METHOD FOR SELECTING APPROACH OF SURGICAL TREATMENT FOR PROXIMAL FEMORAL FRACTURES Russian patent published in 2018 - IPC A61B5/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, traumatology and orthopedics, can be used to determine the approach of surgical treatment for fractures of the proximal femur in patients with concomitant diseases. At first, the patient’s history is recorded with the identification of associated diseases, age, gender is additionally taken into account. At the age of 18–64, the patient belongs to the young age group, 65 years and older – to the elderly. Then, the category of comorbidity is determined: 0 – the absence of concomitant diseases, 1-2 concomitant diseases – the average chronic condition, 3 or more concomitant diseases – multi-morbidity. And the potential risk of complications is determined by a nomogram, where the dimension of the axis of ordinates (Y) corresponds to the potential risk of complications with a division value of 10 % and the scale of division from 0 to 60 %, the dimension of the axis of abscissa (X) corresponds to the age with a division value of 10 years and a scale from 0 to 90 years. Also, the third axis is parallel to the ordinate axis, located at the end of the axis of abscissa and corresponds to the class of severity of the patient's condition according to the ASA classification with the division value of one grade and a scale from 0 to 6 class. Further, the field of the nomogram is divided into two zones by a horizontal line running parallel to the axis of abscissa at the level of the value on the ordinate axis of 30 %. Said nomogram presents graphs corresponding to the three categories of comorbidity by gender, for women and men respectively. And the severity of the patient’s condition is assessed according to the classification of the objective status of the patient of the American Society of Anesthetists (ASA). Then, the type of fracture is determined: medial fractures or intraarticular hip fractures – subcapital, transcervical, basal cervical; lateral or trochanteric extraarticular fractures – intertrochanteric, pertrochanteric. When choosing the approach of surgical treatment, a combination of these parameters in conjunction with the nomogram is used. If a patient is diagnosed with a combination of ASA grade 4 with a potential risk of complications above 30 %, no surgical intervention is performed. With ASA grade 3 with a potential risk of complications of less than 30 % with medial and lateral fractures, minimally invasive osteosynthesis of the proximal femur is performed. With ASA grade 1 or 2 with a potential risk of complications less than 30 %, the patient undergoes osteosynthesis for lateral fractures and basal cervical fractures, in case of medial fractures – subcapital and transcervical – total hip joint arthroplasty.

EFFECT: method provides a quick and objective assessment of the patient's condition, the risk of complications due to the preliminary diagnosis of comorbid conditions, an adequate choice of treatment with a decrease in postoperative complications, the duration of treatment.

1 cl, 5 dwg, 3 ex