A fracture of the femoral neck is a complex and rather dangerous disease, which is classified according to a number of signs. Two well-known scientists, Powels and Garden, proposed methods for systematizing this pathology. Fractures in the elderly have their own characteristics and certain risks. Consider the causes, symptoms, methods of diagnosis and treatment of various types of fractures.
Disease Description
The joint of the femoral neck is very large, plays the role of the musculoskeletal system for the human body, since it mainly distributes the load when walking.
A fracture of the femoral neck is a fracture of the upper part of the femur. A very common problem, especially among older people over fifty.
In fractures, the joint, or rather its part (spherical head), is deprived of nutrition from the blood vessels, this leads to non-healing and avascular necrosis. Blood circulation after the onset of the latter is practically impossible to restore, therefore it is believed that this leads mainly immediately to disability and immobilization of the limb.
Causes
The reasons may be different for people of different ages. Given that older people are more prone to these diseases than the rest, it can be argued that, for example, a small bruise on the bed can easily cause displacement. Therefore, you need to be very careful about your health, monitor it, especially for older people.
What triggers a fracture in the elderly:
- Cancers, benign and malignant.
- A sharp strong drop in the level of clarity of vision.
- Sedentary lifestyle, office work.
- Excess weight, far exceeding the norm.
- Anorexia, starvation.
- Menopause in the fairer sex.
- Stress, disturbances in the nervous system of the body.
- Elevated cholesterol, atherosclerosis.
What triggers a fracture in young people:
- Industrial injuries.
- Various traffic accidents.
- Falling from a great height, severe bruises.
- Battle wounds.
Symptoms and Diagnosis
Fracture most often occurs in the following situations:
- Accidental injury on a hard surface.
- Falling on ice, asphalt and the like.
- Car accident.
- Falling from height.
The following main symptoms are distinguished:
- Sharp sharp pain.
- The pain becomes stronger with movement.
- Violations of the normal function of movement, in especially difficult situations, complete immobilization.
- Bruising.
- There is pain that gives to the inguinal region.
- Swelling in the area of impact, collision with a hard surface.
- Shortening of the moving part of the body (only at displacement), which was bruised.
- Bruises and bruises at the site of the impact.
The main diagnostic methods:
- Interrogation of the patient.
- Examination of the patient.
- Roentgenography.
- In difficult situations, MRI and CT are prescribed.
Treatment
If the above-mentioned symptoms appear, you should contact a traumatologist in a clinic as soon as possible, because this disease affects the general condition of the human body, and adverse effects may develop.
Conservative treatment of elderly patients looks like this:
- The patient is placed in a hospital.
- Impose skeletal traction with a small load.
- Prescribe physical therapy classes.
- Walking is possible only with crutches under the supervision of medical staff or someone close.
- After about six months, full working capacity is restored.
Treatment of young patients:
- Apply a plaster cast to the knee joint.
- Wear up to six months.
- While wearing walk strictly on crutches.
Types of surgical treatment:
- Osteosynthesis - connects parts of the bone with metal structures - Smith-Petersen nail, three screws, dynamic femoral screw.
- Endoprosthetics - replacement of parts that cannot be restored due to age or very large damage. It happens of the following types: cementless and cement, replacing only the head and neck, replacing the head.
After any treatment chosen, it is necessary to carry out a rehabilitation course, which includes a special massage, therapeutic exercises (the doctor can prompt the exercises), drug therapy and classes with a psychologist.
Classifications
The current systematization is determined by the clinical and physiological characteristics of the fractures. There are several subtypes of classifications of femoral neck fractures: according to Powels, according to Garden, according to ICD, according to AO.
Classic views
In the classification of femoral neck fractures, there are many signs and parameters of the division of the disease into various types and subspecies. Below are the main ones.
At the fracture site:
- Basal - a fracture at the base of the cervix.
- Transcervical - in the center of the femur.
- Subcapital - a fracture at the head.
- Extravagant - between the neck and skewers.
Like any fracture, there can be three main types:
In the classification of femoral neck fractures, diseases are also distinguished according to the area of damage:
- Medial - in the joint capsule.
- Lateral - outside the joint.
- Intra-articular - inside the joint.
By the nature of the bone shift:
- Abduction - the bone is moved up out.
- Varus - the bone is moved downward inward.
- Impacted - one bone is shifted to another.
According to the angle indicator, there are three degrees - at 30 °, 50 ° and 70 °.
By the presence of subcapital damage:
- Unfinished.
- Completed.
- With partial displacement.
- With full offset.
Powels
Above, information has been provided on the systematization of hip fractures. The Pauwels classification is based on determining the angle formed by the fracture line and horizontal position.
All three degrees of possible development:
- If 1 degree (tilt angle up to 30 °), then you can quickly and easily recover.
- If approximately 50 °, then any mechanical load on the sore spot acts as a cutting force.
- If the deviations are greater than 70 °, then such fractures do not pass without a trace, accompanied by severe cutting pain. They are very unfavorable for recovery, because they are unstable and constantly displace, and in especially severe cases form false joints.
The degree affects the speed and ability of the recovery process. If the indicator is large, then the treatment will be very long, the fracture is in an unstable state.
The Powels classification of femoral neck fractures considers medial femoral fractures. However, this is not the only systematization of the disease.
Garden systematization
Garden's classification of femoral neck fractures divides the fractures according to the presence and degree of bone displacement. There are 4 types:
- Unfinished. From below, the bone is cracked like a branch, while the upper part is slightly twisted.
- Completed. The bone breaks without displacement to the end. In this case, the ligaments continue to connect the fragment.
- With partial displacement. The only difference from the previous type is that the ball head rotates inward.
- With full offset. Fragments do not hold even on ligaments, parts of the bone are completely separated.
Garden hip fracture classification appeared in 1961. She examines displacements in fractures and how this affects the possibility of recovery.
By JSC
The parameter of this type of classification is the division of the parts of the bones into three types, and then each of the resulting three more. The distribution is based on the severity of the disease.
For the hip area, there are:
1. The proximal segment:
- The trochanteric zone (the overtrovert simple, the overtrovert comminuted, the intertrochanteric), with pronounced valgus more than 15 percent.
- Cervix (subcapital with a slight displacement, transcervical, subcapital with no displacement), with light valgus less than 15 percent.
- Head (splitting, pressing, with a fracture of the neck) without hammering.
2. Diaphysis (transcervical fractures):
- Simple at the base of the femoral neck.
- Wedge-shaped in the middle of the femoral neck.
- Complex in the middle of the neck with a shift.
3. Distal segment (strongly displaced):
- Extraarticular with varus and inverting outwards.
- Intra-articular incomplete with shortening and turning out.
- Intra-articular full with strong displacement.
Classification of femoral neck fractures by AO is designated as 31B - the femur is the third segment, the proximal segment of the segment is considered the first, and the letter B indicates the severity of the fracture - intraarticular.
According to ICD
The international classification of diseases is the main document on the systematization of diseases. At the moment, the latest version is valid - ICD-10.
What is the classification of femoral neck fractures according to ICD-10? The disease code is S72.0.
In older people
The hip bone breaks mainly in the elderly. If you pay attention to statistics, it indicates that women of retirement age are at the highest risk of getting this injury (more than half of the reported cases). All this happens for a reason, it can be explained by the fact that in women at this age menopause occurs and the amount of estrogen in the body decreases sharply, which play a leading role in the formation and existence of bone cells. Therefore, all these processes lead to the emergence and rapid development of a disease such as osteoporosis, which in turn is a destructive renewal of bone tissue of a non-inflammatory nature.
A particularly key moment for the formation of the forecast will be the course and the specific fracture site, its variety. The shorter the distance from the fracture site to the femoral head, the lower the likelihood that blood supply and nutrition can be maintained. And if this happens, then there is a risk of avascular necrosis, which represents the death of bone tissue in the absence of blood supply and the impossibility of fusion broken bones. Elderly people are at this risk regardless of the type of fracture.
Over the years, human movements become less active, fractures are very long and difficult to heal, the whole organism as a whole weakens, including the musculoskeletal system. Older people often experience fracture problems because their bones become fragile, their condition and blood supply worsen. In almost all older people who are older than 50 years old, osteoporosis predominantly appears and develops very actively - a dangerous disease associated with metabolic disorders, which is expressed by an increase in brittle bones. Such malfunctions in the body can lead to very serious injuries and consequences, including complete immobilization and disability, death. The consequences depend on the age and complexity of the injury at the initial stage.
The second most common factor leading to such consequences is muscle weakness. The most popular reason is that modern retirees work mostly in a sedentary mode. It is recommended to add movement to life.
In the case of such a disease in elderly people, surgery is immediately prescribed, because drug treatment does nothing and does not cause positive dynamics. But it is worth noting that elderly patients undergo such operations much easier than drug treatment.
Own classification of femoral neck fractures in the elderly is absent. The systematization of the disease is not based on the age factor.