A hip fracture most often affects older people and is a consequence of falls. It is associated with a high risk of complications resulting from trauma and prolonged immobilization.
As a result of fractures of the proximal femur, femoral deformity, gait disturbance, or inability to move independently can occur. If the neck of a hip in an elderly person is broken, the healing process lasts a very long time and does not always end in a full recovery. Therefore, prevention is needed, which includes exercises that improve the general physical form, eliminate the risk of falls, as well as taking drugs that strengthen the bone structure.
Thigh Anatomy: Proximal
The femur is the longest and one of the strongest skeleton bones. It is divided into the trunk and two ends: proximal and distal. The proximal part creates the hip joint through the spherical femoral head, which is located in the acetabulum of the joint. Between the femoral head and the trunk is the neck, the axis of which forms an obtuse angle: for men about 135 , for women about 126⁰. The neck is set at an angle of approximately 45 degrees to the vertical.
This design of the proximal femur predisposes to the occurrence of injuries, since the loads are transmitted not axially (less load), but angularly (higher load). If there is a large lateral force (fall), a fracture in this place occurs most often.
Causes of injury
Due to the fact that the femur is very thick and strong, at a young age you need to try hard to break the neck of the thigh. In old age, this type of injury appears much more often. The reason for this is a decrease in bone strength. Among the factors predisposing to a hip fracture are:
- osteoporosis;
- bone tumors;
- congenital bone fragility;
- hormonal imbalance;
- steroid medication;
- malnutrition;
- lack of physical activity.
Of course, the most common cause of fractures is osteoporosis, which gradually leads to bone demineralization. This is a consequence of the aging of the skeleton, which manifests itself in susceptibility to fractures even with minor injuries - when stumbling, falling from a chair or bed.
Often, elderly women complain to doctors: "I broke my hip." This is due to hormonal disorders during menopause, which negatively affect the condition of the skeleton.
Sometimes spontaneous fractures can occur, without any noticeable injury, in the case of a pre-existing severe disease of the thigh or skeleton. This condition is called a slow fracture of the femoral neck.
Symptoms
Symptoms of a broken femoral neck include:
- severe pain around the thigh, in most cases interfering with walking;
- pain in the thigh area when touched,
- bruising
- distortion of the hip area;
- the characteristic installation of the affected limb, which turns outward;
- shortening of the affected limb.
When it comes to the process of slow destruction of the femoral neck, it is manifested by pain radiating to the groin, thigh and knees, which occurs when the limbs are stressed, with extreme ranges of motion and disappearing at rest. Sometimes pain may appear at night. Signs of a broken femoral neck are manifested by lameness and lack of movement of the lower limb inward.
Hip fracture - a threat to life
As a result of a femoral neck fracture, blood is lost, which is associated with the formation of a large hematoma (can hold up to about 0.5 l). Blood does not go outside and does not participate in intracardiac circulation. Losing half a liter of blood for a strong body is not a big problem, but if the hip of an elderly person with blood loss is broken, this is a big burden for the body. Often such a patient needs intravenous fluid administration, and sometimes a blood transfusion.
A big problem for the body is prolonged immobilization, especially in the case of conservative treatment. The danger arises from the blood coagulation mechanism, which is very useful in case of damage to blood vessels and is no less dangerous when the vessel is not damaged. Clots formed at this time can block the lumen of an important blood vessel (for example, in the heart, lungs, or brain), leading to ischemic stroke, myocardial infarction, and often death.
Surgery
If an elderly person has a broken thigh neck, treatment should not be delayed, it is important to contact a hospital as soon as possible. In honey. In the institution, the doctor will prescribe an examination (primarily an x-ray) and evaluate the x-rays. Treatment depends on the location and complexity of the injury. Only a doctor can make a disappointing diagnosis: "You have a broken thigh neck." Surgery in this case is the best solution that guarantees a quick recovery.
Surgical treatment is divided into two methods:
- Endoprosthetics - the damaged part is replaced partially or completely by an artificial element - a titanium prosthesis. This operation for hip fracture is performed both for elderly patients and those who have not had bone fusion after other treatment methods.
- Osteosynthesis - is the fixation of bone fragments with titanium screws, pins or spokes for the purpose of their subsequent fusion. If the neck of a hip is broken in an elderly person whose age exceeds 65 years, such an operation is ineffective. At this age, bone tissue regeneration is very slow.
After the procedure, the patient receives painkillers, anticoagulants and antibiotics to protect the postoperative wound from infection and remains motionless in bed. The duration of the period of immobilization depends on the method of operation. However, staff seeks to put patients on their feet as soon as possible, 2-3 days after surgery. Of course, the affected limb is protected from the load. Verticalization is also necessary to prevent deep vein thrombosis and pressure sores, which appear much faster in older people than in young people.
Walking after a fracture of the femoral neck begins first with a walker, preferably with a physiotherapist, then with crutches. A return to normal activity occurs gradually, under strict medical supervision.
Broken thigh neck. How is a patient treated without surgery?
Unfortunately, few older people can undergo surgical treatment due to comorbidities. A patient who cannot be operated on due to poor general health should be treated with skeletal traction with immobilization of the injured limb with a plaster cast. He needs to climb using the Balkan frame. This design provides early activation of patients in bed and is suitable for the restoration of pelvic bones. Such treatment usually requires about 6-8 weeks of bed rest and is associated with a high risk of complications.
When an elderly man’s neck is broken, even simple movements are perceived by him as too difficult, and the patient does not want to perform them. Therefore, at an early stage of treatment, pain medications and NSAIDs are prescribed, then medications that stimulate regenerative processes are given. If the pain is extremely pronounced, anesthetics are given.
Conservative treatment also includes the use of anti-inflammatory, chondoprotective and decongestants.
If the femoral neck is broken, prolonged immobilization is inevitable. For such patients, it is necessary to protect areas that are prone to pressure and pressure sores - especially the sacrum, neck, heel and ankle. Movement of the remaining parts of the musculoskeletal system should be ensured in order to prevent contracture, maintain mobility, muscle strength and stimulate blood circulation.
After the control x-ray, the patient begins to gradually stand up. In the future, close cooperation with a physiotherapist is necessary. Thanks to the patient’s collaboration with the doctor, very good treatment results can be obtained despite limb weakness.
Rehabilitation
In order for the patient to quickly restore his physical form and return to normal functioning, high-quality rehabilitation is necessary. If a person has a broken thigh neck, caring for him and rehabilitation measures can last from 6 to 12 months. Treatment at home is aimed at restoring the functions of an injured limb. The patient learns to walk again, gradually increasing the load.
In the case of the elderly, it is recommended to undergo rehabilitation in a special center so that the patient has physiotherapists and a doctor in one place (without transporting the patient to a medical facility). The rehabilitation of people with bone fractures includes:
- Physiotherapy - the use of procedures to accelerate the healing process (magnetic field, laser therapy), with analgesic and anti-edematous effects (cryotherapy), improve blood circulation in the operated limb (swirl bath, heating lamps). The doctor directs to physiotherapeutic procedures, only after studying the patient's medical history, its concomitant diseases, indications and contraindications for treatment.
- Gentle massage of soft tissues, which reduces their tension, improves blood circulation and nutrition.
- Performing therapeutic exercises aimed at strengthening muscle strength and obtaining mobility in each joint of the operated lower limb. At the initial stage of rehabilitation, it is best to perform simple exercises with a physiotherapist.
- Isometric exercises of the gluteal muscles and quadriceps femoris.
- Breathing exercises.
- Anticoagulant exercises.
Strengthening exercises are gradually introduced to improve the stability, elasticity of soft tissues and the performance of the nervous system. At the end of rehabilitation, training is conducted with the involvement of the entire lower limb, increasing strength, controlling movements and working on an uneven surface.
First, you need to teach the patient to walk with the help of auxiliary equipment (walkers), and then without it. This includes training on the load on the diseased limb, coordination of movements and maintaining balance. Patients are advised to take regular walks, as well as exercise in the pool after healing. Full load on the lower limb occurs approximately 12 weeks after the procedure. This is also the time when you should strive to increase muscle strength and restore full range of motion. All new elements should be introduced after prior consultation with the patient’s doctor.
As part of the rehabilitation, the family must provide the patient with the conditions for recovery at home after his return from the hospital. It is necessary to adapt housing conditions to the new needs of the patient, leveling thresholds and slippery surfaces, installing additional handrails and handles, removing furniture that prevents the patient from moving. The patient should be provided with high stool (so that the angle of the bent knees is 90 °).
Broken femoral neck: consequences and complications
Unfortunately, fractures of the proximal end of the femur, especially in older people, are called the last fracture in life, because up to 20% of patients die due to complications caused by trauma.
Studies show that about 50% of patients return to form, which allows them to move on their own. The other half is doomed to numerous complications that significantly impair daily functioning.
Among the complications of a femur fracture in the elderly can be noted:
- lack of bone fusion;
- damage to blood vessels;
- necrosis of the femoral head;
- thromboembolic complications;
- the creation of a false joint;
- pressure sores;
- muscle contractures;
- large restrictions on joint mobility.
If a person has undergone surgery in a place where the femoral neck is broken, the consequences of such a procedure may be:
- anemia is a large loss of blood as a result of a fracture and subsequent surgical intervention;
- infection;
- weakening of the prosthesis - rarely, most often in cases of widespread osteoporosis, when the bone is very soft.
Nutrition for hip fracture
With bone injury, increased cell division and death occurs, causing the activation of all metabolic processes. This creates the need for an increased amount of nutrients in the body.
If a person breaks his neck, his nutrition should be balanced in the amount of protein, fat and carbohydrates. Dishes should be easily absorbed by the body. The diet should be supplemented with foods rich in proteins - the proteins in them play the role of a "building material" for bone tissue.
It is necessary to fill the body’s deficiency in vitamins C and E. These powerful antioxidants slow down the process of lipid oxidation, which additionally affects bone regeneration.
The most important trace mineral for bone repair is calcium. Its amount in the body can be supplemented with dairy products.
Products recommended for patients with bone fractures include:
- Lean meats and fish (turkey, beef, cod, trout). It is advisable to steam them or bake in the oven.
- Groats - buckwheat, oatmeal, barley. They contain many vitamins, fiber and essential amino acids.
- Dairy products rich in calcium.
- Vegetables and fruits - replenish the supply of vitamins and minerals in the body.
- Legumes are an excellent source of vegetable proteins. Beans, peas, soy should be carefully introduced into the diet of patients with a tendency to flatulence and digestive problems.
- Products containing silicon - radishes, currants, turnips, olives, cauliflower and broccoli. This element increases the absorption of calcium in the body.
The diet of patients should be supplemented with biologically active additives. They include vitamins, minerals, in particular calcium to accelerate bone regeneration.
Expert Advice
In case of a fracture of the femoral neck, first aid and early hospitalization are necessary. The affected leg should be laid motionless relative to the pelvic bone and splinted from the hip to the knee (sometimes to the heel). Hospitalization of the patient is necessary within 3 hours after the onset of painful symptoms. An operation performed during the first three days after the injury improves the prognosis of the patient's recovery.