PRIMARY HIP REPLACEMENT FOR THE RIGHT FEMORAL NECK FRACTURE IN A PATIENT ON CHRONIC HEMODIALYSIS PROGRAM AND REPEATED SURGICAL TREATMENT FOR NEUROENDOCRINE TUMOR

The clinical case is fairly rare combination of severe somatic pathology (neuroendocrine cancer, terminal chronic kidney disease, program hemodialysis, etc.) and orthopedic and traumatologic pathology (right femoral neck pseudarthrosis) requiring surgical intervention with high risks for patient’s life. The patient has been suffering from polyneuroendocrine cancer since 2001. The history of multiple surgical interventions for polyneuroendocrine cancer is presented. Neuroendocrine cancer is considered as the least often oncologic disease. It is very dangerous, because neuroendocrine cells are spread throughout the body and can affect almost any organ. The treatment prognosis is unknown. At present, this type of cancer is poorly researched, which precludes the introduction of new treatment options and preventive activities. In the setting of comorbid pathology that arose from neuroendocrine cancer treatment (comorbidity index 12, according to ASA IV), the patient received the right femoral neck fracture. Surgical treatment for femoral neck fracture in patients burdened with comorbid pathology is a challenge for surgeons, anesthesiologists-resuscitators, therapists, nutritiologists, and doctors of other specialties. An abandonment of surgical intervention worsens the quality of life, aggravates disability, leads to the development of trophic, thrombo-embolic and infectious complications, and increases the likelihood of adverse outcome. Surgical treatment in the setting of specialized hospital is the most expedient. Therefore, due to comorbidity of such patients, a niche-targeted approach to treatment by specialists is needed at all stages of treatment with a seamless transfer of care and consistency of treatment activities.