Medicolegal aspects of rendering traumatologic care to elderly and senile patients with proximal femoral fractures

Introduction. The problem of the quality of rendering medical care to elderly and senile patients (according to WHO, the elderly age is 60-74 years; the senile one - 75-90 years, and the age above 90 years is the age of centenarians) currently remains relevant. The draft protocol of preoperative examination and management of patients with proximal femoral fractures is not officially approved by authorized executive authority of Moscow. Purpose. To analyze the regulatory documents governing the grounds of performing "urgent surgeries” in elderly and senile injured persons; to make a medical-expert analysis of medical documentation management in view of the quality of medical service realization. Materials and methods. Analyzing medical records of the patients from these groups who were admitted to the Department of Traumatology of the Moscow Pirogov Municipal Clinical Hospital (MCH) No1 during the last three years (2012-2014). Totally, the medical-expert analysis was made for 82 medical records of in-patients with the mentioned pathology. Results. The medical-expert analysis has demonstrated that at present there are no regulatory documents governing the grounds of performing "urgent surgeries” in patients of this category. There are no objective recommendations for preoperative preparation as well. The medical-expert analysis of medical documentation revealed some flaws in both the documentation managing and treatment of injured persons from this category. Conclusion. An objective analysis of a significant amount of clinical material indicates the rationality of using an active surgical tactics in treatment of such patients. However, in order to justify legally the need of performing surgery to “urgent indications” it is required to develop the detailed recommendations which determine the complex of preoperative preparation, as well as to approve indications and contraindications for performing surgical intervention in elderly and senile persons with proximal femoral fractures.