Fracture of the femoral neck is a complex and rather dangerous disease, which is classified according to a number of features. Two well-known scientists Powells and Garden proposed their 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.
Description of the disease
The femoral neck joint is very large, it acts as a musculoskeletal system for the human body, as it mainly distributes the load when walking.
A hip fracture is a break in the upper part of the femur. A very common problem, especially among older people over fifty.
When fractures, the joint, or rather its part (spherical head) is deprived of nutrition from blood vessels, this leads to nonunion and avascular necrosis. Circulation after the onsetthe latter is almost impossible to restore, therefore it is believed that this leads mainly immediately to disability and immobilization of the limb.
Reasons
The reasons may be different for people of different ages. Given that older people are more prone to these diseases than others, 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 he alth, monitor it, especially the elderly.
What causes a fracture in the elderly:
- Cancerous tumors, benign and malignant.
- Sharp and strong drop in the level of clarity of vision.
- Sedentary lifestyle, office work.
- Overweight, well overweight.
- Anorexia, starvation.
- Climax in the fairer sex.
- Stress, disturbances in the nervous system of the body.
- High cholesterol, atherosclerosis.
What triggers a fracture in young people:
- Injuries at work.
- Various traffic accidents.
- Falling from a great height, severe bruising.
- Battle wounds.
Symptoms and Diagnosis
Fracture most often occurs in the following situations:
- Accidental bruising on a hard surface.
- Falling on ice, asph alt, etc.
- Car accident.
- Fall fromheight.
The following main symptoms are distinguished:
- Sharp sharp pain.
- Pain gets worse with movement.
- Violations of the normal function of movement, in especially difficult situations, complete immobilization.
- Bruising.
- Pain appears that radiates to the groin.
- Swelling in impact area, impact with hard surface.
- Shortening a moving part of the body (only when displaced) that has been bruised.
- Bruises and bruises at the impact site.
Basic diagnostic methods:
- Interrogation of the patient.
- Examining a patient.
- X-ray.
- In difficult situations, MRI and CT are prescribed.
Treatment
If the above symptoms appear, you should contact a traumatologist in a timely manner and as soon as possible, because this disease affects the general condition of the human body, adverse consequences may develop.
Conservative treatment of elderly patients looks like this:
- The patient is admitted to the hospital.
- Apply skeletal traction with light weight.
- Prescribe physical therapy classes.
- Walking is possible only with crutches under the supervision of the medical staff or someone close to you.
- About six months later, full working capacity is restored.
Treatment of young patients:
- Apply a plaster splint up to the knee joint.
- Wear untilsix months.
- While wearing, walk strictly on crutches.
Types of surgical treatment:
- Osteosynthesis - connects parts of the bone with metal structures - a Smith-Petersen nail, three screws, a dynamic femoral screw.
- Arthroplasty is the replacement of parts that cannot be restored due to age or very large damage. There are the following types: cementless and cement, replacement of only the head and neck, replacement of the head.
After any chosen treatment, it is necessary to conduct a rehabilitation course, which includes a special massage, therapeutic exercises (exercises can be suggested by a doctor), drug therapy and sessions with a psychologist.
Classifications
Currently existing systematizations are determined by the clinical and physiological characteristics of fractures. There are several subtypes of hip fracture classifications: Powells, Garden, ICD, AO.
Classic looks
In the classification of femoral neck fractures, there are many signs and parameters of dividing the disease into various types and subspecies. Below are the main ones.
At the fracture site:
- Basal - fracture at the base of the cervix.
- Transcervical - in the center of the femur.
- Subcapital - break at the head.
- Chetericular - between the neck and the skewers.
Like any fracture, there can be three main types:
- Open.
- Closed.
- Slipped.
In the classification of femoral neck fractures, diseases are also distinguished by the area of damage:
- Medial - in the joint capsule.
- Lateral - outside the joint.
- Intra-articular - inside the joint.
By the nature of the shift of the bone:
- Abduction - the bone is shifted up outward.
- Varus - the bone is shifted down inward.
- Injected - one bone is shifted into another.
There are three degrees of angle - 30°, 50° and 70°.
By the presence of subcapital damage:
- Unfinished.
- Completed.
- With partial displacement.
- Full offset.
Powells
Above is information about the systematization of femoral neck fractures. The Pauwels classification is based on the definition of the angle formed by the fracture line and the horizontal position.
All three degrees of possible development:
- If 1 degree (tilt angle up to 30°), you can recover quickly and easily.
- If about 50°, then any mechanical load on the sore spot acts as a cutting force.
- If the deviations are more than 70°, then such fractures do not pass without a trace, accompanied by severe cutting pain. Very unfavorable for recovery, because they are unstable and constantly shifting, and in especially severe cases form false joints.
The degree affects the speed and ability of the recovery process. If athe indicator is large, then the treatment will be very long, the fracture is in an unstable state.
The Powells classification of femoral neck fractures considers medial femoral fractures. However, this is not the only systematization of the disease.
Garden Systematization
Classification of femoral neck fractures according to Garden divides fractures depending on the presence and degree of displacement of the bone. There are 4 types:
- Unfinished. From below, the bone breaks like a branch, while the upper part turns out a little.
- Completed. The bone breaks without displacement to the end. At the same time, the ligaments continue to connect the fragment.
- With partial displacement. The only difference from the previous type is that the ball head turns inward.
- With full displacement. Fragments do not even adhere to ligaments, parts of the bone are completely separated.
Garden's classification of femoral neck fractures appeared in 1961. She looks at displacement in fractures and how this affects recovery.
By AO
The parameter of this type of classification is the division of parts of the bones into three types, and then each of the obtained ones into three more. The distribution is based on the severity of the disease.
For the hip area, allocate:
1. Proximal segment:
- trochanteric zone (tratrochanteric simple, pertrochanteric comminuted, intertrochanteric), with pronounced valgus more than 15 percent.
- Cervix (subcapital with slight displacement, transcervical, subcapitalnon-impacted with displacement), with mild valgus less than 15 percent.
- Head (cleavage, depression, with neck fracture) without impaction.
2. Diaphysis (transcervical fractures):
- Easy 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 (highly displaced):
- Extra-articular with varus and eversion outward.
- Intraarticular incomplete with shortening and eversion outside.
- Intra-articular complete with strong displacement.
The classification of femoral neck fractures according to AO is designated as 31B - the femur is the third segment, the proximal part of the segment is considered the first, and the letter B indicates the severity of the fracture - intra-articular.
According to ICD
The International Classification of Diseases is the main document for systematizing diseases. At the moment, the latest version is valid - ICD-10.
What is the ICD-10 classification of hip fractures? Disease code - S72.0.
In the elderly
The hip bone breaks mainly in the elderly. If you pay attention to the statistics, it indicates that women of retirement age are at the highest risk of getting this injury (more than half of the registered 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 estrogens in the body decreases sharply, which play a leading role information and existence of bone cells. Consequently, all these processes lead to the emergence and rapid development of such a disease as osteoporosis, which in turn is a destructive renewal of bone tissue of a non-inflammatory nature.
Especially the key point for the formation of the forecast will be the course and the specific location of the fracture, 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 preserved. And if this happens, then there is a risk of avascular necrosis, which is the death of bone tissue in the absence of blood supply and the impossibility of fusion of broken bones. The elderly are at risk regardless of the type of fracture.
As the years go by, human movements become less active, fractures heal for a very long time and are difficult, the whole organism as a whole, including the musculoskeletal system, weakens. Elderly people often face fracture problems because the bones become brittle, the condition and blood supply worsen. In almost all older people who are over 50 years old, osteoporosis mainly appears and develops very actively - a dangerous disease associated with metabolic disorders, which is expressed by an increase in bone fragility. Such failures in the body can lead to very serious injuries and consequences, including complete immobilization and disability, and death. The consequences depend on the age and complexity of the injury onearly 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, surgical intervention is immediately prescribed, because drug treatment does not help in any way and does not cause positive dynamics. But it is worth noting that older patients tolerate this type of operation much easier than drug treatment.
There is no proper classification of hip fractures in the elderly. The systematization of the disease is not based on the age factor.
