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Algorithm of imaging methods of injuries of the neck of the femur in the case of seniors
TOČÍKOVÁ, Miluše
The bachelor thesis deals with the incidence of femoral neck injury in the elderly. The work is divided into a theoretical and practical part. As the number of people of retirement age is growing, the rate of injuries associated with this age group has been increasing as well. It is necessary to accept the idea that age is a stage of human life, which every individual must eventually face. A femoral neck fracture is one of the causes of mortality and morbidity in the elderly. The incidence of this injury has been increasing both in developed countries and in the Czech Republic. A femoral neck fracture represents a threat for mobility and independence of seniors. Some people are then permanently dependent on mobility aids, while others remain in institutional care. The most common cause of femoral neck fractures in the elderly is a fall on their side, which is caused by a complex interaction of external and internal factors. The first imaging method used during a medical examination is sciagraphy, which is one of the oldest methods. It allows physicians to assess the preoperative condition of the hip joint and postoperative check-ups during the treatment by alloplasty or perioperative condition with the use of osteosynthesis. It is beneficial for the above-mentioned group of people to carefully assess the bone metabolism. A healthy bone is constantly reconstructed, it continuously breaks down and a new bone replaces it. With age, the degradation of bone prevails over bone formation and the bone begins to "thin". This disease is called osteoporosis. It is a disease that pertains to the civilisation diseases. It is often only diagnosed at an advanced stage, when it is already increasingly susceptible to fracture incidence. The factors of osteoporosis include an unhealthy lifestyle, hormonal changes in women after menopause, when there is a decrease in the level of calcium, a major weight loss etc. A painless, non-invasive method, by means of which a doctor can obtain comprehensive information about the amount of bone mineral in the examined part of the bone, is a densitometry test, or DXA. This test uses x-rays at two energy levels. The DXA method can be measured as a whole-body mineral content as well as any other part of the body. Other causes, which increase the risk of a femoral neck racture, are bone metastases. The proximal portion of the femur, including the femur neck, metastatically affects especially primary lung cancer, kidney cancer, thyroid, breasts in women and prostate in men. At an early stage, bone metastases are asymptomatic. Clinical symptoms such as pain can occur, when the metastatic process penetrates the periosteum and surroundings of the bone, thereby irritating the neural structures. Another symptom is the emergence of pathological fractures. Bone metastases are helping us uncover laboratory tests and diagnostic imaging methods, which include, for example, scintigraphy. Bone scintigraphy can detect a metastatic process much earlier than X-ray examination. The aim of the work was to describe the principles of individual imaging methods, which help doctors to determine the correct diagnosis, to learn more about the femoral neck injury in the elderly and about causes of their ocurence. Moreover, the two hypotheses were established: 1. The most frequently used method in case of a femoral neck injury is skiagraphic examination. 2. That is why more than a half of femoral neck injuries are diagnosed in the elderly. The practical part was elaborated on the basis of a quantitative research. The data needed for the research were obtained from case studies of patients hospitalized in the orthopedic department of the Hospital Tábor a.s., in the period from 1st April 2014 to 31st March 2015.
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