A hip fracture in older people: causes, treatment and surgery

This violation pathological anatomy of the femur occurs in people of all ages, but the older the patient, the lower the probability of a successful recovery. Doctors refer to this problem a highly complicated. A hip fracture is extremely difficult amenable to conservative treatment. In most cases, doctors have to resort to immediate operative interference, but this does not always lead to a favorable outcome. Have a basic understanding of the causes and characteristics of this pathology, you will be able to avoid the dismal consequences.

The causes of hip fracture

According to statistics, more than others at risk of getting this dangerous injury to the fairer sex. Sounds daunting, but each woman is able to protect themselves from this problem or at least to reduce to zero the probability of its occurrence. Rehabilitation after hip fracture can last for years, so experts recommend to monitor your condition to prevent critical deterioration. For this you need to know exactly what factors may be caused by a hip fracture. Learn more about them you will learn below.

In old age

Over the years locomotor system becomes weaker. The elderly are faced with this problem against the background of deterioration of bone tissue. The elderly often suffer from osteoporosis is a scary metabolic disease that is manifested by increased fragility of bones. This violation leads to serious injury, including injury of the femoral neck. The second most common factor contributing to the emergence of these pathologies is the weakness of muscles and tendons. The main root of all these problems is a sedentary lifestyle.

At a young age

In patients over the age of 40-45 years, injuries of the femoral neck are in the nature of high-energy injuries. Such phenomena can frequently occur in traffic accidents, in falls from a great height, upon hitting a high capacity in manufacturing plants. Chronic diseases associated with a sedentary lifestyle (such as osteoporosis and lack of exercise) rarely lead to injury of the femoral neck in young and middle aged people.

Types of fractures

There are several varieties of injuries of the femoral neck, and each of them is characterized by several features that determine the order of assignment of therapeutic interventions. Modern medicine have studied these species and found many dependencies between the shape of the fracture and the further course of the disease. Along with this was developed a number of treatment programs, each of which is strictly applied in the appropriate situations. After reviewing subsequent sections, you will receive an overview of the classification of mechanisms of damage to the femoral neck.

Relative to hinge mount

Injury of the femoral neck are divided into several categories. The location of fault lines distinguish the two groups of injuries of the hip:

  • Intra-articular fractures (medial). Usually occur in the elderly. The specialists also note that women are affected two times more often than men. Characteristic intra – articular fracture- the lack of retention of open fragments medially. The line of fracture is located at the junction of the neck with femoral head and may be held obliquely or transversely.

 

  • Lateral fractures (lateral). A rare form of injury, which occurs in 15-20% of cases. It is characterized by the fact that the fracture line passes exactly along the literal border. It crosses the base of the femoral neck, but does not reach the area of spits. As a rule, when the fracture displacement is not observed.

By location

The strength and direction of the impact, resulting in cervical trauma depend on the location of the fracture line. Evaluating all cases of injury of the femur by this criterion, it is possible to identify three main categories:

  • Transcervical – crossing the femoral neck; injury of medium gravity with a good possibility of successful conservative treatment.
  • Subapically – located directly at the head of the femur. The most adverse type of fracture. Its danger lies in the fact that in violation of the anatomy of the bone also deteriorates the blood supply to the head. When subcapitale the fracture without surgical intervention is the restoration of bone tissue is almost impossible.
  • Basisarticle – at the base of the femoral neck. The most auspicious of all possible options. The line of fracture is at the beginning of the femoral neck, so the predictions the splice as a rule, positive.

Types of fractures with displacement

On top of that, medicine often uses the classification of injuries of the femur on the system of Garden that takes into account the displacement of the torn tissues. According to her, all the trauma of the femoral neck are divided into three groups:

  • Varus. The head moves inwards and downwards. The angle between the base of the femur neck is reduced.
  • Valgus. The offset head is directed upwards and outwards. The increase of the angle between the neck and the base of the bone.
  • Impacted. With such fractures, one fragment of a thigh bone volutives to another. As a rule, such injuries are valgus.

The main signs and symptoms

A hip fracture manifests itself in many different ways. People faced with this problem, note the following signs/symptoms:

  • contusions/hematoma/bruises in the pelvic area;
  • bony prominences, which are palpated in the upper third of the outer surface of the thigh;
  • sharp unbearable pain in the area of damaged bone;
  • pain in the groin or pelvis when tapped on the heel;
  • a slight shortening of the leg resulting from displacement of fragments;
  • «adhering heel syndrome» when a person is not able to lift the heel while in the supine position;
  • the crunch in the area of damaged bone.

Diagnosis

When a patient turns to the experts with suspected injury of the femoral neck, the doctors analyze the situation, taking into account many factors. When setting the diagnosis takes into account the following:

  1. Complaints of the patient. The patient can mark the impossibility of the axial load on the injured limb, pain in the pelvis or groin. Unpleasant pressing sensation at rest.
  2. History. If the patient will report that there was a fall from a great height or a heavy object damage in an accident, for doctors it will be one of the determining factors.
  3. The clinical picture. The man with the injured neck of the femur there is a violation of axis of the leg and difficulty of active internal rotation. When the load on the axis of the thigh the patient feels a sharp unbearable pain in region of fracture.
  4. X-ray results. A snapshot of the femur can accurately determine the presence of fracture. The line of fracture detected by radiography, is the final objective measure to confirm the preliminary diagnosis displayed on the basis of complaints of patient, anamnesis and clinical picture.

Methods of treatment of femoral neck fractures

After receiving an accurate diagnosis, doctors opt for treatment. The procedure for the appointment of medical activities determined by the type of injury. In addition, it is important that the age of the patient. Be that as it may, all methods of treatment of fractures of the femur are divided into two categories: conservative and surgical. Learn more about them are discussed in later sections of the article.

Conservative treatment

Medicine leans toward conservative treatment only in cases, when there are factors prohibiting surgery. To a number of those include recent myocardial infarction, third trimester of pregnancy, heart failure, etc. in addition, the reasons for involuntary conservative treatment can be of organizational nature – for example, the lack of proper medical equipment, pain relievers or competent surgeon.

The essence of conservative treatment is as follows: the patient immobilizer (immobilize), bandage, performed skeletal traction. In rare cases, fixation of the trunk is used plaster. In this way possible to return the fragments in the correct position and to ensure the splicing, however, not always this happens safely. Conservative treatment is often followed by a mass of complications, so it can be called reliable. This method of dealing with the problem rather relates to the people.

Surgery

Surgery – the gold standard of treatment of injuries of the femur in our day. Modern clinic widely used two effective methods of surgical treatment of this dangerous injury:

  • Reduction, internal fixation (osteosynthesis). Is chosen for patients under the age of 65 years. Surgeons compare bone fragments, and then fix them, significantly increasing the chances of a successful fusion of the femoral head. For fastening the bone in a fixed position surgeons use special screws. They screwed across the fracture line. Due to this minimized the risk of displacement of fragments.
  • Endoprosthesis. Selected for patients aged 65 and older. The aim of the operation is the replacement of the neck and head bones. To the body of the femur attached to a prosthetic denture. This method of treatment does not imply serious risks, because the success of the splice.

The rehabilitation period

After the success of the surgical correction of injuries of the femoral neck, the patient requires a lengthy recovery for full return of motor function of the injured extremity. In such cases is rehabilitation, which includes the following procedures, exercises and therapeutic activities:

  • LFC. Under medical supervision, the patient performs a series of simple exercises from a course of physical therapy. Daily exercises, easy exercises, an insignificant load on the leg all contribute in better blood flow, thereby accelerating the process of jointing the bones.
  • Permanent care. Patient shield them from forced physical activity associated with self-service. To put it a nurse that provides regular meals, and round-the-clock care.
  • Massage. In the first weeks after surgery for removal of injuries of the femoral neck is necessary to massage that muscle is not atrophied.
  • Pharmacological prevention. Doctors prescribe vitamins, immune modulators and natural remedies that support the body in the patient’s normal balance of substances. Sometimes during the first few weeks after surgery is necessary to anesthetize the area of the surgical suture.
  • Fixation of the feet to improve the chances for successful splicing. The patient will have to wear a de-rotational boot when hip fracture.

Possible complications and consequences

Due to the fact that this problem mostly affects elderly people, the consequences can be very severe. In medical practice often refers to the following possible complications:

  • necrosis of the femoral head due to deterioration of the circulation;
  • the formation of a false joint within the bone fragments;
  • venous thrombosis;
  • rejection of the prosthesis after the operation or loosening of the installed design;
  • arthrosis, osteoarthrosis, osteomyelitis.

Video about treatment of a hip fracture in the elderly

The video below contains images of distinct examples of fractures and surgical schematic drawing of structures used for operations. Watch this video to learn what to do in case of fracture of the femur and to get a General idea of how modern medicine deals with this problem.

 

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