Pilot Project: Surgical Treatment of Hip Fracture Patients in FSU

Kiev, Ukraine-- At 86, Joseph G. is considerably less active than he was as a Soviet military aviator, Kiev music school student, brass orchestra conductor or Distinguished Jewish Musician nominee. In Kiev, the former Berdichev, Kharkov and Dushanbe resident, now subsists with his wife and invalid daughter on a meager $26 monthly pension, and since 1996 has received supplemental hot meals, medication and home health services from the Joint Distribution Committee's Moked services.

Despite his need, Mr. G. nevertheless remained an active volunteer in Hesed Avot, a JDC program providing food packages, home health care, urgently needed medications, rehabilitation equipment and winter relief for elderly Jewish residents in Kiev. Mr. G. helped organize Hesed Avot's holiday celebrations-until November 10, that is, when he fell and fractured a hip.

Hip fractures, usually resulting from falls, remain a chief cause of permanent disability among the elderly. Within a year, 25% of untreated hip fracture patients die. Of the rest only a handful regain the ability to walk. Most remain bedridden and need lifetime care.

Surgical treatment sharply reduces the death rate of hip fracture patients. It restores mobility early on, and renders 65% to 75% fully ambulatory. Surgery, in short, generally restores patients' ability to independently manage their basic daily activities, thereby also restoring their human dignity. But in the former Soviet Union, the cost of most surgical procedures far exceeds the patients' financial resources.

A JDC survey of 25 Hesed Avot hip fracture patients in Kiev from January to August 2002 exposed the devastation such injuries visit on this community. Ranging from 66 to 93, patients averaged 81 years. Only five received surgery, presumably because they could afford it. Of those, three (60%) regained their ability to walk with assistance. But of the 20 untreated patients, only two (10%) became ambulatory.

In November, JDC launched a pilot project in Kiev to study the effectiveness of hip fracture surgery for Hesed Avot patients. U.S. surgeons generally treat "stable" femoral neck fractures with cannulated screws, driven under fluoroscopic guidance, reserving endoprosthesis (new femoral heads) only for "unstable" fractures. In Ukraine, however, the simpler (and less costly) former treatment is generally unavailable. In most cases, using an endoprosthesis becomes the treatment of choice.

Since then, JDC has provided financial support (about $800 per patient) for hip fracture surgery at one of two Kiev Hospitals. To date, seven patients have been treated, including five who received new femoral heads (endoprosthesis). Joseph was one of the first. Following his surgery on Nov. 19, Joseph returned home. He can now move about with a cane or his walker, attending to his personal needs. He is well on his way to renewing his community involvement.

Etia L., was an 83-year-old widow who lived alone on a $22 monthly pension. Like Joseph, she received food, home health care, urgently needed medications and winter relief from Hesed Avot. After a fall in early November, she received a 25-minute surgical implant of an endoprosthesis, which enabled her to resume walking with assistance, according to a JDC associate. Unfortunately, Mrs. L. passed away in January of unrelated kidney disease. But hip fracture surgery made Etia more comfortable in her final months than she would have been otherwise.

In younger patients, like 67-year-old Rimma T., the prognosis will generally be excellent. Mrs. T. received her endoprosthesis on February 28.

Hip fractures almost always result from a fall. But the most common underlying cause is osteoporosis, a condition characterized by reduced bone density. Regular exercise and an adequate diet, including daily intake of 800 to 1,000 mg of calcium supplements and 400 to 800 IU of vitamin D helps prevent osteoporosis-and reduces the likelihood of hip fracture.

In societies like the former Soviet Union, which have never seriously encouraged preventative medicine, doctors can find it difficult to implement even simple prevention measures. Thus, JDC gives 500 Hesed doctors newsletters encouraging them to inform their Jewish and other patients of the huge potential benefits that accompany improved diet and vitamin intake.

JDC newsletters recommend both estrogen therapy and Alendronate to help prevent osteoporosis and reduce the incidence of hip fracture. JDC also reminds FSU doctors to avoid giving sedative medications, help patients eliminate household hazards-and to do the daily "muscle-strengthening exercises" that can make them less accident-prone.