RESEARCH ARTICLE

Disability caused by hip joint injuries among the adult population of Moscow in for the period of 2013–2019

M.V. Kovrizhnykh1*, N.S. Zapariy2, E. E. Achkasov3, V.S. Solovev4, A.G. Samusenko5

1City Budgetary Healthcare Institution “City Polyclinic No. 68 of Moscow Health Department”, Moscow, Russia

2Federal State Budgetary Institution “Federal Bureau of Medical and Social Expertise” of the Ministry of Labour of the Russian Federation, Moscow, Russia

3 Federal State Autonomous Educational Institution “I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

4 Multi-Specialty Medical Center of the Bank of Russia, Moscow, Russia

5Federal State Institution «General Bureau of Medical and Social Expertise of Moscow” of the Ministry of Labour of the Russian federation, Moscow, Russia

Abstract

The study found that the 2013–2019 period saw a decrease in the incidence of primary disability caused by hip joint injuries among the adult population of Moscow. The level of primary disability averaged 0.09 ± 0.03 per 10,000 adult population. In the structure of disability caused by injuries of the lower limbs, hip joint injuries accounted for 10.5% over the studied period. The age structure was dominated by disabled people above the working age with a tendency to decrease their share. In the nosological structure, people disabled as a result of femoral neck fractures (46.2%) and femur fractures (29.3%) prevailed. In the structure of people who were first recognized as disabled, disabled people of groups II and III prevailed (with a large proportion of disabled people of group III and a lower share of disabled people of group II). The proportion of people with disabilities in group I is the smallest, and it tends to decrease over the studied period. Among people above the working age, the disabled people of groups I and II prevailed while among people of the working age, the disabled people of groups II and III prevailed.

The incidence of repeated disability of this contingent was also characterized by a downward trend. The level of repeated disability averaged 0.11 per 10,000 population. The share of people repeatedly recognized as disabled due to injuries of the lower limbs was 8.5%. The structure was dominated by people with disabilities caused by femoral neck and femur fractures. The period saw an increase in the proportion of disabled people of the working age. The disabled people of group III with a tendency to increase their share and the disabled people of group II with a tendency to decrease their share prevailed, and the number of disabled people of group I decreased.

Key words: age groups, comparative analysis, disability, disability groups, features of disability, hip joint injuries

*Corresponding author: M.V. Kovrizhnykh, City Budgetary Healthcare Institution “City Polyclinic No. 68 of Moscow Health Department”, Moscow, Russia. Email: ramyanallu@saveetha.com

Submitted: 16 November 2021; Accepted: 22 January 2022; Published: 1 March 2022

DOI: 10.47750/jptcp.2022.889

©2022 Kovrizhnykh MV et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)

The diseases of the circulatory system, malignant tumors, diseases of the musculoskeletal system, and the consequences of injuries of all locations are ranked first in the structure of disability in the Russian Federation.1,2,6,7,10 The high rate of disability caused by injuries of the lower limbs highlights their high prevalence, poor prevention, and rehabilitation at different stages: outpatient, inpatient, and sanatorium stages.3–5,8,9

OBJECTIVE OF THE STUDY

To determine the features and investigate the dynamics of primary and repeated disability caused by hip joint injuries among the adult population of Moscow.

MATERIALS AND METHODS

The study is continuous. The study covers the adult residents of Moscow who were first and repeatedly recognized as disabled due to hip joint injuries. Thedata resources used are the database of the Unified Automated Vertically Integrated Information and Analytical System of the Medical and Social Expertise belonging to Federal State Institution “General Bureau of Medical and Social Expertise of Moscow” of the Ministry of Labour of the Russian Federation.

Methods: Data copying, descriptive statistics (absolute, relative, extensive, intensive indicators), and analytical comparative analysis. The static reliability of different intensive indicators was determined by calculating the statistical significance criteria (t) and confidence (P) and error (p) levels.

RESULTS AND DISCUSSION

In the structure of people first recognized as disabled due to injuries, the number of people with injuries of lower limbs has increased from 8.9% to 13.0% for the 2013–2019 period (on average, 10.5% over the studied period). In Moscow, their absolute number decreased from 128 people up to 40 people (the decline rate is 68.8%) (644 people in total over the period; on average, 92 people per year). The level of primary disability caused by hip joint injuries is characterized by a downward trend (decrease from 0.12 ± 0.03 to 0.04 ± 0.03) over the researched period (on average, 0.09 ± 0.03 per 10,000 adults (See Table 1)).

Table 1. Dynamics of the Number of People First Recognized as Disabled Due to Hip Joint Injuries in the Structure of Lower Limb Injuries in Moscow for the 2013–2019 Period (Absolute Number, %, per 10,000, M ± m)

Year Total number of people first recognized as disabled due to lower limb injuries Number of people first recognized as disabled due to hip joint injuries
Absolute number Share Level Absolute number Share Level
2013 1438 100.0 1.4 ± 0.09 128 8.9 0.12 ± 0.03
2014 1232 100.0 1.2 ± 0.09 120 9.7 0.11 ± 0.03
2015 1103 100.0 1.1 ± 0.09 147 13.3 0.14 ± 0.03
2016 870 100.0 0.8 ± 0.09 78 9.0 0.08 ± 0.03
2017 621 100.0 0.6 ± 0.09 72 11.6 0.07 ± 0.03
2018 455 100.0 0.4 ± 0.09 50 13.0 0.06 ± 0.03
2019 401 100.0 0.4 ± 0.09 40 10.0 0.04 ± 0.03
Average value 874 100.0 0.8 ± 0.09 92 10.5 0.09 ± 0.03

In the nosological structure of primary disability caused by hip joint injuries for the researched period, femoral neck fracture (46.2%), femur fracture (29.3%), trochanteric fracture (11.7%), and bilateral post-traumatic coxarthrosis (10.3%) prevailed. The smallest proportion was that of the fracture of the lower third of the femur (1.3%), traumatic amputation at the level between the hip and the knee joint (0.7%), and traumatic amputation at the level of the hip joint (0.5%).

Among people first recognized as disabled due to hip joint injuries in Moscow, the disabled people of the working age made up 18.5% on average with a tendency to increase their share from 14.1% to 32.2% in 2013–2019. Their level of primary disability was 0.02 per 10,000 of the corresponding population (See Table 2).

Table 2. Dynamics of the Number of People First Recognized as Disabled Due to Hip Joint Injuries Taking into Consideration Age Groups in Moscow for the 2013–2019 Period (Absolute Number, %, per 10,000)

Year Working age Old working age
Absolute number Share Level Absolute number Share Level
2013 18 14.1 0.02 110 85.9 0.37
2014 18 15.0 0.02 102 85.0 0.34
2015 31 21.1 0.04 116 78.9 0.37
2016 7 9.0 0.01 71 91.0 0.22
2017 17 23.6 0.02 55 76.4 0.17
2018 14 23,7 0.02 45 76.3 0.13
2019 13 32.5 0.02 27 67.5 0.08
Average value 17 18.5 0.02 75 81.5 0.24

The number of people who were first recognized as disabled due to hip joint injuries and above the working age is significantly higher than the number of disabled people of the working age, but over the studied period, their number decreased from 110 people in 2013 up to 27 people in 2019 (526 people in total and 75 people on average per year). Their share in the structure of people first recognized as disabled due to hip joint injuries averaged 81.5%. The level of primary disability tended to decrease from 0.37 to 0.08, averaging 0.24 per 10,000 of the corresponding population.

In the structure of primary disability caused by hip joint injuries, the proportion of disabled people of group I is the smallest; over the studied period, it tended to decrease from 25% to 10.1%, averaging 19.6%. The level of primary disability in this contingent was 0.02 per 10,000 of the adult population. The share of disabled persons of group II was also characterized by a decrease from 46.1% to 27.5%, averaging 40.2%. The absolute number of disabled people of group II was 259 people (on average 37 people per year). The proportion of the disabled with group III tended to grow from 28.9% to 60% for the researched period, averaging 40.2%. The level of primary disability in group III averaged 0.04 per 10,000 of the adult population (See Table 3).

Table 3. Characteristics of Primary Disability Due to Hip Joint Injuries Taking into Account the Severity of Disability in 2013–2019

Year Disability group
I II III
Absolute number Share Level Absolute number Share Level Absolute number Share Level
2013 31 25.0 0.03 59 46.1 0.06 38 28.9 0.04
2014 24 20.0 0.02 52 43.3 0.05 44 36.7 0.04
2015 27 18.4 0.03 60 40.8 0.06 60 40.8 0.06
2016 25 32.1 0.02 21 26.9 0.02 32 41.0 0.03
2017 8 11.1 0.01 26 36.1 0.02 38 52.8 0.04
2018 6 10.1 0.001 27 45.8 0.02 26 44.1 0.02
2019 5 12.5 0.0004 11 27.5 0.01 24 60.0 0.02
Average value 18 19.6 0.02 37 40.1 0.04 37 40.2 0.04

(Absolute Number, %, per 10,000)

Taking into account age categories and the severity of primary disability caused by hip joint injuries, we have revealed that the number of the disabled people of group I is higher among people above the working age than among people of working age. For the research period, their proportion was 22.4% against 1.3% (P < 0.05). The level of primary disability among people above the working age averaged 0.06 and among people of working age, it was 0.002. The share of the disabled people of group II among people of working age averaged 35.2% with a level equaled to 0.01. The share of the disabled people of group II among people above the working age is higher (39.1%) with a level of 0.1 per 10,000 of the corresponding population (See Table 4). The proportion of the disabled people of group III among people of working age is the highest (65.3%) against 38.5% among people above the working age (P < 0.05). The level of primary disability of group III among people of working age is lower (0.01) than among people above the working age (0.09). Thus, disabled people of groups I–II and groups III–IV predominate among people above the working age and among people of working age, respectively (See Table 4).

Table 4. Structure of People First Recognized as Disabled due to Hip Joint Injuries Taking into Consideration Disability Severity and Age Categories in Moscow for the 2013–2019 Period (Absolute Number, %, per 10 000)

Year Age category Disability group
I II III
Absolute number Share Level Absolute number Share Level Absolute number Share Level
2013 Of working age 1 5.6 0.001 12 66.7 0.02 5 27.7 0.007
Above working age 30 27.3 0.10 47 42.7 0.16 33 30.0 0.11
2014 Of working age — — — 7 38.9 0.009 1 61.1 0.01
Above working age 24 23.5 0.08 45 44.1 0.15 33 32.4 0.11
2015 Of working age 1 3.2 0.001 14 45.2 0.02 16 51.6 0.02
Above working age 26 23.4 0.08 46 39.7 0.15 44 36.9 0.14
2016 Of working age — — — 1 14.3 0.001 6 85.7 0.008
Above working age 25 36.2 0.08 20 28.2 0.06 26 35.6 0.08
2017 Of working age — — — 5 29.4 0.007 12 70.6 0.02
Above working age 8 14.5 0.02 21 38.2 0.06 26 47.3 0.08
2018 Of working age — — — 4 28.6 0.006 10 71.4 0.01
Above working age 6 13.3 0.02 23 51.1 0.07 16 35.6 0.05
2019 Of working age — — — 3 23.1 0.004 10 76.9 0.01
Above working age 5 18.5 0.01 8 29.6 0.02 14 51.9 0.04
Average value Of working age 03 1.3 0.0002 7 35.2 0.01 9 63.5 0.01
Above working age 18 22.4 0.06 29 39.1 0.1 27 38.5 0.09

In the structure of people repeatedly recognized as disabled due to injuries of the lower limbs among the adult population, hip joint injuries amounted to 8.5% for the researched period, ranging from 7.1% to 9.7%. The number of such people repeatedly recognized as disabled decreased from 174 people up to 51 people (on average, 110 people per year) over the studied period. The level of repeated disability tended to decrease from 0.17 to 0.05, and on average it was 0.11 per 10,000 of the adult population (See Table 5).

Table 5. Structure of People Repeatedly Recognized as Disabled Due to Hip Joint Injuries in the Structure of Disabled People with Lower Limb Injuries for the 2013–2019 Period (Absolute Number, %, per 10 000, M ± m)

Year Total number of people repeatedly recognized as disabled due to injuries of the lower limbs Number of people repeatedly recognized as disabled due to hip joint injuries
Absolute number Share Level Absolute number Share Level
2013 2066 100.0 2.0 ± 0.09 174 7.1 0.17
2014 1955 100.0 1.9 ± 0.09 165 8.4 0.16
2015 1447 100.0 1.4 ± 0.09 134 9.3 0.13
2016 1310 100.0 1.3 ± 0.09 104 7.9 0.10
2017 839 100.0 0.8 ± 0.09 81 9.7 0.08
2018 759 100.0 0.7 ± 0.09 61 8.0 0.06
2019 657 100.0 0.6 ± 0.09 51 7.8 0.05
Average value 1290 100.0 1.2 ± 0.09 110 8.5 0.11

In the nosological structure of such disabled people, femoral neck fractures (33.8%), femur fractures (30.2%), bilateral post-traumatic coxarthrosis (19.7%), and the pertrochanteric fractures (10.4%) predominated. The smallest proportion was made up by the fractures of the lower end of the femur (1.6%), the traumatic amputation at the level between the hip and knee joints (3.3%), the traumatic amputation in the hip joint and the thigh area (0.9%), and traumatic amputation at the level of the hip joint (0.1%) (See Figure 1).

Figure 1. Long-term average annual structure of repeated disability due to hip joint injuries in Moscow for the 2013–2019 Period (%).

The analysis of repeated disability of the adult population due to hip joint injuries in Moscow for the 2013–2019 period taking into account the age categories showed that disabled people above the working age predominated. Over the studied period, their absolute number decreased from 132 people up to 23 people (576 people in total, 82 people on average per year). Their share grew from 75.9% in 2013 to 81.7% in 2016 with a subsequent decrease to 45.1% in 2019, averaging 75.4%. The number of disabled people of the working age is much less (194 people in total, 28 people on average per year). Their share grew from 24.1% to 54.9%, averaging 25.5%.

The level among people above the working age decreased from 0.45 to 0.07 and averaged 0.28 per 10,000 of the corresponding population. Among people of the working age, the level of repeated disability was much lower and averaged 0.04 per 10,000 of the corresponding population (See Table 6).

Table 6. Number of People Repeatedly Recognized as Disabled Due to Hip Joint Injuries among Adults Taking into Account Age Categories in Moscow for the 2013–2019 Period (Absolute Number, %, per 10 000, M ± m)

Year Working age Old working age
Absolute number Share Level Absolute number Share Level
2013 42 24.1 0.06 132 75.9 0.45
2014 37 22.4 0.05 128 77.6 0.42
2015 27 20.1 0.04 107 79.9 0.53
2016 19 18.3 0.03 85 81.7 0.26
2017 22 27.2 0.03 59 72.8 0.18
2018 19 31.1 0.03 42 68.9 0.06
2019 28 54.9 0.04 23 45.1 0.07
Average value 28 25.5 0.04 82 74.5 0.28

In the structure of repeated disability caused by hip joint injuries, the disabled people of group III prevailed. The number of people repeatedly recognized as disabled decreased from 57 people up to 31 people (with a decline rate of 45.5%). The share of such people repeatedly recognized as disabled amounted to 31.7% in 2013 and was followed by its increase to 60.8% in the subsequent years. The long-term average annual proportion was 39.1%. The level of repeated disability decreased from 0.05 to 0.03 and averaged 0.03 per 10,000 of the adult population (See Table 7).

Table 7. Dynamics of Repeated Disability Caused by Hip Joint Injuries among the Adult Population Taking into Consideration the Disability Severity for the 2013–2019 Period (Absolute Number, %, per 10 000)

Year Disability group
I II III
Absolute number Share Level Share Absolute number Level Absolute number Share Level
2013 48 28.6 0.05 69 39.7 0.07 57 31.7 0.05
2014 47 28.5 0.05 58 35.2 0.05 50 30.3 0.05
2015 42 31.3 0.04 43 32.1 0.04 49 36.6 0.05
2016 27 26.0 0.03 36 34.6 0.03 41 39.4 0.04
2017 22 27.2 0.02 24 29.6 0.02 35 43.2 0.03
2018 14 22.9 0.01 17 27.9 0.02 30 49.2 0.03
2019 7 13.7 0.01 13 25.5 0.01 31 60.8 0.03
Average value 30 27.3 0.03 37 33.6 0.04 43 39.1 0.04

The disabled people of group II were ranked second in the structure of people repeatedly recognized as disabled due to hip joint injuries. Their number decreased from 69 people in 2013 up to 13 people in 2019 (the decline rate was 81.2%). Their share was 39.7% in 2013 with a subsequent decrease to 25.5%, averaging 33.6%, which is higher than the extensive indicator of repeated disability of group II due to injuries of the lower limbs (19.9%) (P < 0.05). The level of repeated disability of such disabled people was seven-fold from 0.07 to 0.01, averaging 0.04 per 10,000 of the adult population.

The proportion of disabled people of group I in the structure of people repeatedly recognized as disabled due to hip joint injuries in Moscow decreased from 31.3% to 13.7%, averaging 27.3%, which is three times higher than the extensive indicator of group I disability caused by injuries of the lower limbs (P < 0.05). The number of the disabled people amounted to 207 people in total, averaging 30 people per year. The level of repeated disability of group I of such disabled people decreased from 0.05 to 0.01, averaging 0.03 per 10,000 of the adult population (See Table 7).

The analysis of the rate of repeated disability among the Moscow adult population caused by hip joint injuries taking into account disability severity and age categories revealed that the disabled people of group I accounted for 9.5% among people of the working age in 2013 with a subsequent decrease to 3.6%, averaging 6.7%, with a level equaled to 0.002 per 10,000 of the corresponding population. Among people above the working age, the proportion of the disabled people of group I varied from 43.0% to 26.1%, averaging 34.0%, which is higher than the share among people of the working age (P < 0.05). The level of repeated disability of group I among people of the working age decreased from 0.005 to 0.001, averaging 0.002. This level also decreased from 0.18 to 0.02 and averaged 0.09 per 10,000 of the corresponding population among people above the working age.

Among people of the working age, the share of the disabled people of group II tended to decrease from 54.8% to 17.8%, averaging 34.8%, and it amounted to 31.4% among people above the working age for the researched period (See Table 8). The level of repeated disability of group II among people of the working age ranged from 0.07 to 0.006 and averaged 0.01 with a tendency to decrease from 0.16 to 0.007, averaging 0.09 per 10,000 of the corresponding population, among people above the working age.

Table 8. Structure of People Repeatedly Recognized as Disabled Due to Hip Joint Injuries Taking into Consideration the Disability Severity and Age Categories in Moscow for the 2013–2019 Period (Absolute Number, %, per 10 000)

Year Age category Disability group
I II III
Absolute number Share Level Absolute number Share Level Absolute number Share Level
2013 Of working age 4 9.5 0.005 23 54.8 0.03 15 35.7 0.02
Above working age 44 33.3 0.15 46 34.8 0.16 42 31.9 0.14
2014 Of working age 2 5.4 0.003 15 40.5 0.02 20 54.1 0.03
Above working age 55 43.0 0.18 43 33.6 0.14 30 23.4 0.10
2015 Of working age 3 17.5 0.004 11 40.7 0.01 13 41.8 0.02
Above working age 39 36.4 0.12 32 29.9 0.10 36 33.7 0.12
2016 Of working age 1 5.3 0.001 6 31.6 0.008 12 63.1 0.02
Above working age 26 30.6 0.08 30 35.3 0.09 29 34.1 0.09
2017 Of working age — — — 3 13.6 0.004 19 86.4 0.03
Above working age 22 37.3 0.07 21 35.6 0.07 16 27.1 0.05
2018 Of working age 1 5.3 0.001 4 21.1 0.006 14 73.6 0.02
Above working age 13 31.0 0.04 13 31.0 0.04 16 38.0 0.05
2019 Of working age 1 3.6 0.001 5 17.8 0.007 22 78.6 0.03
Above working age 6 26.1 0.02 8 34.8 0.02 9 39.1 0.03
Average value Of working age 2 6.7 0.002 10 31.4 0.01 16 61.9 0.02
Above working age 29 34.9 0.09 28 33.6 0.09 25 32.4 0.08

The share of the disabled people with group III was the highest among people of the working age: it increased from 35.7% to 78.6%, averaging 61.9% with a level of 0.02. The proportion of disabled people of group III among people above the working age ranged from 13.4% to 39.1%, averaging 32.4% with a level of 0.08 per 10,000 of the corresponding population.

CONCLUSION

For the researched period, the rate of primary disability caused by hip joint injuries among the adult population of Moscow was characterized by a downward trend. The level of primary disability averaged 0.09 ± 0.03 per 10,000 of the adult population. In the structure of disability caused by injuries of the lower limbs, injuries of the hip joint accounted for 10.5% over the studied period. In the age structure, the disabled people above the working age prevailed. During the observation period, their share decreased and averaged 81.5% with an average intensive rate of 0.24 with a downward trend. The nosological structure was dominated by people with disabilities caused by the femoral neck and femur fractures (46.2% and 29.3%, respectively). In the structure of those who were first recognized as disabled, the disabled people of GROUPS II–III groups prevailed (more than 40%) with a large share of the disabled people of group III and a small proportion of the disabled people of group II. The proportion of disabled people of group I is the smallest (averaged 19.6%), and it tended to decrease. In the structure of primary disability taking into account age categories and the disability severity, the disabled people of groups I–II and groups II–III predominated among people above the working age and people of the working age, respectively. The latter was characterized by a large proportion of patients of group III and a small per cent of people of group II.

The rate of repeated disability of this nature was also characterized by a downward trend. The level of repeated disability averaged 0.11 per 10,000 of the population. In the structure of repeated disability caused by injuries of the lower limbs, the share of people repeatedly recognized as disabled reached 8.5%. The structure was dominated by disabled people due to the femoral neck and femur fractures. Disabled people above the working age made up 74.5% with a level of 0.28 per 10,000 of the corresponding population. Over the studied period, we could observe the decreasing proportion of people of the working age. In terms of disability severity, the disabled people of group III (with the increasing share) and group II (with decreasing proportion) prevailed. The number of disabled people with group I decreased (their share was 27.3%).

REFERENCES

1. Goryannaya, NA. The Change of the Life Quality of Patients after Hip Arthroplasty at the First Rehabilitation Stage. N.A. Goryannaya, N.I. Ishekova, V.V. Popov [and others]. Human ecology. 2017;1:41–44. 10.33396/1728-0869-2017-1-41-44

2. Lebedev, VF. The Assessment of Life Quality and Rehabilitation Potential of Patients with the Hip Joint Post-traumatic Pathology. V.F. Lebedev, G.V. Sidorova, L.A. Dmitrieva [and others]. The Siberian Medical Journal (Irkutsk). 2009;5:114–117.

3. Leonov, SA. On Some features of Traumatism in the Russian Federation–E-text. S.A. Leonov, E.V. Ogryzko, N.M. Zaychenko. Scientific e-journal “The social Aspects of Public Health” 2009;3(11):15. Available at: http://vestnik.mednet.ru/content/view/143/30/lang.ru/

4. Mironov, SP. The Dynamics of the Traumatism among Adult Population in the Russian Federation. S. P. Mironov, N.A. Yeskin, T.M. Andreeva [and others]. N.N. Priorov Herald of Traumatology and Orthopedics. 2019;3:5–13. 10.17116/vto20190315

5. Peter, EL., Kaligirwa, A., Lukwago, T. Stability indicating highperformance thin layer chromatography method for estimation of ascorbic acid in Hibiscus sabdariffa L. aqueous extract. Journal of Complementary Medicine Research, 2019;10(1):50–57. 10.5455/jcmr.20181211114301

6. Ondar, VS. The structure of Disability Caused by the Diseases of the Musculoskeletal System with Consideration to the Main Disease Forms. V.S. Onfar. Medical and Social Expertise and Rehabilitation. 2010;3:38–40.

7. Halaharvi RS, Kanala MC, Chella MC. A Case Report On Non Diabetic Foot Ulcer With Cellulitis: Split Thickness Grafting Technique (Stgt). IJPRT. 2021;11(2):50–52. 10.31838/ijprt/11.02.08

8. Shurgaya, MA. The Nosological Aspect of Disability of the Elderly People in the Russian Federation and the Features of Rehabilitation and Expert Diagnostics, Rehabilitation and Abilitation. M.A. Shurgaya. Medical and Social Expertise and Rehabilitation. 2017;20(3):136–143. 10.18821/1560-9537-2017-20-3-136-143

9. Manna Mj, Jabur MS. The value of lisnopril in managing impaired fertility in experimental rats following alloxan induced hyperglycemia. PNR. 2021;12(2):18–23. 10.47750/pnr.2021.12.02.003

10. Sorokoletov DV. Traumatism and diseases of the musculoskeletal system as one of the most important problems of persistent disability leading to significant economic losses of society. D.V. Sorokoletov, G.M. Dubrovin, Yu. N. Kirichenko [et al.]. Kursk Scientific and practical bulletin “Man and his health”. 2012;4:102–107.

11. Puzin, SN. Aspects of rehabilitation and habilitation of disabled people at the modern level. SN. Puzin, SS. Memetov, MA. Shurgaya. Medical and social expertise and rehabilitation. 2016;19(1):4–7. 10.18821/1560-9537-2016-19-1-4-7

12. Chernikova, OM. Potential opportunities for improving the rehabilitation of patients with the consequences of injuries and diseases of the musculoskeletal system at the regional level. OM. Chernikova, GV. Sidorova, NI. Arsentieva [et al.]. Medico-social expertise and rehabilitation. 2012;3:6–8.

13. Memetov, SS. Problematic issues of the implementation of individual rehabilitation and habilitation programs for disabled people at the present stage. S.S. Memetov, N.P. Sharkunov, N.S. Govorushkina [et al.]. Bulletin of the All-Russian Society of Specialists in Medical and Social expertise, rehabilitation and rehabilitation industry. 2017;4:11–17.