Metode liječenja prijeloma vrata bedrene kosti

master's thesis

• Title (english): Methods of treatment for femoral neck fractures
• Author: Grgur Matolić
• Mentor: Žarko Rašić (mentor)
• Committee member: Zvonko Zadro (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Žarko Rašić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Prijelomi kuka jedni su od najčešćih prijeloma danas u svijetu te njihova incidencija eksponencijalno raste s dobi i kod žena i muškaraca. Povećanje incidencije prijeloma kuka s povećanjem životne dobi rezultat je smanjenja koštane mase uslijed starenja, kao i povećanja učestalosti padova vezanih uz stariju dob. Uobičajeni uzrok prijeloma je jednostavan pad u starijih osoba te visokoenergetska trauma u mlađih. Prijelomi vrata bedrene kosti imaju vrlo nepovoljan ishod na vitalnost glave bedrene kosti zbog specifične vaskularizacije. Ugrozom opskrbe glave bedrene kosti krvlju, može doći do razvoja AVN-a. Pacijenti su obično nepokretni pri dolasku, sa skraćenjem, vanjskom rotacijom i bolnosti ozlijeđenog ekstremiteta. U većini slučajeva, prijelom će se dijagnosticirati rentgenskom snimkom. Prijelomi vrata bedrene kosti danas se najčešće dijele na prijelome s pomakom i na prijelome bez pomaka glave bedrene kosti. Metode i ciljevi liječenja razlikuju se za starije i mlađe dobne skupine. U mlađih i zdravih pacijenata glavni je prioritet očuvanje glave bedrene kosti i osiguravanje uspješnog srastanja prijelomnih ulomaka. U takvih pacijenata preporučuje se repozicija prijelomnih ulomaka i unutarnja fiksacija zbog prednosti očuvanja prirodnog zgloba kuka. Anatomska repozicija i stabilna unutarnja fiksacija ključni su za dobar ishod. U starijih pacijenata ciljevi liječenja uključuju povratak mobilnosti s podnošenjem vlastite težine te minimiziranje komplikacija povezanih uz dugotrajan odmor u bolesničkom krevetu. Starija dob i manje funkcionalne potrebe čine očuvanje glave bedrene kosti manje važnim, stoga se PEP i TEP izdvajaju kao najbolje terapijske opcije za takve pacijente. Fiziološka dob pacijenata, kvaliteta kostiju, razina aktivnosti, tip prijeloma i komorbiditeti glavni su čimbenici koje treba uzeti u obzir pri odlučivanju o metodi liječenja.

Abstract (english)

Hip fractures are one of the most common fractures in the world and their incidence increases exponentially with age in both women and men. With ageing, the incidence of hip fractures is increasing as a result of decreased bone mass, as well as an increase in falls associated with older age. The common cause of fractures is a simple fall in the elderly and high-energy trauma in young adults. Femoral neck fractures have a very unfavourable outcome on the vitality of the femoral head due to specific vascularization. The development of AVN can occur by endangering the blood supply to the femoral head. Patients are usually immobile on presentation, with shortening, external rotation, and pain in the injured hip. In most cases, the fracture will be diagnosed with an X-ray. Today, femoral neck fractures are most commonly classified as femoral neck fractures with or without displacement. Methods and goals of treatment differ for older and younger age groups. In young and healthy patients, the main priority is to preserve the femoral head and ensure successful union of fracture fragments. In such patients, fracture reduction and internal fixation is recommended because of the benefits of preserving the natural hip joint. Anatomical reduction and stable internal fixation are key to a good outcome. In elderly patients, treatment goals include restoring mobility with self-weight bearing and minimizing complications associated with prolonged bed rest. Older age and lower functional needs make the preservation of the femoral head less important, therefore hemiarthroplasty and total hip arthroplasty stand out as the best treatment options for such patients. Physiological age of the patient, bone quality, activity level, fracture type, and comorbidities are major factors to consider when deciding on a method of treatment.

• Keywords: PEP; prijelom vrata bedrene kosti; repozicija i fiksacija; TEP
• Keywords (english): femoral neck fracture; hemiarthroplasty; reduction and fixation; total hip arthroplasty
• Language: croatian
• URN:NBN: urn:nbn:hr:105:201163
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-19 09:23:04