Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

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Abstract

Proximal femoral fractures (PFF) are one of the most common reasons for admission of patients to a traumatological and orthopedic hospital. For the vast majority of patients with PFF, such injury means a loss of the previous degree of mobility.

Clinical guidelines are the main working tool of a practicing physician, both a specialist and a narrow practice doctor. Conciseness, structuredness of information about a particular nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, allow to give in a short time one or another answer to a question of interest to a specialist, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the classification, clinical presentation, diagnosis, and treatment of proximal femoral fractures. In addition, they provide methods for the rehabilitation of patients with this pathology.

About the authors

Vadim E. Dubrov

Lomonosov Moscow State University

Email: info@fbm.msu.ru
ORCID iD: 0000-0001-5407-0432
SPIN-code: 8598-7995

MD, PhD, Dr. Sci. (Med.), professor, traumatologist-orthopedist

Russian Federation, Moscow

Alexey A. Shelupaev

Research Institute of Health Organization and Medical Management

Email: trauma-ortho.dzm@mail.ru

specialist

Russian Federation, Moscow

Gregory P. Arutyunov

Pirogov Russian National Research Medical University

Email: rsmu@rsmu.ru
ORCID iD: 0000-0002-6645-2515
SPIN-code: 9765-0761

MD, PhD, Dr. Sci. (Med.), professor, physician

Russian Federation, Moscow

Mikhail V. Belov

Clinical Emergency Hospital named after N.V. Solovyov

Email: bolnsolov@yandex.ru
ORCID iD: 0000-0001-7955-3625
SPIN-code: 9920-8319

MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Yaroslavl

Anna S. Bogopolskaya

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: info@rniito.ru
SPIN-code: 4596-3014

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Svetlana A. Bozhkova

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: info@rniito.ru
ORCID iD: 0000-0002-2083-2424
SPIN-code: 3086-3694

MD, PhD, Dr. Sci. (Med.), professor, clinical pharmacologist

Russian Federation, Saint Petersburg

Alexandr V. Boyarkov

Pirogov Russian National Research Medical University

Email: gkb40@zdrav.mos.ru
ORCID iD: 0000-0002-5406-2106

anesthesiologist-resuscitator

Russian Federation, Moscow

Tatyana N. Vorontsova

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: tnvoroncova@win.rniito.ru
ORCID iD: 0000-0002-4594-6655
SPIN-code: 9278-9897

MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Saint Petersburg

Sergey I. Gilfanov

“Central State Medical Academy” of the Administration of the President of the Russian Federation

Email: info@cgma.su

MD, PhD, Dr. Sci. (Med.), professor, traumatologist-orthopedist

Russian Federation, Moscow

Alexandr V. Gubin

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: shugu19@gubin.spb.ru
ORCID iD: 0000-0003-3234-8936
SPIN-code: 2014-6518

MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Moscow

Nikolay V. Zagorodni

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito@cito-priorov.ru
ORCID iD: 0000-0002-6736-9772
SPIN-code: 6889-8166

MD, PhD, Dr. Sci. (Med.), professor, traumatologist-orthopedist

Russian Federation, Moscow

Yulia S. Zlobina

Research Institute of Health Organization and Medical Management

Email: dr.zlobina@mail.ru
ORCID iD: 0000-0002-5696-9190
SPIN-code: 8262-3450

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Viktor A. Koryachkin

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, PhD, Dr. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Saint Petersburg

Georgy P. Kostyuk

Pirogov Russian National Research Medical University

Email: george.kostyuk@gmail.com
ORCID iD: 0000-0003-4320-3644
SPIN-code: 3424-4544

MD, PhD, Dr. Sci. (Med.), professor, psychiatrist

Russian Federation, Moscow

Elena A. Litvina

Russian Medical Academy of Continuous Professional Education

Email: rmapo@rmapo.ru
ORCID iD: 0000-0001-8540-0676
SPIN-code: 5624-9390

MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Moscow

Denis N. Protsenko

Pirogov Russian National Research Medical University

Email: gkb40@zdrav.mos.ru
ORCID iD: 0000-0002-5166-3280
SPIN-code: 1019-8216

MD, PhD, Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Moscow

Nadezhda K. Runikhina

Russian Gerontological Research and Clinical Center of the Pirogov Russian National Research Medical University

Email: nkrunihina@rgnkc.ru
ORCID iD: 0000-0001-5272-0454
SPIN-code: 7127-1801

MD, PhD, Dr. Sci. (Med.), professor, geriatrician

Russian Federation, Moscow

Irina A. Solomyannik

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito@cito-priorov.ru

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Dmitriy V. Stafeev

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: info@rniito.ru
SPIN-code: 9042-2348

MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Saint Petersburg

Rashid M. Tikhilov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: info@rniito.ru
ORCID iD: 0000-0003-0733-2414
SPIN-code: 3602-4912

MD, PhD, Dr. Sci. (Med.), professor, traumatologist-orthopedist

Russian Federation, Saint Petersburg

Olga N. Tkacheva

Russian Gerontological Research and Clinical Center of the Pirogov Russian National Research Medical University

Email: rgnkc@rgnkc.ru
ORCID iD: 0000-0002-4193-688X
SPIN-code: 6129-5809

MD, PhD, Dr. Sci. (Med.), professor, geriatrician

Russian Federation, Moscow

Mikhail B. Tsykunov

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: rehcito@mail.ru
ORCID iD: 0000-0002-0994-8602
SPIN-code: 8298-8338

MD, PhD, Dr. Sci. (Med.), professor, traumatologist-orthopedist

Russian Federation, Moscow

Igor I. Shubnyakov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: info@rniito.ru
ORCID iD: 0000-0003-0218-3106
SPIN-code: 3531-7679

MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Pipkin classification of femoral head fractures

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3. Fig. 2. The Garden classification of femoral neck fractures [16]

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4. Fig. 3. Pauwels classification of femoral neck fractures [18]

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5. Fig. 4. AO/OTA classification of femoral neck fractures [13]* To classify B2 type fractures, an additional parameter is used that characterizes the angle between the fracture line and the horizontal plane: p — Pauwels 1 (angle of the fracture line with the horizontal <30°); q — Pauwels 2 (the angle of the fracture line with the horizontal 30–70°); r — Pauwels 3 (angle of the fracture line with the horizontal >70°)

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6. Fig. 5. AO/OTA classification of trochanteric fractures [13]* n — fracture of the large trochanter; o — fracture of the small trochanter

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7. Fig. 6. Determining the height (thickness) of the lateral wall [13]

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8. Fig. 7. Selection algorithm of treatment tactics for the patients with femoral head fractures

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9. Fig. 8. Selection algorithm of treatment tactics for the patients with femoral neck fractures

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10. Fig. 9. Selection algorithm of treatment tactics for patients with trochanteric fractures

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11. Алгоритмы действий врача

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Copyright (c) 2021 Dubrov V.E., Shelupaev A.A., Arutyunov G.P., Belov M.V., Bogopolskaya A.S., Bozhkova S.A., Boyarkov A.V., Vorontsova T.N., Gilfanov S.I., Gubin A.V., Zagorodni N.V., Zlobina Y.S., Koryachkin V.A., Kostyuk G.P., Litvina E.A., Protsenko D.N., Runikhina N.K., Solomyannik I.A., Stafeev D.V., Tikhilov R.M., Tkacheva O.N., Tsykunov M.B., Shubnyakov I.I.

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