Pathologies of the musculoskeletal system are most often found among older people. This is not surprising, because practicing throughout life, strong loads on the joints lead to damage and degeneration. A femoral neck crack is no exception. Such trauma is most often encountered by people in old age. The mechanisms of its development have their own characteristics.
The most common problem is osteoporosis. This disease is characterized by a decrease in bone density. Most often, the fair sex is exposed to cracks, since the structure of their bones significantly deteriorates against the onset of menopause.
Changes in the body of the elderly prevent the full restoration of the integrity of the damaged femoral neck. The treatment tactics are selected taking into account the age of the patient and the severity of the injury. In advanced cases, a person may be prescribed endoprosthetics.
Where is the thigh neck
The tip of the femur has a rather complex structure. The rounded end is the head of the bone, and the narrowed part that connects the bone itself to the head is the femoral neck. In the photo you can see the placement of the listed parts and understand how they are located.
On both sides of the neck there are peculiar bony protrusions, which are called skewers. Muscles are attached to them. You can see all this in detail in the photo.
The femoral neck is considered the most fragile component of the hip joint. All kinds of injuries in this area are extremely common. They occur in approximately 60% of the elderly. Therapy and rehabilitation of fractures and fissures of the femoral neck are always very difficult and long. In some cases, it is impossible to achieve a complete restoration of the motor functions of the lower extremities.
Causes of damage
It was noted above that a femoral neck crack is diagnosed mainly in older women. Menopausal osteoporosis often becomes its cause.
Why is this happening? This phenomenon is explained by the peculiarity of the female body, which consists in cyclical changes in the concentration of hormones throughout the month. With the onset of menopause, the volume of female hormones in the blood gradually decreases, which affects the structure of bone tissues.
If a woman does not carry out systematic prevention, she may develop osteoporosis during menopause. This pathology is characterized by a decrease in bone density. Over time, this disease leads to the development of such pathologies:
- Bone strength is reduced.
- Even the slightest damage can lead to fractures and cracks.
- A fall from a height of its growth can cause a crack in the femoral neck.
- Against the background of ongoing osteoporosis, the femoral neck cannot recover on its own after an injury, which entails prolonged immobilization. As a result, the bone marrow may be damaged, which will provoke the development of various complications.
Another common cause of hip fractures in the elderly is coxarthrosis. Fat people are often exposed to this disease, as well as those who regularly loaded the hip joints while working and playing sports.
If a fissure of the femoral neck appears in middle-aged and young people, these probable causes can be identified:
- Too high load when playing sports.
- Intoxication of the body.
- Pathologies in the work of the endocrine system.
- Accidents like traffic accidents or severe falls.
- Sedentary lifestyle.
- Completeness.
- Regular strict diets that lead to a deficiency of calcium and other nutrients.
- Oncological diseases.
Signs of hip fracture in the elderly
If trauma is preceded by osteoporosis, then most often patients simply do not notice any problems in their condition. After all, this pathology proceeds unnoticed due to the lack of specific symptoms. To prevent osteoporosis and femoral neck injuries, doctors recommend a systematic densitometry procedure for older people to evaluate bone strength.
A crack is the easiest form of injury, because the fracture does not pass through the entire bone. In this situation, doctors are able to achieve a complete restoration of the femoral neck through competent conservative therapy.
If we are talking about a fracture of the bone, that is, its through damage, then without surgery in this case can not do. Conservative treatment, especially in the elderly, is often ineffective.
Whatever the damage to the femoral neck in an elderly person, he should immediately contact a traumatologist. The doctor will conduct the necessary examination, establish an accurate diagnosis and prescribe the appropriate treatment. When trying to self-medicate, a person can develop numerous complications. Therefore, do not give up professional treatment.
Symptoms of a femoral neck crack are far from always specific and may well correspond to other pathologies. This particular feature is another reason to contact a traumatologist at the first suspicion of damage to a limb.
It is important to understand that a femoral neck crack may not be felt for a long time, but this trauma can occur even with minor damage. This is especially true for people who have arthrosis or osteoporosis.
Doctors distinguish several main symptoms of a hip neck crack:
- Acute pain in the pelvic area immediately at the time of injury, that is, with a fall or a strong blow.
- The occurrence of aching pain during movement and attempts to lean on a limb.
- Usually a person can move around, but it is given to him with difficulty.
- The muscles near the damaged joint become painful due to reflex spasms.
- Other symptoms of a femoral neck crack may not be pronounced for the reason that the injured area is not on the surface of the limb, and therefore visually invisible.
If prior to the moment of the injury a person already had arthrosis of the joint, then he can take all the described symptoms for the next manifestation of an exacerbation of the pathology. In such a situation, it is very important to pay attention to exactly when the symptoms arose. With a crack, they always appear immediately after injury.
Another feature is the prolonged presence of pathological signs that do not disappear, despite the usual treatment for arthrosis. At the same time, non-steroidal anti-inflammatory drugs that were previously effective do not help with injury.
A crack in the femoral neck can go into a fracture. Therefore, if you suspect an injury, do not expose the limb to excessive stress. In such a situation, you should immediately go to the doctor.
As for the symptoms of the fracture, it is more specific and differs from the manifestations of the fracture:
- An unusual turn of the foot out.
- A hematoma or intense redness appears at the site of damage.
- Lameness develops due to shortening of the limb.
- The patient cannot tear his heel off the floor and keep his foot on weight.
- An increase in body temperature is not ruled out.
What is dangerous injury
Treating a hip fracture in old age is considered extremely important because of the high risk of serious complications. Doctors distinguish several dangerous consequences that can lead to very serious pathologies.
- Prolonged immobilization of the leg, the inability to move without special orthopedic appliances, repeated cracks and fractures, as well as the formation of a false joint, deprived of the ability to function.
- Fat embolism. At the time of injury, there is a very high risk of penetration of bone marrow particles in the form of fat cells into the bloodstream. These substances can clog vessels and provoke consequences that pose a direct threat to life.
- Pulmonary embolism. Due to a prolonged stationary state after bone damage, blood clots form in the veins on the legs. If they come off the walls of the vessels, they can enter the pulmonary artery, which will provoke their blockage. This condition requires emergency care and is quite capable of leading to death.
- Secondary arthrosis. Even after complete restoration of the bone, pathological deformations form in it. They can be the cause of secondary arthrosis. The result is a vicious circle, because the risk of repeated fractures and cracks increases.
- Prolonged bed rest and lack of mobility can lead to the development of congestive pneumonia.
- In the buttocks, in most patients with a femoral neck crack, pressure sores appear, which are very difficult to get rid of.
The described consequences are considered basic, but far from unique. Therefore, it is necessary to carry out professional treatment of the resulting crack. Before proceeding with treatment, an accurate diagnosis should be made. A number of studies are being carried out for this purpose.
Diagnostics
An experienced traumatologist will be able to determine the nature of the pathology by its specific clinical manifestations and the patient's history. In addition, the described symptoms of trauma are considered a fairly reliable sign of a crack or fracture of the femoral neck.
But before prescribing a specific treatment, the doctor must verify the presence or absence of suspected damage. For this, instrumental diagnostics are used:
- Radiography of the joint. It is shown to all patients with the assumption of a crack or fracture of the femoral neck. In the picture you can carefully consider the nature of the injury and violation of the integrity of bone tissue. In some cases, radiography alone is enough to make an accurate diagnosis and even detect a small crack.
- CT scan. This is a modern technique, which is considered more informative, but expensive. Computed tomography makes it possible to detect any damage to bone structures.
- Magnetic resonance imaging. This technique allows you to assess the condition of not only bones, but also soft tissues. Such an examination is recommended for patients with suspected various complications.
- Densitometry. This is one of the radiological techniques that makes it possible to assess the density of bone tissue. It is used to diagnose a hip fracture in old age to detect osteoporosis.
- Ultrasound examination of the hip joints. In old age, this technique is considered insufficiently informative. It is used only if it is not possible to conduct other instrumental examinations.
Features of the diagnosis and the degree of damage to the joint are the main criteria for determining further therapy.
First aid for femoral neck injury
With such damage to the victim, it is advisable not to transport it yourself. It is best to call a team of doctors. Before their arrival, you should try to alleviate the condition of the victim. To do this, follow these steps:
- Lay the person on his back.
- Give him painkillers such as Nimesil, Ibuprofen, or Ketoral.
- Fix a damaged limb with a tire made of durable material. The leg should be fixed in several places: in the zone of the knee, thigh and ankle.
- If bleeding is observed during trauma, a tight tourniquet must be applied.
Features of conservative treatment
A crack is considered a minor injury. With this damage, the fracture site is limited; it does not cross the entire femoral neck. In this case, it is advisable to use conservative treatment. But such therapy in the elderly is quite difficult. Fractures in old age are very rare.
Surgical intervention can be dispensed with minor cracks in the bone. In such a situation, the victim should be immobilized for a long period. To do this, a plaster cast is applied to the injured leg. A limb hood can also be used with a load of about 2-3 kg. Physical therapy is recommended for the patient. After the hood is removed, a person is allowed to move on crutches.
It is important to note that treatment of the femoral neck in the elderly involves the treatment of osteoporosis. In this case, a special diet is prescribed, complexes of preparations with vitamin D and biophosphates to enrich the body with the necessary dosage of calcium. Calcitonin is much less commonly used. This is a hormone that helps increase bone strength.
If the patient uses drugs from the group of corticosteroids that help him get rid of the manifestations of rheumatological pathologies and other chronic problems, such medications will have to be abandoned for the period of treatment of the femoral neck crack.
With such an injury, people of any age, doctors recommend a special diet. It includes products that stimulate the formation of new cartilage tissue. Such a diet is rich in calcium-rich ingredients.
The patient’s daily menu must contain eggs, dairy products, nuts, and fatty fish. At the same time, preparations containing vitamin D are prescribed to a person. It helps to better absorb microelements coming from food.
For full recovery, people in old age need about 6-8 months. In young patients, bone tissue regeneration is much faster (on average, it takes about 4-5 weeks).
Surgical intervention
Surgery is considered the most effective way to treat hip fractures in the elderly. It is she who gives patients in old age the chances of a full life. Conservative therapy for them may be ineffective, so doctors prescribe it only when there are contraindications for the operation.
Osteosynthesis is most often used to treat a femoral neck crack. During this intervention, the damaged area of the bone is connected using special knitting needles or medical nails.
If the joint is too worn, endoprosthetics are recommended for the patient. It is also very often prescribed to people in old age. Such an intervention is considered quite complicated, which greatly scares patients. But it is worthwhile to understand that endoprosthetics may be the only chance that a person can walk without crutches.
We examined the symptoms observed during trauma (fracture or fissure) of the femoral neck. The most characteristic are problems with movement, up to complete immobility. In order not to end up in a wheelchair, you must agree to the operation. It consists of several stages:
- First, the injured femoral neck is removed along with the femoral head.
- A prosthesis is installed in their place.
- In some cases, additional replacement of skewers is required.
- After endoprosthetics, a person is raised to his feet on the third day. At first he moves only on crutches. This stage lasts up to 3 months.
After the operation, rehabilitation follows. The thigh neck is restored with the help of physiotherapeutic procedures, therapeutic exercises, massage sessions. A properly selected set of exercises will improve the nutrition of damaged tissues and blood circulation. Healing classes and regular walks will help restore normal limb mobility. After the operation, it will be useful to resort to sanatorium treatment.
What awaits the patient after surgery
Treatment of the femoral neck is a very long task, especially for the elderly. In the hospital, paramedics perform the following actions:
- Within a week, antibiotics and blood thinners are administered to a person.
- A pillow is fixed between the legs, which keeps the limbs at a safe distance from one another.
- On the second or third day after surgery, the patient is recommended minimal mobility. For example, he can do breathing exercises and simple gymnastics for the leg muscles.
- 3-4 days after surgery, a person is helped to stand up with crutches.
- On the 12-14th day after the prosthetics, the doctors remove the stitches and send the patient home.
Rehabilitation
For an accelerated recovery after an injury, a whole range of therapeutic measures is required. The approach to restoring the femoral neck should be comprehensive.
Unfortunately, very little time and attention is paid to patient rehabilitation in state clinics. That is why most affected people are forced to go to specialized medical centers and sanatoriums.The rehabilitation program is compiled individually for each person. Almost always, it consists of several stages:
- Painkillers After the injury and surgical intervention, a person, as a rule, experiences strong pain. For successful recovery, discomfort should be completely eliminated. For this, local anesthesia, sedatives and pain medications are used.
- Mechanotherapy. These are physical exercises performed with the help of special devices. Such devices are specifically designed to develop joints and restore former mobility.
- Physiotherapeutic procedures.This is one of the most important stages of rehabilitation. Physiotherapeutic procedures help get rid of edema, pain and infections, significantly accelerate the healing of wounds left after surgery. Some methods contribute to the resorption of hemorrhages, prevent the occurrence of various complications and help restore full mobility. During the rehabilitation period after a femoral neck crack, electrophoresis, ultrasound, paraffin baths, magnetotherapy, UHF therapy, and therapeutic mud are used.
- Massage sessions. Such procedures allow you to maintain normal blood flow and muscle tone. Massage therapy helps prevent bedsores, osteoporosis, congestive pneumonia and muscular atrophy. In addition, it significantly improves the activity of the cardiovascular apparatus and respiratory system.
- Physiotherapy. This kind of gymnastics is extremely important for quick recovery after repairing a femoral neck crack. A set of exercises is individually selected for each patient. In the process of rehabilitation, respiratory and motor physical education is used. As the condition alleviates and mobility returns, the complexity of the exercises should increase.
- Diet therapy. People who are diagnosed with a hip fracture must follow a diet. The food should be not only tasty, but also high-calorie. You need to give preference to products that are rich in calcium and trace elements necessary for bone restoration. The diet should contain dairy products, cheeses, meat broths, jellies.
- Psychotherapy. Due to prolonged forced immobility, people with injuries to the femoral neck are often depressed. Many patients even develop severe depression against this background. In this case, the therapist comes to the rescue.
Injury prevention
The main way to prevent damage to the hip joint is the timely detection and treatment of conditions preceding a hip fracture - coxarthrosis and osteoporosis. These pathologies can only be detected during the examination process. Therefore, people in old age should regularly undergo densitometry of the skeleton.
It is also recommended for elderly patients to enrich their diet with dairy products, vegetables and sea fish. Additionally, vitamin D and calcium-containing medications can be taken as prophylaxis.
To prevent injuries of the femoral neck, it is useful to train the muscular skeleton. Systematically performed exercises protect the bones from damage due to the increased tonus of skeletal muscles.
It is equally important to make your life as safe as possible. Those planning long walks should use the cane. It is advisable to install convenient handles in the bathroom, which can be relied on during various manipulations. Special care should be taken when walking on stairs and on slippery sections of the road.
These simple rules of prevention can significantly reduce the risk of injury and protect the neck of the thigh from any damage.