Types, consequences, first aid and treatment of hip fracture
Content:
- What is a hip fracture?
- Symptoms of a hip fracture
- Types of hip fractures
- Recovery time after fracture
- Consequences of a hip fracture
- What is the danger of a hip fracture in the elderly?
- First aid for hip fracture
- Treatment of a hip fracture
- Rehabilitation after hip fracture
What is a hip fracture?
A hip fracture is an injury to the integrity of the femur. The injury is localized in its thinnest part, which is called the neck and connects the body of the bone and its head.
For many people, such a diagnosis is perceived as a sentence. This attitude towards trauma is due to the severity of recovery and the need for surgery in most cases. The hip joint is large and powerful; in the human body, it takes up the bulk of the load when walking.
Sometimes both the neck itself and the head of the femur are injured, and sometimes the greater trochanter suffers. In the cervical zone, fractures are subdivided into lateral or lateral, as well as intra-articular. Medial fractures are considered the most dangerous, since the bone inside the joint is difficult to restore.
This type of injury is extremely common and accounts for 6% of the total mass of fractures. The main category of affected people is pensioners who have crossed the 65-year mark. More often women turn to doctors with such a problem. This is due to changes in their bodies after menopause. A person with osteoporosis can have a fracture even after a minor blow. Although young people sometimes suffer from such an injury, they are fractured after falling from a height, during an accident or at work.
Symptoms of a hip fracture
Such injuries are well studied and are manifested in the following:
- Prolonged persistent pain that is localized in the groin area. At the same time, it does not have a pronounced character, a person can endure it for some time without seeking emergency medical help. Most people take pain as a sign of another joint disease, such as arthrosis or osteoporosis. Over time, the unpleasant sensations intensify, especially when trying to perform active movements and when resting on the heel of a sore limb.
- External rotation of the foot, that is, its rotation outward. This can be detected by carefully examining the position of the foot relative to the knee.
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The shortening of the injured leg, but not much, by no more than 4 cm, so this symptom is also often ignored. The reason for the shortening lies in the contraction of the muscles of the limb, inside which the fracture occurred. They seem to be pulled closer to the injured joint. This symptom is characteristic of varus fractures.
- A symptom referred to by doctors as "stuck heel." It manifests itself in the fact that when the patient holds the leg in weight, it slides off the horizontal surface, but at the same time the limb retains the ability to bend and unbend.
- The appearance of a crunch when the patient tries to turn the leg, which is in a horizontal position.
- Painful sensations on palpation of the injured area.
- Sometimes too intense pulsation of the femoral artery is noticeable.
- Due to the displacement of the greater trochanter, the Shemaker line is violated.
- In some fractures, the function of the leg is completely impaired and the person cannot not only walk, but also stand.
- When pressing or tapping on the victim's heel, unpleasant, sometimes very painful sensations arise.
- The appearance of a hematoma, which may not form immediately. The delay is due to the fact that the vessels are damaged deep in the tissues, next to the joint. And only after some time the hemorrhage becomes visible.
Types of hip fractures
There are several types of classification, they are based on different characteristics:
- Depending on the area of injury localization: in the area of the greater trochanter, in the area of the neck or head of the femur.
- From the fracture site: middle (medial), lateral (trochanteric, lateral).
- From the level of location: subcapital (most dangerous), cervical and basic cervical.
- From the type of displacement: varus fracture (the head is displaced downward and inwardly), a valgus fracture (the head is displaced upward and outward), a punctured fracture (a fragment is inside another)
- From the nature of the injury: open and closed fracture.
Each of them has characteristic features and its own symptoms. The most difficult and dangerous is an impaired intra-articular fracture, which, with inadequate therapy, can turn into an unplugged fracture and require surgical intervention.
Displaced pertrochanteric hip fracture
Peritotrochanteric fractures of the femur are injuries that extend from the base of the neck to the subtrochanteric line. Most often, the reason for obtaining such a fracture lies in a fall on a large trochanter, but sometimes an injury is formed as a result of a limb twisting. Retirement age is an additional risk of a displaced pertrochanteric fracture. Sometimes it is accompanied by a fracture of the ilium.
Characteristic features of a transtrochanteric fracture:
- A clear deterioration in the general condition of the victim.
- Large blood loss.
- There is a shift of the femoral neck, without destruction of the spongy structure of the trochanter. There is a risk of displacement of fragments of the damaged bone.
- Extensive tissue damage.
- Swelling of the thigh.
- Extensive hematoma.
- Intense pain with marked rotation of the limb.
For the treatment of a pertrochanteric fracture, it is urgent to immobilize the limb by fixing and stretching it. After the patient is taken to the emergency room, a plaster cast will be applied to him. But in most cases, patients of retirement age cannot withstand its load for a long time, so they need surgery. This procedure needs careful preparation and is carried out under general or local anesthesia, only in the orthopedic department. After its completion, the patient will need to wear a derotation boot for some time. When the bone fragments are securely held together, you can move around without crutches.
Impacted hip fracture
More often it occurs inside the joint; in people of retirement age, a fracture can form even as a result of intense walking, increased load on the limb and a slight push, without falling. Since the pain is not too intense, and the functions of the leg are unlimited, a person can continue to lead a normal life without seeking medical help. The thought of a fracture may arise only due to the fact that the pain, although not expressed, is chronic.
The special danger of a hammered hip fracture lies in its latent course. Due to the fact that the injury remains undiagnosed, further displacement of one or more bone fragments occurs. This is fraught with the transition of a punctured fracture into an unplugged one. To confirm the diagnosis, the doctor will need an X-ray taken in two projections - axial and anteroposterior.
A distinctive feature of a hammered fracture is a favorable prognosis for a complete cure, which is uncharacteristic for other types of femoral neck trauma. But it is important to start therapy on time, which will consist of skeletal traction, immobilization of the limb with a plaster cast, taking medications and exercise therapy.
Comminuted fracture of the femoral neck
This species is characterized by the following features:
- Pain of moderate intensity.
- Swelling of the damaged area.
- Extensive bruising in the joint, usually in the left third of the thigh.
- Inability to step on the heel.
- Dizziness and general malaise.
Treatment consists of surgery. It consists in the imposition of skeletal traction, which aims at repositioning the fragments, as well as carrying the wire into the corresponding section of the bone. After the operation, therapy with antibiotics and anticoagulants is performed, after about 10 days the sutures are removed. Rehabilitation includes mandatory exercise therapy. The forecast is favorable.
Open fracture of the femoral neck
This is the worst injury. Its main feature is the rupture of soft tissues with access to the external environment. Most often, such fractures are observed with a gunshot wound. They are characterized by high blood loss and severe pain. The victim must be taken to the hospital as soon as possible. Most often, such injuries are accompanied by damage to other internal organs.
Closed hip fracture
A closed fracture is the result of a fall or a direct blow to the thigh. In this case, displacement of fragments is often observed. As in other cases, people of retirement age are most often affected by it.
A closed fracture with a displacement of two condyles, which have a direction up and to the side, requires special treatment. The fracture line runs along the entire joint due to which hemarthrosis is formed. Blood is poured into the joint from the damaged area.
A closed hip fracture is accompanied by the following symptoms:
- With a lower fracture, pain in the part of the thigh that is closer to the knee is characteristic. Limb movements are impossible, flexion and extension of the leg is painful.
- If the fracture occurs directly inside the joint, then the pain will not be too intense, and edema and hematoma may appear.
Treatment consists in performing a puncture of the joint, in order to suck out stagnant blood. If there is no separation of the fragments, which will be visible after the X-ray examination, then a plaster cast is applied to the injured limb.
The timing of wearing it is individual and depends on the intensity of restoration of the damaged bone, but not less than a month. If fragments were found, then it is necessary to reposition them, and only after that it is possible to apply a plaster cast. When it is impossible to match the broken parts of the joint, its complete replacement is required. If possible, for elderly people, doctors try not to do traction, as this leads to a long period of rehabilitation and bed rest, which is fraught with the development of other diseases.
Recovery time after fracture
The recovery time cannot be accurately calculated, since everything depends on its severity, character, patient's age and other factors. But on average, they are at least six months. Only after this time has passed a person will be able to stand on the injured limb completely transferring body weight onto it.
In most, the stage of treatment is accompanied by the following periods:
- On the third day after the application of the plaster cast, the patient should begin to massage the lumbar region. Then you should go to the intact limb. After a week, you can begin to massage the thigh, which was injured. This should be done carefully, following the doctor's recommendations.
- After two weeks, if the cast is removed, knee movements can be started. It is best to do this under the supervision of a doctor and only after his permission. Moreover, at the initial stages, the patient will need outside help. After about a month, you can start doing flexion and extension yourself. After 2 months, the patient may attempt to sit down. This must be done according to specialized instructions.
- After 3 months, the patient will be allowed to stand up on crutches and begin to move independently. In this case, the support should be on a healthy limb, you can only slightly start on a sore leg.
- Gradually, the load on the hip should be increased, and after six months, attempts can be made to return to a full life.
Consequences of a hip fracture
Since in most cases elderly people are affected, the consequences are quite severe. But with proper treatment, they can be avoided.
However, the consequences of a hip fracture are:
- As a result of circulatory disorders - death of the head of the bone, up to its decomposition and complete disappearance. This condition is called aseptic necrosis. When there is a high risk of such a pathology, it is better to carry out prosthetics in advance, which does not make sense to refuse. This will be the best prevention of this type of complication.
- Sometimes a false joint can form inside the fragments. It develops when they do not fuse. It is treated promptly. The degree of movement disorder is determined individually. A person either completely loses the ability to step on a limb, or moves on it, experiencing some discomfort.
- The sooner a person regains physical activity, the lower the risk of venous thrombosis forming. Pathology develops against the background of a long stay in one position. Venous blood stagnates and, as a result, blood clots form. The consequences of such a complication are serious, up to the death of the victim. Proper care is essential for prevention.
- Sputum congestion can lead to the patient suffering from pneumonia. Due to the long stay in one position, the lungs are not able to function normally. The inflammation is difficult and can be fatal. An additional risk factor is a decrease in immunity. Therefore, it is imperative to correctly conduct breathing exercises.
- Sometimes complications arise after surgery. This can happen when the screws are inserted too deep into the bone or at the wrong angle. Nerves and blood vessels, the acetabulum are affected. All of this refers to early postoperative consequences.
- Rarely, but still there are complications delayed in time, after the operation. They are expressed in the rejection of the prosthesis or loosening of the metal structure implanted inside.
- Infection during the operation.
- Violation of a psychological nature, the development of depression, the appearance of an unwillingness to live.
- Sometimes bedsores can form, which occurs due to inadequate care of the injured immobilized person.
- Joint contractures, osteoarthritis, osteomelitis can form.
- Arthrosis can develop when a joint undergoes degenerative destruction and dysfunction. Prevention consists in constant medical supervision and adequate therapy of the disease in the early stages of its appearance.
The main prevention of possible complications is reduced to proper care of the victim, assistance in performing hygiene procedures. Psychological support of a person is also important; a positive attitude and belief in the possibility of recovery are important in treating a fracture. Strict adherence to all the doctor's prescriptions, the implementation of rehabilitation procedures in full is a guarantee that the patient will restore the previous standard of living, regardless of the age and nature of the injury.
What is the danger of a hip fracture in the elderly?
When a hip is injured, especially in old age, there are some additional risks associated with:
- The emergence of severe complications. They are associated with both physical and psychological health of a person.
- Due to a decrease in immunity, there is a risk of developing other diseases not associated with joints. Most often, the cardiovascular and respiratory systems are affected.
- A long time in bed undermines the health of an elderly person, exacerbates those who already have chronic diseases.
- The greatest danger is that the person could die. The most common causes of death after such a fracture are heart failure, thromboembolism, and pneumonia.
- Sometimes an elderly person, deciding that he is becoming an unbearable burden for his family, decides to commit suicide.
- Refusal of surgery and complete immobilization of the patient.
First aid for hip fracture
The most effective help in the event of such an injury is to call the medical team.
If there is a need to independently deliver the victim to the hospital, then a number of measures must be taken:
- To begin with, the person must be laid on his back.
- With severe, unbearable pain, anti-shock measures must be taken. They consist in anesthesia, both local and general. Any pain reliever will do, such as ibuprofen or ketoral.
- It is important to immobilize the diseased limb. To do this, it must be fixed with a tire. A rail, board or plywood is suitable as an improvised material. All joints of the leg need fixation, not just the hip. If no suitable thing was found, then you can tie the diseased limb to the healthy one.
- It is important to apply the splint correctly. It should take its beginning in the groin, from the inside of the limb, and end near the heel. It should be fixed in the area of the heel, knee and groin.
- Clothes and shoes should not be removed. If the injury was received in the cold season and the victim is on the street, then the limb must be additionally insulated. Since it will be more susceptible to frostbite than a healthy leg.
- It is necessary to carry a person on a hard surface, preferably on a stretcher.
- When bleeding, you need to tighten the leg with a tourniquet, but not too much. If the limb begins to turn blue, then it is important to loosen the bandage.
- It is important to calm the patient down, do not panic because of his screams and groans - this is a normal human reaction to such an injury. You should pay more attention to the victim, who remains indifferent to pain, most likely he is in a state of shock.
- If you have to deliver the person yourself, then it is important to calm down and not exceed the speed.
Treatment of a hip fracture
Trauma therapy is a prerequisite for the victim's recovery. In some cases, surgical intervention is required, but sometimes it is possible to do without it. A surgeon will not be needed if the fracture is located in the lower part of the cervix or if it is of the impacted type. Moreover, the latter is not treated promptly only when its line is horizontal and there is no risk of splitting. Also, it is impossible to carry out the operation when the patient is not able to transfer it.
There is a certain sequence of therapeutic measures. The circuit consists of:
- Finding the victim in a hospital. For this, there are specialized orthopedic and trauma clinics and departments.
- Skeletal traction is performed during the first two months after injury.
- The massage leads to a mandatory treatment regimen.
- When the tension is released, the patient will be able to move independently, for this he will need crutches. Leaning with a fracture is prohibited.
- In the fourth month, you can begin to gradually use the limb, but under the strict supervision of a doctor.
- After 6 months, the former patient most often begins to walk independently.
Immobilization for hip fracture
As a therapeutic technique, immobilization is used, that is, immobilization of the limb. It is shown in a number of cases and its purpose is to preserve human life.
The indications for its use are strictly limited:
- If a sick person is unable to endure the necessary surgical intervention for a number of reasons. Most often, they are in the general serious condition of a person, for example, with increased bleeding, general exhaustion, and the presence of certain diseases.
- If the patient has persistent mental disorders, for example, senile marasmus.
- If, even before the injury, the person was not able to move independently.
Immobilization consists of a series of sequential actions:
- Injecting the joint with local anesthetics, mainly lidocaine and novocaine are used.
- Application of skeletal traction for a short period, up to 10 days.
- Removing the structure.
- Turning the patient from side to side, planting him on the bed.
- From day 20, the patient is allowed to stand up using crutches.
- If the patient feels satisfactory, he is discharged, but he will not be able to move fully, without the help of crutches.
Operation
Before carrying out surgery, it is necessary to carry out a competent diagnosis. For this purpose, use classical techniques, radiography, computed or magnetic resonance imaging. Naturally, visual examination and palpation is necessary, as well as taking anamnesis and listening to a person's complaints.
It should be understood that surgery is most often an unavoidable procedure. Depending on the nature of the injury, special structures will be inserted into the fracture. These can be knitting needles, rods, or screws. If indicated, the doctor may recommend partial or complete joint replacement. This intervention is called prosthetics.
It is desirable, and sometimes even vital, to have the operation done early - on the first day after the injury. But sometimes the dates are postponed if a person has any contraindications. It is possible to spend some time at the hood.
Surgical intervention is based on several basic points:
- Mandatory use of anesthesia, which can be local or general. This directly depends on the complexity of the operation and the patient's condition.
- Before fixing the fragments, the doctor matches them correctly or, in another way, conducts a reduction.
- When the fracture is not complicated, the operation is performed under X-ray control, without opening the joint capsule. This method is called closed.
- Sometimes an open reduction is required; for this, the capsule is opened.
As for endoprosthetics, it also has certain indications and is used when there is a high risk of complications. The older the patient, the more often his native joint is replaced with a prosthesis. This is also done with a pronounced displacement of the fragments, when fragments are detected, with necrosis of the head.
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Exercises after a hip fracture
Performing a specialized set of classes is a prerequisite for effective recovery. Exercise helps to avoid serious consequences, gives the proper load to the muscles, prevents their atrophy, and contributes to the speedy recovery to feet. Therefore, the complexes recommended by doctors must be performed without fail.
They consist of three parts:
- To begin with, it is recommended to simply imagine how the movements will be performed. Then you can move on to contracting the muscles of the back, abs, buttocks, legs and arms. It is not worth keeping them in suspense for long, 30 seconds is enough. Flexion of all movable joints is performed - neck, limbs, shoulder girdle, etc. From the first days it is necessary to perform breathing exercises.
- When the cast is removed, you can move on to more complex exercises, which consist in active movement with healthy limbs. But the whole complex should be performed lying on your back.
- After a person starts to get up, it is important for him to try to walk with a stick, with one, with two, with the help of stilts, and then independently.
Rehabilitation after hip fracture
Recovery after an injury is not only physical exercise, but also in the normalization of the psychological state. Even after a person begins to move independently, he still feels vulnerable, may be depressed. If close people cannot help him get out of depression, then it is better to send the person to see a psychotherapist.
For the rehabilitation stage, normal sleep, proper nutrition, attending massage and treatment of exacerbated chronic diseases are important. An integrated approach will help the former bed hostage to recover faster and gain strength.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
