Fracture of the neck of the femur most often affects the elderly and is the result of falls. It is associated with a high risk of complications resulting from trauma and prolonged immobilization.
Fractures of the proximal femur can result in hip deformity, gait disturbance, or inability to move independently. If the femoral neck is broken in an elderly person, the healing process takes a very long time and does not always end in a complete recovery. Therefore, prevention is needed, which includes exercises that improve overall physical fitness, eliminate the risk of falls, as well as taking drugs that strengthen the bone structure.
Hip Anatomy: Proximal
The femur is the longest and one of the strongest bones in the skeleton. It is divided into a trunk and two ends: proximal and distal. The proximal part creates the hip joint through the spherical head of the femur, which is located in the acetabulum of the joint. Between the head of the femur and the trunk is the neck, the axis of which forms an obtuse angle: in men about 135⁰, in women about 126⁰. The neck in relation to the vertical is set approximately at an angle of 45⁰.
This proximal femur design predisposes to injury because loads are not transferred axially (lower load) but angularly (higher load). If there is a large lateral force (fall), a fracture occurs most often at that location.
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 femoral neck. 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;
- taking steroid medications;
- malnutrition;
- lack of physical activity.
By far 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 is manifested in the susceptibility to fractures even with minor injuries - when stumbling, falling from a chair or bed.
Elderly people often complain to doctorswomen: "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 trauma, in cases of pre-existing severe hip or skeletal disease. This condition is called a slow hip fracture.
Symptoms
Symptoms of a broken femoral neck include:
- severe pain around the thigh, in most cases interfering with walking;
- pain in the thigh when touched,
- bruising;
- thigh distortion;
- characteristic installation of the affected limb, which turns outward;
- shortening 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, hips and knees, which occurs with the load on the limbs, with extreme ranges of motion and disappears at rest. Sometimes the pain may appear at night. Signs of a broken femoral neck include lameness and lack of inward movement of the lower limb.
Fracture of the neck of the femur - a threat to life
As a result of a hip fracture, blood is lost, which is associated with the formation of a large hematoma (can hold up to about 0.5 liters). The blood does not go outside and does not participate in the intracardiac circulation. Losing half a liter of blood for a strong body is not a big problem, but if the femoral neck is broken in an elderly person with blood loss, this is a big burden for the body. Often such a patient needs intravenous fluids 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 mechanism of blood clotting, which is very useful in case of damage to the vessels and no less dangerous when the vessel is not damaged. Clots formed during this time can block an important blood vessel (such as in the heart, lungs, or brain), leading to ischemic stroke, myocardial infarction, and often death.
Surgical treatment
If an elderly person has a broken femoral neck, treatment should not be delayed, it is important to go to the hospital as soon as possible. In honey. In the institution, the doctor will prescribe an examination (especially x-rays) and evaluate the x-rays. Treatment depends on the location and complexity of the injury. Only a doctor can voice a disappointing diagnosis: "Your hip is broken." Surgery in this case is the best solution, which guarantees a quick recovery.
Surgical treatment is divided into two methods:
- Endoprosthetics - the damaged part is replaced partially or completely with an artificial element - a titanium prosthesis. This hip fracture surgery is performed on elderly patients and those who have not experienced bone fusion after other treatments.
- Osteosynthesis - consists in fixing bone fragments with titanium screws, pins or knitting needles for the purpose of their subsequent fusion. If the neck is brokenhip in an elderly person over 65 years of age, such an operation is ineffective. At this age, bone 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 length of the immobilization period depends on how the operation is performed. However, the staff strives to get patients back on their feet as soon as possible, 2-3 days after surgery. Of course, the affected limb is protected from the load. Standing upright is also essential to prevent deep vein thrombosis and pressure ulcers, which appear much faster in older people than in younger people.
Walking after a hip fracture begins first with a walker, preferably with a physical therapist, then with crutches. The return to normal activities is gradual, under strict medical supervision.
Broken femoral neck. How is a patient treated without surgery?
Unfortunately, few older people can undergo surgery due to comorbidities. A patient who cannot be operated on due to poor general he alth should be treated with skeletal traction with immobilization of the injured limb in a 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 the pelvic bones. Such treatment usually requires about 6-8 weeks of bed rest andcarries a high risk of complications.
When an elderly person has a fractured femoral neck, 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, painkillers and NSAIDs are prescribed, then they are given drugs that stimulate regenerative processes. If the pain is extremely pronounced, they give painkillers injections.
Conservative treatment also includes taking anti-inflammatory, chondoprotective and decongestants.
If the femoral neck is broken, prolonged immobilization is inevitable. For such patients, it is necessary to protect areas subject to pressure and bedsores - especially the area of the sacrum, occiput, heels and ankles. Movement of the rest of the musculoskeletal system should be ensured to prevent contractures, maintain mobility, muscle strength, and stimulate 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 mutual work of the patient with the doctor, very good treatment results can be obtained, despite the weakness of the limbs.
Rehab
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 femoral neck, care and rehabilitation can take 6 to 12 months. Treatment at home is aimed at restoring the functions of the injured limb. The patient learns to walk again, gradually increasing the load.
In the case of older people, 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). Rehabilitation for people with broken bones includes:
- Physiotherapy - the use of procedures to accelerate the healing process (magnetic field, laser therapy), with analgesic and anti-edema effects (cryotherapy), improving blood circulation in the operated limb (whirlpool bath, heating lamps). The doctor refers to physiotherapeutic procedures only after studying the patient's medical history, his concomitant diseases, indications and contraindications for treatment.
- Gentle soft tissue massage that relieves tension, improves circulation and nourishment.
- Performance of therapeutic exercises aimed at strengthening muscle strength and obtaining mobility in each joint of the operated lower limb. In the initial phase of rehabilitation, it is best to do light exercises with a physical therapist.
- Isometric glutes and quadriceps exercises.
- Breathing exercises.
- Anticoagulant exercise.
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 carried out involving the entire lower limb, increasing strength, controlling movements and working on uneven surfaces.
First you need to teachpatient to walk with assistive equipment (walker) and then without it. This includes learning to load the affected limb, coordinate movements, and maintain balance. Patients are encouraged to take regular walks, and after the wound has healed, to play sports in the pool. Full weight bearing of the lower limb occurs approximately 12 weeks after the procedure. This is also the time when you should strive to increase muscle strength and regain full range of motion. All new elements should be introduced after prior consultation with the patient's doctor.
As part of rehabilitation, the family must provide the patient with conditions for recovery at home after he returns from the hospital. It is necessary to adapt the 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 a high chair (so that the angle of bent knees is 90 °).
Fractured femoral neck: consequences and complications
Unfortunately, fractures of the proximal end of the femur, especially in the elderly, are called the last fracture in life, because up to 20% of patients die due to complications from the injury.
Studies show that about 50% of patients get back in shape, allowing them to move on their own. The other half is doomed to numerous complications that significantly impair daily functioning.
Amongcomplications of a hip fracture in the elderly can be noted:
- lack of bone union;
- damage to blood vessels;
- femoral head necrosis;
- thromboembolic complications;
- creating a false joint;
- bedsores;
- muscle contractures;
- great limitation in joint mobility.
If a person has had surgery on a fractured femoral neck, the consequences of such a procedure may be:
- anemia is a large loss of blood as a result of a fracture and subsequent surgery;
- infection;
- weakening of the prosthesis - occurs rarely, most often in cases of advanced osteoporosis, when the bone is very soft.
Nutrition for hip fracture
When bones are injured, increased cell division and death occur, causing the activation of all metabolic processes. This creates a need for increased nutrient intake.
If a person has broken his femoral neck, his diet should be balanced in terms of the amount of proteins, fats and carbohydrates. Meals should be easily absorbed by the body. The diet should be supplemented with protein-rich foods - proteins in them play the role of "building material" for bone tissue.
It is necessary to compensate for the lack of vitamins C and E in the body. These powerful antioxidants slow down the process of lipid oxidation, which additionally affects the regeneration of bone tissue.
MostAn important trace element for the restoration of bone structures is calcium. Its amount in the body can be supplemented with fermented milk products.
Foods recommended for patients with broken bones include:
- Lean meats and fish (turkey, beef, cod, trout). It is advisable to steam them or bake them in the oven.
- Groats - buckwheat, oatmeal, pearl barley. They contain many vitamins, fiber and essential amino acids.
- Calcium-rich dairy products.
- Vegetables and fruits - will replenish the supply of vitamins and trace elements in the body.
- Beans are an excellent source of vegetable proteins. Beans, peas, soybeans should be carefully introduced into the diet of patients with a tendency to flatulence and digestive problems.
- Foods 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 dietary supplements. They contain vitamins, minerals, in particular calcium to accelerate bone regeneration.
Expert Tips
In case of a fracture of the femoral neck, first aid and prompt hospitalization are needed. The injured leg should be placed motionless relative to the pelvic bone and a splint should be applied 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 within the first three days after injury improves the patient's prognosis.
