Abstract
Background. Treatment of patients with unstable trochanteric fractures of proximal femur (PFF) is of increased complexity and is associated with high risks of complications. Intramedullary osteosynthesis is the most common method of treating patients with this injury, while hip replacement is an alternative method that has become increasingly popular in recent years. However, at present, the issue of choosing a surgical method for the treatment of patients with unstable trochanteric fractures remains unresolved and debatable. The aim of the review is to present a systematic analysis of the effectiveness of hip replacement and osteosynthesis operations in the treatment of patients with unstable trochanteric fractures of the proximal femur in people over the age of 60 based on data from the available specialized scientific literature. Materials and methods. 71 sources in Russian and English with a search depth of 20 years were selected for the analysis (except for individual fundamental studies included regardless of publication date). The sources were included into the review on the basis of their type characterization (systematic literature reviews, meta-analyses of literature, materials of clinical studies). The search and selection of sources was carried out using electronic databases: Pub-Med, ScienceDirect, Medline, EMBASE, Google Scholar, Cochrane Library, Web of Science, eLIBRARY, CyberLeninka. Results. The analysis allowed us to conclude that in the surgical treatment of patients in the older age group with unstable trochanteric fractures using intramedullary fixation, there is a high risk of developing complications associated with the implant (fixation failure, cut-out effect, etc.), which, as a rule, leads to the need for repeated interventions and often to conversion into a technically complex hip replacement. At the same time, an increasing number of specialized scientific publications in recent years have shown a higher effectiveness of hip replacement using bipolar structures or dual mobility systems, as well as the femoral component of distal fixation.