Verlag, 1990. 202 р.
Hadji P, Klein S, Gothe H, Häussler B, Kless T, Schmidt T, Steinle T, Verheyen F, Linder R. The epidemiology of osteoporosis — Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int. 2013; 110(4):52–7, doi: 10.3238/arztebl.2013.0052.
Li Z, Liang Y, Zhao C, Wu H. Treatment of elderly femoral intertrochanteric fractures with long Gamma nail. 2014;94(43):3436–8.
Luo W, Yin L, Zhu X, Yan J, Xiao Y, Yin Z. Treatments of geriatric femoral intertrochanteric fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009;23(10):1209–11.
Matre K, Vinje T, Havelin LI, Gjertsen JE, Furnes O, Espehaug B, Kjellevold SH, Fevang JM. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013;95(3):200–8, doi: 10.2106/JBJS.K.01497.
Kanto K, Sihvonen R, Eskelinen A, Laitinen M. Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up. Arch Orthop Trauma Surg. 2014;134(9):1251–9, doi: 10.1007/s00402-014-2053-1.
Copyright (c) 2016 Andrii Kalchenko, Vladimir Babalyan, Tamara Hurbanova, Serhiy Maznyakov
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available after 6 months from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).