Abstract
The following report is focused on the principles and results of management of proximal femoral fractures in the Orthopaedics and Traumatology Department of Kladno Hospital. The observed file includes patients treated from 1998 to 1999.
Proximal femoral fracture is the most frequent diagnosis in traumatology hospitalisation. Correct management is very important from a medical point-of-view not only because of the frequency, but also with regard to economics.
We strive to operate on traumas indicated for operation as soon as possible, but we often treat them in the regular operation program the next day. For pertrochanteric fractures, the Dynamic Hip Screw is most often used. We use cervicocapital endoprostheses for cervical fractures of elderly patients, total endoprostheses for younger patients, and osteosyntheses for patients with the joint in good condition. Subtrochanteric fractures are treated by a reconstructional nail, or rarely by a Gamma nail because of its financial demands. As a preventive measure, patients are given antibiotics for 24 hours. Drains are extracted on the third postoperative day and patients are verticalized on crutches. The stitches are removed on the tenth to twelvth post-operative day and patients are transferred to out-patient treatment. It is worth mentioning that an attempt is made to stabilise subtrochanteric fractures by external fixation for a patient contraindicated for operation.
From 1998 to 1999, 283 patients (217 female, 66 male) with proximal femoral fracture were hospitalised. The types of fracture were: 137 cervical (11 were undislocated, wedged, and primarily indicated for conservative therapy), 104 pertrochanteric, and 31 subtrochanteric. There were also four false-joints, two periprosthetic fractures and three luxation of endoprostheses. We conservatively treated 11 patients with stable cervical fractures, with good results. There were 21 patients contraindicated for operation and only four of them are mobile. In the observed file there were seven deaths prior to operation, ten in the immediate postoperative period, and no mors in tabula.
There were 283 patients with proximal femoral fractures hospitalised in the studied period. From the total of 216 operations, 186 (86%) are independently mobile and satisfied with the result.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
