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© Borgis - Postępy Nauk Medycznych 6/2013, s. 433
Prof. Stanisław Pomianowski, MD, PhD
In this issue we are presenting a problem of fractures in elderly patients. Currently treatment of these patients constitutes everyday practice of traumatologists. With the expected ageing and demographic changes of the society importance of presented problem will be even more evident.
The opening paper covers a topic of vitamin D concentrations in Clinic employees. The problem reduced vitamin D concentration is common in Polish population. Vitamin D deficiency has been linked not only to abnormalities in bone metabolism, but to variety of diseases including cancer, type I diabetes and autoimmune diseases. In patients with reduced vitamin D concentration results of hip endoplasty are worse. Although small sample number precludes generalization of results, we observed reduced concentration of this vitamin in all subjects. We want to give a message, that not only our patients, but also us should receive proper vitamin D supplementation.
Among fractures in the course of osteoporosis proximal femoral fractures are life-threatening. It is therefore mandatory to treat them as effectively as possible. Early surgical treatment and early rehabilitation give a chance to protect patients from consequences of immobilisation. The paper “Destabilization of intramedullary fixation with Gamma nail for intertrochanteric fractures with sliding screw cut out” presents evolution and contemporary methods of treatment. In the field of trochanteric fractures operative treatment became a cornerstone. In Poland, similarly to other countries, two operative methods prevail: constructs with plate and sliding screw (such as DHS implant) and interamedullary trochanteric nails (such as Gamma nail). In our Clinic nailing is more popular than plating. In the article “Trochanteric fractures in the elderly” we analyse reasons of mechanical failures of such fixation. The main reason here is reduced quality of bone tissue itself. Observing some technical rules, however, can reduce the incidence of such complication.
Majority of presented papers is constituted by review articles. The opening paper “New trends in fracture fixation in elderly patients” gives a short summary description of the treatment modalities. This is followed by the more detailed papers.
Following papers cover the field of proximal humeral, distal radial and proximal tibial fractures. The latter is not considered to be a typical osteoporotic fracture. Nevertheless treatment of proximal tibial fractures in the setting of reduced mechanical properties of bone presents unique problems and therefore we decided to include them in this review.
The last article “Osteoporosis from a traumatologist’s point of view” is a call for multidisciplinary approach to an elderly patient with fracture. The fragility fracture is a risk factor for sustaining another fractures.
Prof. Stanisław Pomianowski, MD, PhD
Postępy Nauk Medycznych 6/2013
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