Hip fracture: symptoms, treatment, and rehabilitation after injury
Treatment, rehabilitation and consequences after hip fracture
Hip fracture is a very dangerous injury that can cause death. In most cases, such fractures occur over the age of 65 years.
Young people are usually associated with serious accidents and other severe injuries. In the elderly these fractures are usually the result of osteoporosis.
Anatomy of a joint
A joint has certain anatomical features that affect the appearance of such fractures:
- femoral neck located within the cavity of the joint, it is covered by a capsule, but not protected by the periosteum;
- the neck of the thigh bone moves away from the body at an angle of 115-135 degrees: the smaller this index, the greater the load, and it increases the risk of fracture;
- main arteries responsible for blood supply of the neck and the femoral head, through the bottom edge of the joint capsule;
- the head of the thigh bone fits only one artery, but the elderly she grows.
The mechanism of injury
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Generally, femoral neck breaks under the impact of traumatic force that is directed along the axis of the lower limb. This can happen when a person falls on the straight leg. If the traumatic force is applied perpendicularly, usually a broken pelvis, but sometimes suffers and thigh.
Hip fractures are very serious problem because there are very often entail dangerous consequences including death.
Even in developed countries, about 30% of patients dying during the year after such injury. The inability to perform human surgery tie him to his bed, which entails the development of complications – exacerbated chronic illness, deteriorating heart function, develop pneumonia.
Causes of fractures are substantially different depending on the age of the patient. Hip fracture in the elderly usually occurs due to the reduction of bone strength is osteoporosis. Bones affected by this disease can break even at ordinary fall. Also refer to risk factors:
- neurological pathology;
- lack of physical activity;
- irrational nutrition;
- weakened vision.
Young patients typically receive similar injuries due to serious accidents, falls from a height.
How is the bus Kramer on the lower limb you can find here. Also, the material about the rules of wearing the device.
Classification of injury
There are many varieties of such fractures. On the site of the occurrence is isolated:
- medial arises in the attachment of the joint capsule to the femur;
- lateral – situated at the head of the thigh bone near the joint.
Localization one can distinguish the following types of injuries:
- subapically – in this case his line is located directly outside of the femoral head;
- transcervical – is in the middle of the femoral neck;
- basiccally, the line is located at the beginning of the femoral head.
The closer the fracture is to the femur head, the higher the risk that it will fail. In such cases, seriously disturbed blood supply to the head.
The angle of the fracture to identify the following varieties:
The higher the value, the greater a threat than the bones won’t mend.
Depending on the displacement of the fragments and completeness of the fracture is isolated:
- incomplete without displacement;
- full without offset;
- complete with partial displacement;
- complete with full displacement.
The greater the displacement of the fragments, the lower the chance that the fracture will heal.
In addition, isolated fractures of the femoral neck are different kinds of offsets:
- Varus – in this case, the head moves downwards and inwards.
- Valgus – there is a shift upward and outward.
- Impacted – in this case Outlook volutives one bone to another.
Also the fracture is open or closed.
The symptoms of trauma
In this fracture the person usually complains of pain that increases when trying to raise or rotate the foot. Sometimes it can be turned outwards, there is shortening of the limb. In addition to the major symptoms in hip fracture include the following:
- Impaired motor activity. As the joint loses its configuration, the person usually cannot walk and even stand.
- Pain in the groin. As a rule, pain does not have a pronounced character. Sometimes the person does not notice the moment of crisis, as acute pain do not exist.
- No pain at rest. She comes back when trying to move your leg.
- Turn foot outward. This symptom in the hip fracture can be seen in a relaxed state – it is judged by the position of the knee and foot.
- The inability to deploy the foot inside. This symptom is associated with features of the attachment of muscles.
- Pain with axial load. When pressure or effleurage heel pain appear.
- Shortening the legs. Typical varus fractures, thereby decreasing the angle between the femur and the neck.
- Subcutaneous hematoma. May develop several days after injury.
Methods of diagnosis
The correct diagnosis is usually easy. The technician will do it after clinical examination.
To clarify the diagnosis assigned to the x-ray.
In some situations, in order to clarify the nature of the offset can be used computed tomography.
In difficult cases to confirm the diagnosis by magnetic resonance imaging or scintigraphy, however, usually need not arise.
Treatment of a hip fracture is a complex process, which is not always effective.
Today can be used conservative or operative therapy.
This therapy can be applied under certain types of fractures, and the presence of contraindications to the operation.
It is usually used in the following situations:
- in impacted fractures;
- in fractures of the lower part of the neck of the femur;
- if a person is in serious condition, and he can’t do the surgery.
In the conservative treatment of immobilization of a patient with a circular plaster bandage for 3-5 months. From the first day of the overlay system a person needs to perform breathing exercises and using a special frame to raise the upper body.
The main risk of conservative treatment is nonunion of the fracture. The fact that the head often is devoid of blood supply, and this prevents the fusing of bones. Conservative treatment often leads to various complications they are related to the fact that the patients for a long time lose the ability to independent movement.
For the elderly are often the consequences when hip fracture is very heavy and often end in fatal results.
The most common complications of conservative treatment include:
- the sores;
- psychoemotional disorders;
- deep vein thrombosis.
Surgical treatment of injuries
If there are no contraindications to surgical intervention, the operation for hip fracture should be performed as soon as possible. If this procedure cannot be done immediately, in the beginning impose skeletal traction.
Before fixation of bone fragments reduction is usually carried out, i.e., their comparison with each other. Sometimes to improve the chances for fusion of the fracture reduction is not anatomic, which restores the original position of the bones, and special – in this case, the fragments slip so as to facilitate knitting of the fracture.
For surgical treatment using two main methods.
The operation is a compound bone fractures with special metal constructions. Perform these types of osteosynthesis:
- using a three-blade nail Smith-Petersen – their score in the hip with a special hammer;
- with the help of three screws – is considered a more reliable method and is typically used in young people;
- using dynamic hip screw – in this case in the thigh twist is quite cumbersome metal structure.
The main drawback of this surgery for a hip fracture is a risk of necromania bones, so this procedure is not performed in people older than 65 years.
In addition, the osteosynthesis may lead to post-traumatic osteoarthritis and avascular osteonecrosis of the. There is also a risk of infection during the operation and development of pulmonary embolism.
The operation is a replacement of the prosthesis head of the thigh bone and acetabulum. This operation is usually carried out in the following cases:
- older age of the patient;
- significant displacement of fragments;
- the high complexity of the fracture;
- the presence of multiple fragments;
- aseptic necrosis of the femoral head.
There are several types of this operation:
- total joint replacement prostheses – in this case, the total prosthesis replaces the head and neck of the bone, and acetabulum of the pelvis;
- unipolar prosthesis – is used exclusively for the replacement of the head and neck of the femur;
- bipolar prosthesis – in this case, the head of the prosthesis located in a special capsule, which has a point of contact with the acetabular cavity, thereby reducing the wear and tear of the joint.
The operation of arthroplasty can also lead to serious health effects – thromboembolic complications, infection, development of dislocation, nerve damage or blood vessel, loosening or wear of implants, different length of feet.
After removal of plaster and intensive treatment is necessary to proceed to a phase of rehabilitation after hip fracture.
Young people are much easier to recover, whereas in the elderly the risk of death is quite high. Rehabilitation after such an injury involves the execution of complex exercises, the purpose of which is to restore the functions of the feet and also whole body.
Hip fracture is a very dangerous injury, because it often leads to death. It is therefore important time to begin treatment and be sure to pay special attention to recovery after surgery.