Accompanying Therapy in the Surgical Treatment of Pathological Fractures of the Long Bones and Chronic Fractures of the Trochanteric Region

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.

INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.

AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.

MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.

RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.

CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.

1. Lazarev AF, Solod EI, Antonov AA, Vychuzhanin DV. Surgical treatment for chronic proximal femur fractures. Vrach. 2020;31(12):65–69. (In Russ.) https://doi.org/10.29296/25877305-2020-12-13

2. Lazarev AF, Solod EI, Antonov AA, Vychuzhanin DV, Antonov AK, Gorenkov RV, et al. Total left hip arthroplasty for an old pertrochanteric fracture of the left femur. Vrach. 2021;32(6):73–77. (In Russ.) https://doi.org/10.29296/25877305-2021-06-14

3. La Combe B., Gaillard S., Bennis S., Chouaid C. Management of spinal metastases of lung cancer. Rev Mail Respir. 2013; 30(6):480–489. PMID: 23835320 https://doi.org/10.1016/j.rmr.2012.12.016.

4. Moreno-Smith M., Lutgendorf S.K., Sood A.K. Impact of stress on cancer metastasis. Future Oncol. 2010;6(12):1863–1881. PMID 21142861 https://doi.org/10.2217/fon.10.142.

5. Antonov AK, Kochemasov VM, Filimonyuk-Smelkov AV, Mekhtikhanov DS, Antonov AA, Antonov KA, et al. Treatment of Pathologic Fracture of the Humeral Diaphysis Using Metal and Polymer Express Endoprosthetic Replacement as an Example of the Accelerated Rehabilitation of Cancer Patients. Russian Sklifosovsky Journal Emergency Medical Care. 2020;9(1):130–135. https://doi.org/10.23934/2223-90222020-9-1-130-135

6. Antonov AK. Surgical Treatment of Cancer Patients with Metastatic Vertebral Fractures Using Elixir Altai (“Vitavis”) Using Ion-Activated Water Flows. Journal of New Medical Technologies, Eedition. 2014;1:2–107. Available at: http://www.medtsu.tula.ru/VNMT/Bulletin/E2014-1/4949.pdf. (Accessed Nov 18, 2014). (In Russ.) https://doi.org/10.12737/6534.

7. Antonov AK. Surgical and Reducing Treatment of Oncologic Patients in the Last Stage of Disease. Journal of New Medical Technologies, Eedition. 2014;1:2–124. Available at: http://www.medtsu.tula.ru/VNMT/Bulletin/ E2014-1/5051.pdf (Accessed Nov 18, 2014) (In Russ.) https://doi.org/10.12737/7366.

8. Bouras G, Markar SR, Burns EM, Mackenzie HA, Bottle A, Athanasiou T, et al. Linked Hospital and Primary Care Database Analysis of the Incidence and Impact of Psychiatric Morbidity Following Gastrointestinal Cancer Surgery in England. Ann Surg. 2016;264(1):93–99 PMID: 26649592 https://doi.org/10.1097/SLA.0000000000001415

9. Stepanova AM, Merzljakova AM, Sokolovskij VA. Rehabilitation after endoprosthetic replacement in the orthopedic oncology. Bone and soft tissue sarcomas, tumors of the skin. 2017;(1):27–31. (In Russ.)

10. Bocharova OA, Baryshnikov AYu, Davydov MI. Fitoadaptogeny v onkologii i gerontologii (na primere izucheniya Fitomiksa-40). Moscow: MIA Publ.; 2008 (In Russ.)

11. Bubnova NA., Egorova EN; Sankt-Peterburgskiy gosudarstvennyy meditsinskiy universitet im. akad. I. P. Pavlova. Obobshchennyy opyt primeneniya Ronkoleykina® (rekombinantnogo interleykina-2) v lechenii khirurgicheskikh zabolevaniy. 2nd ed., upd. and corr. Saint-Petersburg. SINEL Publ., 2016. (In Russ.)

12. Leonov BI, Bakhir VM, Vtorenko VI. Elektrokhimicheskaya aktivatsiya v prakticheskoy meditsine. In: Elektrokhimicheskaya aktivatsiya v meditsine, sel’skom khozyaystve, promyshlennosti: tezisy dokladov. i kratkikh soobshcheniy. Vtoroy Mezhdunarodnyy simpozium. Moscow; 1999. Pt.1: 15–23. Available at: https://ikar.udm.ru/sb/sb21_1999_l.htm [Accessed Oct 13, 2022]

13. Volkov NM, Moiseyenko VM. A History of Cancer Immunotherapy. Practical Oncology. 2016;17(2):53–61 (In Russ.)