Pathologies of the musculoskeletal system are most common among the elderly. This is not surprising, because strong loads on the joints practiced throughout life lead to their damage and degeneration. A hip fracture is no exception. This type of injury is most commonly experienced by older people. The mechanisms of its development have their own characteristics.
The most common problem is osteoporosis. This disease is characterized by a decrease in bone density. Most often, the fair sex is at risk of getting a crack, since the structure of their bones deteriorates significantly against the background of the onset of menopause.
Changes in the body of older people prevent the full restoration of the integrity of the damaged femoral neck. Treatment tactics are selected taking into account the age of the patient and the severity of the injury. In advanced cases, a person may be prescribed arthroplasty.
Where is the femoral neck
The tip of the femur has a rather complex structure. The rounded end is the head of the bone, and the narrowed part,which connects the bone itself to the head is the femoral neck. In the photo you can see the placement of the listed parts and understand exactly how they are located.
On both sides of the neck there are peculiar bony protrusions called skewers. Muscles are attached to them. You can see all this in detail in the photo.
The femoral neck is considered the most fragile component of the hip joint. All sorts of injuries of this area are extremely common. They occur in about 60% of older people. Therapy and rehabilitation of fractures and fissures of the femoral neck are always very difficult and long. In some cases, it is impossible to achieve complete restoration of the motor functions of the lower extremities.
Causes of damage
It was noted above that a fissure of the femoral neck is diagnosed mainly in older women. Its cause is often menopausal osteoporosis.
Why is this happening? This phenomenon is explained by the peculiarity of the female body, which consists in cyclic changes in the concentration of hormones throughout the month. With the onset of menopause, the volume of female hormones in the blood gradually decreases, which affects the structure of bone tissue.
If a woman does not carry out systematic prophylaxis, she may develop osteoporosis during menopause. This pathology is characterized by a decrease in bone density. Over time, this disease leads to the development of such pathologies:
- Decreased bone strength.
- Eventhe slightest damage can lead to fractures and cracks.
- Falling from your height can cause a hip fracture.
- Against the background of ongoing osteoporosis, the femoral neck after an injury cannot recover on its own, which entails prolonged immobilization. As a result, the bone marrow may be damaged, which will provoke the development of various complications.
Another common cause of hip fracture in the elderly is coxarthrosis. This disease is often affected by overweight people, as well as those who regularly loaded the hip joints during work and sports.
If a fissure of the femoral neck appears in people of middle and young age, the following probable causes can be identified:
- Exercising too much.
- Intoxication of the body.
- Pathologies in the work of the endocrine system.
- Accidents like car accidents or hard falls.
- Sedentary lifestyle.
- Completeness.
- Regular strict diets that lead to deficiency of calcium and other nutrients.
- Oncological diseases.
Signs of a hip fissure in the elderly
If the injury is preceded by osteoporosis, then most often patients simply do not notice any problems in their condition. After all, this pathology proceeds imperceptibly due to the absence of specific symptoms. To prevent osteoporosis and femoral neck injuries in the elderlydoctors recommend that people systematically undergo densitometry, which allows you to assess the strength of bone tissue.
Fracture is the mildest form of injury, because the fracture does not go through the entire bone. In such a situation, doctors manage to achieve complete restoration of the femoral neck in a person through competent conservative therapy.
If we are talking about a bone fracture, that is, its through damage, then surgery is indispensable in this case. Conservative treatment, especially in the elderly, is often ineffective.
Whatever the damage to the femoral neck in a person in old age, he should immediately contact a traumatologist. The doctor will conduct the necessary examination, establish an accurate diagnosis and prescribe the appropriate treatment. When trying to self-medicate, a person can develop numerous complications. Therefore, do not refuse professional treatment.
Symptoms of a hip fissure are far from always specific and may well correspond to other pathologies. It is this feature that is another reason for contacting a traumatologist at the first suspicion of a limb injury.
It is important to understand that a fissure of the femoral neck may not make itself felt for a long time, but this injury can appear even with minor injuries. This is especially true for people who have arthrosis or osteoporosis.
Doctors identify several main symptoms of a hip fracture:
- Sharp pain in the pelvic area immediately at the time of injury, that is, when falling or hitting hard.
- Occurrence of aching pain during movement and attempts to lean on a limb.
- Usually a person can move, but it is given to him with difficulty.
- Musculature near the damaged joint becomes painful due to reflex spasms.
- Other symptoms of a hip fissure may not be pronounced due to the fact that the injured area is not on the surface of the limb, therefore it is not visually noticeable.
If before the moment of injury a person already had arthrosis of the joint, then he can take all the described signs for another manifestation of an exacerbation of the pathology. In such a situation, it is very important to pay attention to exactly when the symptoms occurred. With a crack, they always appear immediately after the injury.
Another feature is the long-term presence of pathological signs that do not disappear, despite the usual treatment of arthrosis. At the same time, non-steroidal anti-inflammatory drugs, which were previously effective, do not help with trauma.
Fracture of the femoral neck can turn into a fracture. Therefore, if you suspect an injury, you should not expose the limb to excessive load. In such a situation, you should immediately go to the doctor.
As for the symptoms of a fracture, it is more specific and different from the manifestations of a crack:
- An unusual outward turn of the foot occurs.
- A hematoma or intense redness appears at the site of injury.
- Lameness develops due to shortening of the limb.
- The patient is unable to lift the heel off the floor and keep the foot on the weight.
- An increase in body temperature is possible.
What is dangerous injury
Treatment of a hip fracture in the elderly is considered extremely important due to the high risk of severe complications. Doctors identify several dangerous consequences that can lead to very serious pathologies.
- Prolonged immobilization of the leg, inability to move without special orthopedic devices, repeated cracks and fractures, and the formation of a false joint, unable to function.
- Fat embolism. During an injury, there is a very high risk of bone marrow particles in the form of fat cells entering the bloodstream. These substances are capable of clogging blood vessels and provoking consequences that carry a direct threat to life.
- Pulmonary embolism. Blood clots form in the veins of the legs due to prolonged immobility after bone damage. If they break away from the walls of blood vessels, they can enter the pulmonary artery, which will provoke their blockage. This condition requires emergency care and is quite capable of being fatal.
- Secondary arthrosis. Even after complete restoration of the bone, pathological deformities are formed in it. They can be the cause of secondary arthrosis. As a result, a vicious circle occurs, because the risk of repeated fractures and cracks increases.
- Long bed restand lack of mobility can lead to the development of congestive pneumonia.
- In the buttock area, most patients with a hip fissure develop bedsores that are very difficult to get rid of.
The described consequences are considered the main ones, but far from the only ones. Therefore, it is necessary to carry out professional treatment of the resulting crack. Before starting treatment, an accurate diagnosis should be established. A number of studies are being carried out for this purpose.
Diagnosis
An experienced traumatologist will be able to determine the nature of the pathology by its specific clinical manifestations and the patient's history. In addition, the described symptoms of injury are considered a fairly reliable sign of a crack or fracture of the femoral neck.
But before prescribing a specific treatment, the doctor must verify the presence or absence of a suspected injury. For this, instrumental diagnostics are used:
- X-ray of the articulation. It is indicated for all patients with a suspected fracture or fracture of the femoral neck. In the picture, you can carefully consider the nature of the injury and the violation of the integrity of the bone tissue. In some cases, X-ray alone is enough to make an accurate diagnosis and detect even a small crack.
- Computed tomography. This is a modern technique that is considered more informative, but expensive. Computed tomography makes it possible to detect any damage to bone structures.
- Magnetic resonance imaging. This techniqueallows you to assess the condition of not only bones, but also soft tissues. Such an examination is recommended for patients with suspected various complications.
- Densitometry. This is one of the radiological techniques that makes it possible to assess bone density. Used to diagnose hip fracture in the elderly for osteoporosis.
- Ultrasound examination of the hip joints. In old age, this technique is considered insufficiently informative. It is used only if it is not possible to conduct other instrumental examinations.
Peculiarities of the diagnosis and the degree of damage to the joint found are the main criteria for determining further therapy.
First aid for hip injury
With such damage to the victim, it is advisable not to transport it yourself. Your best bet is to call the medical team. Before their arrival, you should try to alleviate the condition of the victim. To do this, follow these steps:
- Lay the person on their back.
- Give him painkillers like Nimesil, Ibuprofen or Ketoral.
- Fix the injured limb with a splint made of durable material. The leg should be fixed in several places: in the area of the knee, thigh and ankle.
- If bleeding occurs during an injury, a tight tourniquet should be applied.
Features of conservative treatment
A crack is considered a minor injury. With this injury, the fracture sitelimited, it does not cross the entire femoral neck. In this case, it is advisable to apply conservative treatment. But such therapy in the elderly is quite difficult. Fractures in old age grow together very rarely.
Without minor cracks in the bone, surgery can be dispensed with. In such a situation, the victim should be immobilized for a long period. To do this, a plaster cast is applied to the injured leg. It can also be used to stretch the limb with a load, the weight of which is approximately 2-3 kg. The patient is recommended physical therapy. After the hood is removed, the person is allowed to move around on crutches.
It is important to note that the treatment of the femoral neck in the elderly involves the treatment of osteoporosis. At the same time, a special diet, complexes of preparations with vitamin D and biophosphates are prescribed to enrich the body with the necessary dosage of calcium. Calcitonin is used much less frequently. It is a hormone that helps increase bone strength.
If a patient uses drugs from the group of corticosteroids that help him get rid of the manifestations of rheumatological pathologies and other chronic problems, such medications will have to be abandoned during the treatment of a hip fissure.
With such an injury, doctors recommend a special diet for people of any age. It includes foods that stimulate the formation of new cartilage tissue. Such a diet is rich in components with a lot of calcium.
The daily menu of the patient must contain eggs, dairy products, nuts, fatty fish. At the same time, a person is prescribed drugs containing vitamin D. It helps to better absorb microelements from food.
It takes approximately 6-8 months for the elderly to fully recover. In younger patients, bone tissue regeneration occurs much faster (on average, it takes about 4-5 weeks).
Surgery
Surgery is considered the most effective way to treat a hip fracture in the elderly. It is she who gives patients in old age the chances for a full life. Conservative therapy for them may be ineffective, so doctors prescribe it only when there are contraindications to the operation.
Osteosynthesis is most often used to treat a femoral neck fracture. During such an intervention, the damaged area of the bone is connected using special needles or medical nails.
If the joint is too worn out, the patient is advised to have an arthroplasty. It is also very often prescribed to people in old age. Such an intervention is considered quite complicated, which greatly frightens patients. But it should be understood that arthroplasty may be the only chance for a person to be able to walk without crutches.
We examined the symptoms observed in trauma (fracture or crack) of the femoral neck. The most characteristic is problems with movement, up to complete immobility. To avoid being inwheelchair, you need to agree to the operation. It consists of several stages:
- First, the injured femoral neck is removed along with the head of the femur.
- In their place, a prosthesis is installed.
- In some cases, additional replacement of skewers is required.
- After endoprosthetics, a person is raised to his feet on the third day. At first, he moves only on crutches. This stage lasts up to 3 months.
After the operation, rehabilitation necessarily follows. The femoral neck is restored with the help of physiotherapy, therapeutic exercises, massage sessions. A properly selected set of exercises will improve the nutrition of damaged tissues and blood circulation. Therapeutic exercises and regular walking will help restore normal limb mobility. After the operation, it will be useful to resort to sanatorium treatment.
What to expect after surgery
Treatment of the femoral neck is a very long occupation, especially for the elderly. At the hospital, he althcare workers do the following:
- During the week, a person is injected with antibacterial drugs and blood thinners.
- A pillow is fixed between the legs, which keeps the limbs at a safe distance from one another.
- On the second or third day after surgery, the patient is recommended to have minimal mobility. For example, he can do breathing exercises and simple leg exercises.
- 3-4 days after surgery for a personhelp you get back on your feet with crutches.
- On the 12-14th day after prosthetics, doctors remove the stitches and send the patient home.
Rehab
For accelerated recovery after an injury, a whole range of therapeutic measures is required. The approach to hip reconstruction should be comprehensive.
Unfortunately, in state clinics, the rehabilitation of patients is given extremely little time and attention. That is why most of the affected people are forced to turn to specialized medical centers and sanatoriums. The rehabilitation program is compiled individually for each person. Almost always it consists of several stages:
- Pain relief activities. After an injury and a surgical intervention, a person, as a rule, experiences severe pain. For successful recovery, discomfort must be completely eliminated. For this, local anesthesia, sedatives and painkillers are used.
- Mechanotherapy. These are physical exercises performed with the help of special devices. Such devices are specifically designed to develop joints and restore previous mobility.
- Physiotherapy treatments. This is one of the most important stages of rehabilitation. Physiotherapy procedures help to get rid of swelling, pain and infections, significantly accelerate the healing of wounds left after surgery. Some techniques contribute to the resorption of hemorrhages, prevent the occurrence of various complications and help restore a fullmobility. During the rehabilitation period after a hip fracture, electrophoresis, ultrasound, paraffin baths, magnetotherapy, UHF therapy, therapeutic mud are used.
- Massage sessions. Such procedures allow you to maintain normal blood flow and muscle tone. Therapeutic massage helps prevent pressure sores, osteoporosis, congestive pneumonia, and muscle atrophy. In addition, it significantly improves the activity of the cardiovascular apparatus and the respiratory system.
- Therapeutic exercise. Such gymnastics is extremely important for quick recovery after repairing a hip fracture. For each patient, a set of exercises is selected individually. In the process of rehabilitation, respiratory and motor physical education is used. As the condition improves and mobility returns, the difficulty of the exercises should increase.
- Diet therapy. People diagnosed with a hip fracture are required to follow a diet. The food you eat should be not only tasty, but also high-calorie. It is necessary to give preference to foods that are rich in calcium and trace elements necessary for the restoration of bone tissue. Dairy products, cheeses, meat broths, jellies should be present in the diet.
- Psychotherapy. Due to prolonged forced immobility, people with femoral neck injuries are often depressed. Many patients even develop severe depression against this background. In this case, a psychotherapist comes to the rescue.
Injury prevention
The main way to prevent damageof the hip joint is the timely detection and treatment of conditions preceding the fracture of the femoral neck - coxarthrosis and osteoporosis. These pathologies can only be detected during the examination. Therefore, older people should have regular skeletal densitometry.
Also, elderly patients are advised to enrich their diet with dairy products, vegetables and sea fish. Additionally, as a preventive measure, you can take vitamin D and preparations containing calcium.
To prevent injuries of the femoral neck, it is useful to train the muscular frame. Systematically performed exercises protect the bones from damage due to the increased tone of the skeletal muscles.
It is equally important to make your life as safe as possible. For those planning long walks, a cane should be used. In the bathroom, it is desirable to install comfortable handles that you can rely on during various manipulations. Take extra care when walking on stairs and on slippery roads.
These simple prevention rules can significantly reduce the risk of injury and protect the femoral neck from all kinds of damage.
