Fracture of the femur. Why is a femur fracture dangerous?

When a hip fracture occurs, rehabilitation after surgery must strictly comply with the prescribed recommendations. Any surgical intervention requires certain rules recovery of the body, and the period may vary significantly.

A hip fracture is a very serious injury. Most often, surgical intervention is required after... This injury is practically not treated with a conservative method. If the patient is over 60 years old, then osteosynthesis is not performed, since the likelihood that the bone will heal is very low. However, there is another treatment method - endoprosthetics.

In any form surgical intervention absolutely necessary recovery period, which will last long enough in the case of a fracture femur. The rehabilitation period will strengthen the therapeutic effect, as well as restore limb mobility. If you ignore the treatment of this injury, then in some cases not only disability, but also death occurs.

Certainly, rehabilitation period It's quite difficult. The patient may have problems with the further functioning of the hip, side effects with trophic and mild disorders. It is necessary to begin performing all rehabilitation procedures as soon as possible.

General rules for patient rehabilitation

After the operation has been performed, it is recommended to start getting out of bed as soon as possible. The staff at the clinic will help you with this procedure. The sooner physical activity begins, the lower the risk of developing any complications. On the first day you are allowed to move to a chair. If you have the strength, you can stand for a while, leaning on something.

If after surgery the patient feels pain, then you should not endure it. You definitely need to take painkillers medications. Painful sensations will harm the heart, and this is harmful to the whole body, which will ultimately take longer to recover. Most often, doctors independently prescribe such drugs in the first days after surgery.

You need to be calm and balanced. If no complications are found, the patient will be discharged within a week.

Physiotherapeutic procedures will be very useful, because... they speed up the process of tissue repair. However, during these actions it is necessary to be careful and careful, since the bone is still very fragile.

It is best to use a cane, crutches, or walker after surgery. For several months after surgery, you simply cannot do without them. Strict monitoring is imperative so that the patient should not live alone for the first 2 months.

In the first months the patient should be monitored medical staff or instructor. Each of the exercises within therapeutic exercises performed 8-12 times.

During the first treatment period, the following exercises are required:

1. Starting position - lying on your back, arms extended along the body.
2. Raise your arms up as you inhale and lower them as you exhale.
3. Make movements with your hands that imitate boxing.
4. Exercise for the head. You need to lean forward and reach your chest, and then return to the starting position.
5. Clench your fingers into fists as you inhale and unclench your palm as you exhale.
6. Pull your feet towards you, and then return them to their normal position. On the leg that has been injured, actions are performed only with the fingers.
7. Bend the knee of the healthy limb. During this exercise, it is better not to lift your heel off the bed.
8. Raise your arms and reach the headboard with them, and then return to the starting position.

During the second treatment period, you also need to do all tasks in supine position. The patient will have a cast on the damaged areas.

• place your hands behind your head, clasping your fingers. Stretch your arms up and then return them back;
• make a movement with your hands similar to stretching rubber;
• bend your leg at the knee and then straighten it. Only the healthy leg can do this exercise.

In addition, it is very important to do tasks with so-called impulses. A person mentally sends an order to bend and straighten the sore leg at the knee, ankle joint. Makes a mental impulse to make movement in the hip joint.

Be sure to make turns with your body. To do this you will need the help of an instructor. In addition, you need to do the exercise in pairs: pass objects to your partner with your left and right hands. Finally, a board is applied to the foot of the injured limb. The patient must press on it.

During the third treatment period, it is allowed to make circular movements with the arms, raise the arms, and do exercises that imitate boxing. It is imperative to roll over onto your stomach in a lying position and back without the help of an instructor. Do all previous tasks for breathing and developing limbs.

Massage after a hip fracture

Massage speeds up the process of restoration of all organs and tissues, so that the patient will recover much faster. Doctors recommend starting this procedure 2-3 days after surgery. In elderly people, massage should be carried out very carefully, because... this procedure should not have too much impact heavy load on the heart and blood vessels.

If the massage is done according to the rules, then the person’s blood circulation improves. And this affects cell access to oxygen, which improves the regeneration process. Massage will be an excellent preventative against congestive pneumonia. In addition, this procedure will improve muscle tone. However, it is necessary to distinguish massage from manual therapy. With massage, the action is performed on superficial tissues, while with manual therapy, a deeper effect is produced. The massage must be performed by a qualified and experienced specialist.

Diet for hip fracture

Rehabilitation after a hip fracture includes special nutrition for the patient. It is very important to follow all doctor's recommendations regarding diet. The body urgently needs calcium and collagen. Bone restoration will take place much faster if there is a sufficient amount of these substances in the body. In addition, the human body necessarily requires vitamins and useful microelements. This is important to maintain a person’s strength, which will go towards enhanced recovery.

To avoid problems with digestive processes, it is best to eat lighter foods. Be sure to consume dairy and fermented milk products. In addition, the diet should include low-fat broths, soups, vegetable purees and other dishes based on products containing a large number of fiber. It is best to choose natural products and from environmentally friendly areas. After surgery, it is necessary to introduce food slowly, starting with liquid and light meals. It should be ensured that the patient does not have an individual intolerance to any substances in medications or food.

A femur fracture is a serious injury to the human body.

In this case, after surgery, the recovery process will be quite long. It is necessary to strictly adhere to all the doctor’s recommendations, as well as carry out special therapeutic exercises, massage and take into account diet rules.

It can incapacitate a person for the longest period of time. In the event of an injury, not only the mobility of the limb is lost, but the muscles gradually atrophy as a result of the loss of the ability to contract. Let's find out what activities are required for rehabilitation after hip fracture surgery.

Risk group

According to statistics, rehabilitation after surgery is most often required. Usually, it is people who are older who are exposed to such injuries. This is due to the development of the main manifestation of which are structural changes in bone tissue. Who else may need rehabilitation after hip fracture surgery? Reviews from traumatologists indicate that people who lead a sedentary lifestyle and suffer from decreased health are also at risk. muscle mass. As soon as a weakened person accidentally falls on his side, the likelihood of getting a fracture immediately increases. Although the bruise may not be the most serious.

People who suffer from the development of malignant tumors are also susceptible. Metastases often migrate to bone tissue, causing its weakening and destruction. Injuries of this nature can occur here only because a person awkwardly turned abruptly to the side or stumbled. A problem such as rehabilitation after hip fracture surgery mainly affects women. Representatives of the fairer sex are several times more likely to suffer from injuries of the presented nature. As for women of retirement age, the risk of a hip fracture increases 3-4 times more often than men.

Symptoms

Like any other damage to bone tissue, this injury is accompanied by the development of serious pain. The main location of discomfort is the groin area. Here the pain is progressive. When the femoral neck is fractured, the leg is visually shortened. This is caused by a reflex contraction of muscle mass. Tense muscles automatically pull the limb upward, reducing its length. A direct sign of injury is the inability to raise the leg in a supine position. At the same time, the foot may turn outward unnaturally. IN best case scenario in this case, it will only be possible to slightly bend the limb at the knee.

Sometimes when a hip fracture occurs, the pain is quite bearable. While maintaining the ability to lean on the leg, the victim may assume that the discomfort is caused by a dislocation or bruise. The result of untimely identification of the problem and lack of appropriate therapy often results in complications in the form of suppuration, inflammation of soft tissues, necrosis of bones and joints. To avoid disability, at the first suspicion of a hip fracture, it is recommended to go to the hospital.

Features of patient care

Rehabilitation after hip fracture surgery at home requires those around you to be especially attentive to the needs of the victim. The defining moment is the fight against the occurrence of bedsores. As a preventative measure, it is recommended to periodically change the position of the person’s body in bed. The development of complications can also be avoided by placing the mattress on a rigid frame and using a bed with an anti-bedsore system.

Since rehabilitation after surgery for a hip fracture at home involves an absolute restriction of body mobility, the patient needs help in implementing physiological needs. Not least important are measures aimed at body hygiene. The groin and armpit area, natural curves, folds on the body should be regularly washed and dried antiseptics, treated with powders.

Consequences of injury

As practice shows, in the best case, rehabilitation after a hip fracture in a sanatorium takes at least six months. Limited body mobility, inability to self-satisfy natural needs, lack of full communication with others - all this can cause unbearable discomfort to the victim. The physical consequences of a hip fracture include:

• the occurrence of bedsores;
• development of intestinal atony;
• venous blood stagnation;
• pneumonia;
• vascular thrombosis.

As for mental consequences, the most common manifestations here are prolonged depression, neuroses. All this does not allow a person long time go back to how it was before full life, even if successful rehabilitation was performed after surgery for a femoral neck fracture. The victim literally has to learn to master own body and emotions again.

Surgical treatment

It is extremely rare to eliminate the consequences of a hip fracture without surgery. Specific Features blood circulation in the represented area of ​​the skeletal apparatus complicates the fusion of bones. There are several options for dealing with a hip fracture operational recovery tissue integrity:

1. Osteosynthesis. This surgical intervention involves fixing the bone in the area of ​​the fracture. Metal screws are used as elements that connect damaged areas of tissue. The method does not guarantee successful bone fusion in victims over the age of 60-65 years. Therefore, such an operation is used to treat young people. In this case, how much does rehabilitation after hip fracture surgery take? A set of exercises allows you to restore limb mobility within 4-5 months.
2. surgical intervention aimed at replacing part of the hip joint with an implant. Both the head of the bone and the entire joint can be subjected to prosthetics. To perform the procedure, high-strength implants made of titanium or cobalt-chrome are used. Currently, this option is practically the only chance for people in old age restore normal functionality of the limb. About a week after endoprosthetics, a person can already perform simple leg movements, and in some cases, walk on crutches.

Physiotherapy

Regular physical activity is a prerequisite for victims who expect a speedy restoration of activity. During therapy, specialists develop a whole complex of motor and breathing exercises, with the help of which rehabilitation occurs after surgery for a femoral neck fracture. The transition to a cane with a gradual complication of training here is possible within a few months from the start of the rehabilitation program.

Physiotherapy

Physical treatment methods are an integral part of activities aimed at recovery after a hip fracture. Their use helps eliminate swelling, fight infections, and heal postoperative wounds, restoration of normal blood circulation in the injured limb. During rehabilitation, the following methods of physiotherapy are used: UHF, electrophoresis, paraffin applications, magnetic therapy, mud therapy and balneo.

Nutrition

Quite often, long-term rehabilitation after surgery for a hip fracture reduces a person’s interest in the world around him. As a result, the victim experiences loss of appetite. For this reason, a special diet is required here. The food that is offered to the patient should not only be varied, but also be tasty, nutritious and high in calories. The main attention should be paid to foods rich in calcium and vitamins that are required for speedy recovery bone tissue. Proper rehabilitation after a hip fracture involves avoiding food that could potentially cause bloating, constipation or diarrhea in the patient. Avoiding such manifestations allows you to consume fermented milk products, in particular cottage cheese.

Massage

Massage procedures are a fairly effective rehabilitation after hip fracture surgery. How is the recovery going? First of all, the victim is prescribed daily exercise of the muscles of the healthy leg. This approach to rehabilitation makes it possible to activate reflex stabilization of blood supply in damaged tissues. If the victim’s leg is in traction, resort to light massage using spiral rubbing, stroking touches along the entire circumference of the limb. Regular massage helps:

• Eliminates the effect of muscle tightness.
• Saturation of tissues with oxygen and their supply with nutrients.
• Preventing the development of muscle atrophy.
• Activation of regenerative processes in bone tissue.
• Reducing pain.
• Warning possible complications upon completion of the rehabilitation period.

Pain relief medication support

As rehabilitation progresses, the victim has to overcome a whole host of pain. To avoid discomfort during the recovery period, the patient is prescribed to take effective analgesics. If the pain is unbearable, local anesthesia is prescribed in the form of intramuscular injections.

Prevention

To avoid injury, elderly people are recommended to move with a cane or special walkers that allow them to maintain balance. When it comes to strengthening bone tissue, they can help medications with calcium content. Along with this, it is extremely important for older people to be physically active. Moderate, regular loads on the musculoskeletal system help strengthen it, regardless of age.

Finally

As practice shows, the timing of successful rehabilitation after a femoral neck injury depends on the effectiveness of treatment methods and the competent development of a therapy program. What is also important is how timely measures were taken to restore the mobility of the limb. It is necessary to begin rehabilitation approximately 2-3 days after the operation. To consolidate the results, you may need to undergo several successive courses of rehabilitation therapy.

A displaced fracture of the femur is the most dangerous injury for a person. Elderly people should especially protect themselves from injuries, since if the femoral neck is damaged, they have to lie down for a long time, which can cause complications in the cardiovascular and respiratory systems.

Types of femur fracture

The femur bone is the largest tubular bone in the human body. It is divided into the following departments:

• upper end section (epiphysis);
• lower end section;
• central section (diaphysis);

In this regard, hip fracture is divided into three types.

Upper thigh injury

The proximal femur is located in the hip area, that is, at the junction of the bone with its head.

When a proximal injury occurs, the following parts of the bone are damaged:

• femoral neck;
• femoral head

Femoral neck injury dangerous look damage, and has a high rate of complications.

The main signs of injury to the upper third of the thigh are the following symptoms:

1. Pain in the pelvic area.
2. The pain intensifies when tapping on the heel of the injured leg.
3. Slight shortening of the leg.
4. “Stuck heel syndrome” appears when the victim cannot lift his foot off the surface.
5. IN horizontal position The victim's leg is turned outward.

The hematoma appears within a couple of days after the injury. In the lying position, the pain decreases significantly.

Important! With a so-called “impacted fracture,” some victims can easily lift their leg off the surface and even walk, leaning on it.

If this type of injury is not detected in time, the “fused” parts of the bones will disintegrate, and the injury will be complicated by displacement of the bones, which in turn will complicate the healing of an already difficult fracture.

Treatment

Conduct the following types operations:

1. Fixation of bone fragments using various devices, for example, a nail. After the operation, the patient is immobilized for 3 weeks. It is forbidden to put any weight on the affected leg for about six months.
2. Endoprosthetics. After this operation, the patient is recommended to develop his leg within a month.
3. Rehabilitation after a hip fracture.

Replacing a damaged joint is undoubtedly a significant benefit for older adults.

Mid thigh injury

The main symptoms of such an injury are the following:

1. Painful sensations at the fracture site.
2. Atypical bone mobility.
3. The leg below the fracture is turned outward.
4. Shortening of the limb.
5. Edema.

Often the bone from this type of injury becomes dislodged due to muscle contraction during the injury.

Treatment

For a fracture of the middle part of the femur, the following types of treatment are used:

1. Limb traction.
2. Surgery on the femur. It involves fixing the bone with a special pin.

Also, fixation of a broken bone is carried out with special plates.

When treating a fracture by traction of the injured leg, the following actions are performed:

1. The limb is fixed on a special device at an angle depending on the type of fracture. Fixation is carried out for 1.5-2 months.
2. Afterwards a cast is applied for about 3 months.

You can walk about two months after completing the traction, without putting too much strain on your leg, and only with the help of crutches.

A person becomes able to work 3-6 months after injury; this period largely depends on age and physical fitness the victim.

Lower thigh injury

Distal femur - Bottom part tubular bone of the femur, most often the fracture occurs in the area above the knee joint.

The main symptoms of such a fracture are the following:

• knee pain;
• swelling of the knee;
• limited knee mobility;
• The shin can be rotated inward or outward.

Elderly people are at risk for this type of injury. A displaced hip fracture may also occur.

Treatment

For a non-displaced injury, the following treatment is performed:

1. Blood is pumped out of the injured knee using a special syringe.
2. Skeletal traction.
3. Plaster application for 4-5 weeks.

Treatment can take place either with or without opening the knee joint. For a displaced fracture, the following treatment is used:

1. The fragments are fixed with special plates.
2. If the fracture was fixed well, then subsequent application of plaster is not performed.

If the middle part of the femur is injured, the child has a risk that the leg will be shortened in length, since the growth of the limb in length occurs precisely due to the bones that make up the femur. knee-joint. With such a fracture, shortening of the bone occurs in 25% of cases. Therefore, surgery is often used after a hip fracture, and rehabilitation after surgery is also very important.

Important! When providing first aid to the victim, it is necessary to palpate the area under the knee to make sure there is a pulse in the artery, since the femoral artery is very close to this section.

A person begins physical activity 3-4 months after injury.

Recovery period

A very important stage after a hip fracture will be rehabilitation, which lasts up to 6 months. It can also occur at home.

Important! Rapid and complete healing of fractured parts of the femoral neck occurs only in childhood.

How to quickly recover after a fracture? Undoubtedly, the most difficult recovery period for people occurs after a hip fracture. In this case, it is important to immediately begin to rehabilitate the injured leg.

Exercise therapy

Gymnastics is the basis for successful leg recovery. You can start doing it soon after surgery, without even getting out of bed. You can do the following exercises:

1. Move your toes.
2. Shoulder rotation from a lying position.
3. Head rotation.
4. Exercises with small dumbbells or an expander to train your arms.

Such actions will prevent blood stagnation in the body and improve metabolism.
After the patient is allowed to get out of bed, the following exercises will be added to the arsenal of exercise therapy:

1. Knee flexion and extension.
2. Raising straight legs alternately.
3. Rotate your feet in a circle.
4. Bringing your knees together and so on.

The next stage will be learning to walk with the help of crutches or a walker, reducing the support on the hands from the moment of strengthening the leg muscles.

Important! Children should recover under the supervision of a rehabilitation specialist.

If pain occurs during exercise, it cannot be tolerated, it is harmful to the heart. vascular system. You should take pain medication.

Massage

Massage can work wonders. The advantages of massage are the following:

1. Improves blood circulation.
2. Prevents lung problems.
3. Normalizes muscle condition.

Massage can begin as early as 2 days after surgery.

Important! Massage should be done carefully, especially for older people, so as not to harm the body’s cardiovascular system.

The duration of the massage must be agreed with the attending physician. Also, do not trust a massage to a non-professional.

Nutrition

Nutrition is an important component of the recovery period after surgery, since better healing bones require a whole range of vitamins and minerals. The diet of a patient with a broken leg should consist of the following products:

• products with increased content calcium;
• rich bone broths;
• cereals;
• vegetables;
• vegetable soups and purees.

All these principles of rehabilitation are also suitable for people with a femur fracture who were treated using a conservative method.

Femur fractures are very serious injuries. The best prevention fracture of the femur is the maintenance physical activity throughout life, which strengthens bones and the body as a whole.

A displaced hip fracture can occur due to various reasons, but its consequences are always the same: long-term immobility, the same long rehabilitation. However, even long treatment is not always able to protect against the occurrence of complications, the formation of a false joint or a banal nonunion. What is this fracture and how to treat it to avoid all negative consequences?

Types and causes of injury

There are several types of femur fractures that may be accompanied by displacement:

• trochanteric;
• diaphyseal;
• condylar;
• pertrochanteric.

Hip fractures are more common in older people because their bones have already undergone significant changes due to age and internal diseases.

Damage occurs during a blow or fall, but if you have osteoporosis, it can even occur as a result of a sharp turn of the leg. The displacement in this case occurs as a result of contraction of the muscles that stretch the fragments, and under the influence of its own weight.

Symptoms

When displaced, the leg ceases to look natural, so even a person ignorant of injuries is able to visually determine the damage. It is shortened, but not too much, by about 4-5 cm. This is easiest to determine in a lying position. In the same position, you can see the rotation of the foot relative to the knee - it is unnaturally turned outward or inward.
If the fragment could injure the internal vessels, this will manifest itself in the rapid formation of a hematoma. With a slight displacement or a small number of fragments, the bruise does not appear immediately, but somewhat later.
Patients often complain of pain, not only in the groin area, but also in the knee. They are sharp, especially increasing when trying to move. Swelling may spread to kneecap. A person is unable to lift his leg while lying down - this is a very common symptom when a displaced fracture of the femur occurs.
IN in rare cases It remains possible to lean on the leg, but this threatens to cause even greater separation of the fragments, which significantly aggravates the situation.

First aid

When a bone is displaced, the risk of traumatic shock is very high, so the victim should always receive painkillers beforehand. An ambulance is immediately called, because it is not always known what consequences the divergence of fragments entailed.
You should try not to change the position of the victim, but if he is uncomfortable, you can help him turn around by lifting him by the upper torso. It is better not to touch the injured leg at all unless there is bleeding or open injury. In such cases, it is necessary to apply a bandage to stop the bleeding.
If ambulance wait a long time, the limb must be immobilized before transportation. The hip injury is very complex, so it is better to have a paramedic apply the splint.

Treatment

If blood loss occurs, a decision is made about the need for a blood transfusion.

The formation of a large number of fragments always entails surgery. At the time of surgery, any resulting fragments that cannot be attached to the joint and that injure the surrounding soft tissue are removed. For uncomplicated damage, it is permissible to use the pulling method using a derotation shoe.
A plaster cast is not able to retain the displacement at the initial stage, so it is not applied. In addition to osteosynthesis and special devices for external fixation, which are classified as surgical methods for treating a hip fracture, the skeletal traction technique is also used:

• the needle penetrates the tuberous area tibia and condyles, holding the bone in one position;
• the leg is placed on the Beler splint, the patient himself must be on the backboard;
• a load is suspended from the other end, the weight of which is determined by the nature of the fracture;
• the average weight of the load is up to 10 kg, but for patients with well-developed muscles (including at a young age), this figure is often increased;
• the load is gradually reduced, monitoring the effectiveness of eliminating displacement;
• At the end, the traction is removed and a cast is applied, which is worn for about 4 months.

Skeletal traction is also used in cases where there are contraindications for surgery. For example, if a wound becomes infected, poor general condition or if available serious illnesses. The traction itself lasts up to 12 weeks.

The occurrence of hemarthrosis entails mandatory puncture.

Why is surgery preferable?

A hip fracture can lead to a number of complications, because a person remains motionless for a long time. It takes up to 4-5 months to recover from an uncomplicated fracture, while displaced injuries always take much longer to recover. The operation allows for immediate reduction, which significantly speeds up healing.
After surgery, motor activity is restored for 5-6 months, and at 3-4 months active rehabilitation begins, aimed at returning the atrophied muscles to their former strength and elasticity. The likelihood of pseudarthrosis and contractures due to early rehabilitation is greatly reduced, meaning that the likelihood of a recurrent fracture in the future will be very low.
Usually, reposition and osteosynthesis are sufficient for recovery, but in case of serious damage joint capsule it is necessary to resort to endoprosthetics. This procedure It is recommended especially for people over 65 years of age, as it helps to avoid bone non-fusion.

Rehabilitation

A patient of any age must undergo rehabilitation therapy.

The victim will be immobilized for a long time. It will also be impossible to put weight on the injured leg for a period of time determined by the doctor, but this does not mean that you need to lie down all the time. It is necessary to do breathing exercises, perform exercises for the healthy leg and arm, rise, and strain the muscles of the injured limb. The foot and toes also need to be moved regularly to maintain at least minimal tone and thereby avoid complications.
The basis of rehabilitation is always physical therapy. After 40-60 days, the doctor may allow you to perform passive exercises: an assistant moves the victim’s leg. People begin to begin exercise therapy on their own under the supervision of a rehabilitation specialist after 3-3.5 months, but sometimes much later, since this period entirely depends on the complexity of the injury.
Physiotherapy and massage help maintain blood circulation and muscle tone. Self-massage should be avoided at first or massage areas of the body that are not located near the injury. Recovery motor activity also happens on different dates, but on average, after 3-4 months a person is already able to stand on crutches and gradually put weight on his leg. Over the course of a year (especially for older people!) it is recommended to repeat physiotherapy 2-3 times or undergo sanatorium-resort treatment twice.

A hip fracture is one of the most severe injuries

The article describes a fracture of the femur with displacement of fragments. Symptoms of injury, methods of diagnosis and treatment, and prognosis are described.

Since the femur is one of the largest bones in the body, a displaced femur fracture represents quite a dangerous condition. In the absence of medical attention, it can be fatal.

Features of the structure of the hip

The femur is located between the pelvis and the knee, forming two joints. This is one of the largest and strongest bones in the human body, which bears a lot of stress.

There are several departments in it:

• the proximal part where the femoral neck is located (collum femoris) - the hip joint is formed in this place;
• diaphysis, or body;
• the distal part, which forms the knee joint (articulatio genus) with the bones of the lower leg.

Each department has its own structural features. Depending on which part of the femur fracture occurs with displacement, symptoms and treatment will differ.

Table 1. Features of the structure of different sections of the thigh:

Bone piece	Structural features	Photo
Proximal section	Collum femoris has no periosteum. Head and most of the necks are located in the cavity of the hip joint. The blood supply to the neck and head of the femur is minimal.	The head and neck of the femur fit into the hip joint
Body	This part is called the diaphysis. It is surrounded by powerful muscles, they pass here major arteries and nerves. The blood supply here is the best.	The longest part of a bone is its body
Distal section	Contains condyles, which form the articulatio genus with the tibia. Here are the muscles, ligaments, and blood vessels.	The femur condyles form the knee joint

Surrounding the bone are a large number of large muscles, blood vessels and nerves. All this creates certain features when a particular part of the hip is fractured.

Causes of fractures

The main reason why a fracture can occur is the impact of direct physical force on different parts of the bone.

Most often this happens when:

• a strong blow to the thigh area, for example, in car accidents;
• falling to the ground, for example, in ice;
• falling from a height;
• falling on a limb with a heavy object.

There are several factors predisposing to fracture, which become more relevant in old age:

• osteoporosis, leading to decreased bone strength;
• change in the angle between the collum femoris and the body of the bone.

Thus, for older people, a displaced collum femoris fracture is more typical. At a young age, fractures of the bone body or its distal part occur more often.

Fracture is common in older people

Types of fractures

There are several types of fracture, depending on the location and nature of the damage:

1. Damage to the proximal femur. A displaced fracture of the upper third of the femur can be intracapsular or extracapsular. There are also pertrochanteric and intertrochanteric fractures. Depending on the nature of the damage, they can be impacted or unimpacted. A displaced collum femoris fracture is always intra-articular.
2. Displaced fracture of the middle third of the femur. Damage can be localized in the upper, middle or lower part of the diaphysis. Based on the nature of the fracture line, a simple fracture, an oblique femur fracture with displacement, and a complex fracture are distinguished.
3. Displaced fracture of the lower third of the femur. In this area, fractures can be extra-articular or intra-articular. Based on the nature of the damage, simple, wedge-shaped and comminuted fractures are distinguished.

Each type has its own symptoms.

Clinical picture

Common symptoms of injury are sharp pain at the site of injury and dysfunction of the limb. During the examination, the doctor identifies signs characteristic of a particular type of fracture.

Table 2. Symptoms different types fracture:

Type of fracture	Symptoms	What does it look like
Collum femoris with displacement of fragments	The pain is localized in the groin area and is low-intensity at rest. Any movement leads to increased pain. Characterized by the inability to step on the injured leg. A medial fracture is accompanied by a typical sign - a symptom of a stuck heel. This is the inability to lift the leg from a supine position.	There is a symptom of a stuck heel
Body bones	A pronounced pain syndrome is characteristic. The circumference of the injured thigh increases due to swelling, hematoma, and displacement of fragments. In almost all cases, vascular damage occurs, which leads to intense bleeding. Pathological mobility of the hip is characteristic. Upon palpation, the edge of bone fragments can be detected. Due to the displacement of fragments, shortening of the damaged limb is observed.	When the diaphysis is fractured, there is a high risk of bleeding
In the area of ​​articulatio genus	Pain of moderate intensity. The knee swells, movement in it is almost impossible. A condyle fracture is accompanied by a displacement of the limb relative to its axis. Damage to blood vessels leads to bleeding.	With a fracture in the articulatio genus area, swelling and hematoma form

Clinical picture alone is not enough to confirm the diagnosis. The victim needs to carry out instrumental methods examinations.

Diagnostic methods

Fracture of the left femur with displacement, right femur, hip joint - all these injuries require X-ray examination. It allows you to determine the nature and location of the fracture, the presence of soft tissue damage.

X-ray diagnostics is also used to differentiate bruises, cracks and fractures. It is carried out in two projections.

Below are images of various femur fractures in the most common locations.

This type of fracture can be easily diagnosed using x-rays.

If there are difficulties in making a diagnosis, it can be used CT scan, which can detect even minor damage.

First aid

Initial health care carried out at the scene of the incident. It includes immobilization of the injured limb with available materials, stopping bleeding, and the use of general analgesics. Instructions for first aid for fractures should be familiar to every person.

Ambulance staff immobilize the limb with pneumatic or wooden splints. Pain relief is achieved intramuscular injection analgesics. The patient is hospitalized in a trauma hospital, where the main treatment will be carried out.

Therapeutic measures

Treatment of a displaced fracture depends on its type, location and individual characteristics of the patient. Initially, the injury site is treated, dead tissue is removed, and the wound is washed.

Damage to the femoral neck

Treatment of a displaced fracture begins with local anesthesia. It is carried out with a solution of novocaine. Depending on the characteristics of the fracture, further treatment can be conservative or surgical.

1. Conservative treatment is used for impacted fractures. In patients young use a plaster cast from the knee to the lower back. You need to wear it for 3-4 months, walking with crutches is allowed. In elderly patients, skeletal traction is first applied using a Beler splint. The patient remains in this traction for up to two months, then a plaster cast is applied.
2. Surgical treatment. It is preferable to use for non-impacted fractures. Closed osteosynthesis with metal plates is used.

In old age, there are certain features that worsen the course of the disease and slow down the healing process. The mortality rate from such fractures in the elderly reaches 20%.

The formation of callus and healing of the fracture occurs within 8 months. The need for prolonged bed rest, in turn, leads to the development of bedsores, pneumonia, and a high risk of thromboembolic complications.

Femoral neck fractures are more difficult to heal in older people

To avoid such complications, elderly people are not prescribed conservative methods treatment in the form of skeletal traction and wearing a cast.

Surgical treatment would be preferable if there are no contraindications.

If an elderly patient has a displaced fracture of the hip joint, it is recommended to perform joint endoprosthesis rather than osteosynthesis.

Damage to the body of the bone

The method of conservative treatment of a bone fracture is skeletal traction. It is also used as preparation for surgery.

Skeletal traction is performed using a Beler splint. The patient is on bed rest within 1.5-2 months. After this, a plaster cast is applied to the limb for a period of three months.

Conservative treatment, due to its duration, leads to the formation of bedsores, contractures, and muscle atrophy. This is especially true for the elderly. Therefore, the preferred treatment method is surgery.

The operation consists of repositioning the fragments and fixing them with a metal rod or plate. Double fracture with displacement - absolute reading to surgical intervention. After fixing the fragments, it is necessary to apply a plaster cast.

The preferred treatment method is osteosynthesis

Distal injury

Conservative therapy is rarely carried out; skeletal traction is used, followed by the application of a plaster cast. Surgery is the most preferable. It consists of fixing the fragments with a metal plate.

Rehabilitation activities

Rehabilitation should begin as early as possible. The purpose of it is as follows:

• preservation of motor function of the limb;
• prevention of muscle atrophy and muscle contractures;
• acceleration of callus formation and fracture healing.

Rehabilitation after a displaced hip fracture includes the use of therapeutic exercises, massage, and physiotherapy. Exercise therapy and massage begin in doses from the first days of injury.

As the fracture heals, the volume physical activity increases. It is necessary to prevent muscle atrophy and the formation of contractures, strengthening ligaments. During exercise, blood flows to the damaged area, which helps accelerate tissue healing.

Physiotherapy procedures are prescribed to improve microcirculation, supply tissues with oxygen, and reduce pain. The greatest effect In this case, magnetic therapy, ultraviolet irradiation, and electrophoresis are available.

Rehabilitation continues at home. The patient can independently perform complexes of therapeutic exercises and perform self-massage.

Some useful exercises can be seen in the video in this article. If you have a physiotherapy device at home, you can conduct physiotherapy courses. For such devices home use include Mag-30, Almag, Vitafon. You can buy them in medical equipment stores and pharmacies. The price is quite high, but these devices can be used for any disease.

Forecast

How long a displaced femur fracture heals depends on several factors. First of all, this is the condition of the patient’s body, the presence concomitant pathology. The nature of the fracture also matters. On average, the recovery time for work is 1.5-2 months. In older people, a fracture takes a little longer to heal.

Source: https://travm.info/patologii/perelomy/perelom-bedra-so-smeshheniem-132

Hip fracture: symptoms, treatment and prognosis

A hip fracture is a violation of the integrity of the femur that occurs as a result of trauma and various pathologies femur. Any bone fracture causes a person to worry and worry: whether the bone will heal correctly and how the functions of the lower extremities will be restored.

In order to survive a broken leg, it will take a lot of strength and courage and, above all, a psychological nature. After all, having remained bedridden for a long time, a person is in a constantly depressed state of mind and develops depression.

One such complex injury that requires serious treatment and long-term immobility is a femur fracture.

Structure and functions of the femur

The largest anatomical segment of the lower extremities is the femur, which is a tubular bone. On the outside, the bone is lined with periosteum (connective tissue), which determines the development and growth of bones in children, and also promotes its fusion during fractures and injuries.

The femur has its own specific structure:

• two epiphyses (upper and lower);
• body of bone - diaphysis;
• bridges or areas connecting the diaphysis to the epiphyses;
• the site of attachment of muscles to bone (apophyses).

The upper epiphysis contains the head, which is located in the glenoid cavity. Below the head is the neck, the thinnest and most vulnerable part of the hip joint. It is attached to the body of the bone at a certain angle. At their junction there is a lesser and greater trochanter. When the femur is fractured, the functionality of the entire anatomical structure, that is, the lower limb, is disrupted.

It is especially difficult for the femur to heal in old age; for young people or children, such a fracture is also dangerous, but the chance of a successful outcome is much higher.

The femur performs one of the most important functions in the body - it connects top part skeleton with lower limbs. It also performs a number of other functions:

• supporting function (the main ligaments, muscles and tendons that are responsible for the movements of the lower extremities are attached to it);
• motor function (is a certain point of support when moving);
• blood-forming function (in the area of ​​the femur there is Bone marrow, where stem cells are born and mature into adult blood cells);
• participates in phosphorus-calcium metabolism.

Causes of fracture

In young people, such injuries occur as a result of falls from a height, road accidents, or a strong direct blow to the hip.

In older people, such injuries are also caused by trauma, but in this case, even the slightest blows and falls, and sometimes even a simple trip, causes damage to the integrity of the femur.

This fragility and fragility of bones is explained by the degradation of bone mass in older people (after 65 years).

In children, similar injuries also occur and their causes are still the same: a fall from a height, a strong blow or twisting of a limb. If a pathological process is observed in the femur, then impact on it will lead to damage and injury.

Types of hip fractures

Injuries may be as follows:

• displaced hip fracture;
• open hip fracture;
• closed hip fracture.

Displaced fracture

Occurs as a result of the impact of significant force on different areas femur. This type damage is most common in older people with osteopenia and osteoporosis. In this case, the body of the bone or its distal part is most often damaged.

A displaced fracture can be of several types:

• damage to the proximal part (lateral and medial);
• damage to the middle third with displacement (diaphyseal);
• damage to the lower third (distal or condylar).

Each type of damage has its own characteristic symptoms.

Damage to the proximal part

Medial - represent damage to the head and neck of the femur. Lateral - damage to the trochanter (greater and lesser).

In case of injury, a slight pain syndrome is felt in the groin area, which is barely noticeable at rest. However, when you try to move your leg or lean on it, the pain increases and becomes unbearable. With this damage, a characteristic manifestation occurs - the symptom of a stuck heel. It is manifested by the inability to lift the leg while lying on the back.

Damage to the middle third with displacement

Characterized by acute pain syndrome, hematoma formation, severe swelling, displacement of bone fragments, increase in thigh circumference.

Bone fragments damage blood vessels, which always leads to heavy bleeding. There is pathological mobility of the hip and crepitus of fragments.

When palpated, you can detect the ends of bone fragments, which, when displaced, lead to shortening of the limb on the damaged side.

Damage to the lower third

The pain is moderate and extends to the knee. Swelling and limited mobility are also observed. The limb is displaced relative to its axis, and vascular rupture entails significant blood loss.

Open fracture

One of the most dangerous injuries, which has many unpleasant complications. Successful treatment and restoration of an open fracture depends on how competently first aid was provided.

Trauma can be identified by the following symptoms:

• unbearable pain in the hip area;
• the formation of an open wound due to a violation of the integrity of the skin;
• development of severe bleeding;
• limited mobility;
• bone fragments come into contact with the external environment.

Since bone fragments are visible through the wound, it is not at all difficult to diagnose the type of injury. Bone fragments can severely injure blood vessels, muscles or nerve endings.

If large vessels are damaged, severe bleeding may occur. When providing first aid, the bleeding should first be stopped; otherwise, blood loss can lead to damage. heart rate, traumatic shock, panic attack, loss of consciousness, and sometimes death.

Closed fracture

If the femur is severely impacted, many bone fragments may occur. Typically, such injuries are closed and without displacement of fragments. Recognizing a closed fracture is not so easy. The following symptoms generally accompany injury:

• severe pain that spreads from top to bottom of the leg;
• inability to put weight on the leg and stand on it;
• swelling of the limb;
• hematoma and bruises in the area of ​​injury;
• shortening of the affected leg;
• change in the shape of the thigh at the site of injury (breeches effect).

Damage can be identified by visual changes in the hip joint and limb after injury. Impacted injuries to the upper part of the hip joint are a different matter. In this case, the person will be able to stand and even step on his foot, since the clinical picture of such injuries is less pronounced.

First aid for a hip fracture

Depending on the type of fracture, first aid is provided. For example, with an open fracture, it is necessary first of all to stop the bleeding. When closed fracture, it is impossible to determine where the injury occurred.

So, first of all, it is necessary to immobilize the injured limb using a Dieterichs splint. However, such a design may not be available as it is found in specialized ambulances.

Therefore, such a tire must be built from available materials. Such means can be skis, boards, pieces of plywood, etc. To firmly fix the limb, two oblong objects made of dense material are used.

They are applied from different sides, opposite to each other.

When using a splint, you must remember that it is applied taking into account anatomical features this zone.

Which joints need to be fixed for a hip fracture? It is necessary to fix three joints at once: hip, knee, ankle. The splint should not be adjacent to the wound, that is, in the area where bone fragments protrude outward.

In the area of ​​the joints, soft tissue should be placed under the splint so as not to compress the blood vessels and interfere with blood circulation.

In order to apply the splint correctly, you need to place its long part on the outside so that one end is at the level of the heel, and the other rests against armpit. The other tire must reach groin area and is located with inside. I use the third tire when transporting a victim.

It overlaps posterior region lower limb and should grab the foot. If there is no object that can be used as a splint, then immobilization can be ensured by tightly bandaging the injured leg to the healthy one.

You can tie one leg to the other using a towel, piece of fabric, sheet, shirt or other material.

To prevent development painful shock it is necessary to carry out anti-shock measures and analgesic therapy.

The ideal painkiller is injections of promedol or morphine, but the presence of such drugs in an ordinary first aid kit is unlikely, so you can give the victim analgin tablets or other painkillers.

If you don’t have them at hand, you can reduce the pain with a few sips of strong alcohol.

Transport the victim to medical institution is possible only in a lying position, otherwise there is a risk of displacement of bone fragments and development severe consequences(fat embolism, large blood loss).

What is contraindicated to do in case of injury

If an injury occurs, the following is strictly contraindicated:

• the victim can move independently;
• lean on the affected limb;
• fix the splint too tightly to the leg, since blood circulation and innervation may be impaired; regularly monitor the color of the leg and its sensitivity;
• hold the sore leg too weakly;
• beware of sagging of the foot, this happens when it is poorly fixed;
• there is not enough soft tissue under the splint, which can lead to wounds;
• remain calm and cool, since confidence and calm can be transferred to the victim.

Treatment

Treatment involves the use of skeletal traction and pins. However, each type of injury has its own treatment principles.

1. When proximal injury occurs, the cervix is ​​most often affected. In this case, treatment is surgical. When treating young people they use conservative therapy, which involves wearing a plaster cast for 2-3 months. Then the movement is carried out on crutches, however, without putting load on the injured leg. You can load the limb a year after the injury. Full recovery occurs after eight months. Older people undergo skeletal traction for two and a half months.
2. For lateral injuries they use conservative treatment, which has good performance. Elderly people are prescribed skeletal traction, and then cuff traction.
3. For diaphyseal ones, both conservative and surgical treatment are used. A large hip bandage is applied if the bone fragments have not been displaced. Skeletal traction is prescribed for oblique and spiral injuries.
4. For distal - superimposed gypsum bandage for two months. If displacement of fragments is noted, their reposition is carried out before applying a bandage.

Devices such as splints and pins are used as fixators. They are inserted into the bone and head through the saddle. Several fixing screws are also used.

Hip fracture rehabilitation

Rehabilitation must begin as quickly as possible. It pursues the following goals:

• prevention of muscle atrophy;
• rapid formation of callus;
• ensuring motor activity and functioning of the limb.

The following are used as recovery procedures:

• physiotherapeutic procedures;
• massage;
• physical therapy.

Massage and physical therapy are used from the very first days. As you recover, the amount of physical activity increases. This is a mandatory condition that prevents the development of muscle atrophy, the formation of contractures and strengthening of ligaments. During exercise, blood circulation in the damaged area improves, and accelerated regeneration of soft tissue occurs.

Physiotherapeutic procedures are carried out to improve the condition of blood vessels, soft tissues and oxygen enrichment. For this purpose they prescribe:

• ultraviolet irradiation (UVR);
• electrophoresis;
• magnetic therapy;
• iontophoresis.

Recovery continues at home. A person independently performs physical therapy and massage.

For a speedy recovery, you must follow several rules and restrictions:

• have a good rest;
• avoid stressful situations;
• avoid excessive physical activity;
• eat right, include foods containing calcium, phosphorus and vitamin D in your diet;
• do not miss physical therapy sessions;
• avoid hip and limb injuries;
• regularly perform therapeutic exercises;
• take medications prescribed by your doctor.

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Source: https://ZaSpiny.ru/travmy/perelom-bedra.html

Fracture of the femur with and without displacement: causes, symptoms, treatment, rehabilitation

Femur fracture currently accounts for 6% of overall indicator fractures in adults and approximately 17% among children.

Such injuries not only cause serious consequences, but they also need to be treated effectively and for a long time. Today, there are quite a lot of treatment methods, including pins, skeletal traction, splints, etc.

n. A specific method should be selected only by a doctor after diagnosing the disease.

Today we’ll try to figure out what factors contribute to hip injury and how to deal with the disease.

Classification of injuries

There are several types of hip fracture. There are open and closed types of fracture. In particular, doctors determine the following:

1. Head fracture. Often such a disease occurs after strong blow. Complications are characterized by dislocation of the hip joint.
2. A femoral neck injury is a fracture at the head, neck, or greater trochanter. It is divided into extra-articular and medial types.
3. The subtrochanteric type is a fracture between the trochanter and the area below it and may involve the body.

With a closed or open injury, complications may arise. Based on this, the following types of displaced bone fractures are distinguished:

1. Valgus (displacement occurs upward and to the side).
2. Impacted (entry of one bone particle into another).
3. Varus (shift of the bone downwards and inwards).

Experts note that non-displaced fractures are not so difficult because they do not require reposition or surgery. Fracture open type unofficially referred to as displacement injuries, because in this position the sharpened areas of displaced bone fragments tear soft tissue. When the femur is fractured under pressure from the muscles and ligaments, the bone fragments overlap each other.

Common causes of a femur fracture at the top are accidents, bruises or falls. For older people, injury can result from a direct blow or fall to the hip joint.

Since in older people the bones are no longer so strong (due to the loss of hormones responsible for calcium retention), injury can occur even when stumbling, after which, in order to hold it, the person suddenly transferred the entire body weight to one leg.

Symptoms can be different and manifest in different ways. Among the common ones are the following:

1. Severe pain in the hip and groin area. With an intra-articular injury, the pain can be tolerable and aching, but increases with movement.
2. With a vertical fracture of the femur, the pain is intense and increases with pressure on the damaged area.
3. Patients with a vertical hip fracture most often cannot fully move, and they are tormented by sharp pain. This injury classified as severe.
4. The injured leg rotates outward.
5. With a displaced fracture, the leg becomes noticeably shorter.
6. The difference between an impacted fracture is the absence of a shortened joint, and in some cases a patient with such an injury can rely on the sore leg.
7. At superior fracture femur, the patient, lying on his back, will not be able to straighten and raise his leg.
8. A vertical fracture is characterized by severe swelling and bruising. If the femoral neck has been injured, swelling may be minor and no bruising may be observed.

If the symptoms described above are ignored, the patient may end up with disability at best, or death at worst. In this regard, if you suspect a hip fracture, you must contact a medical facility as soon as possible.

How to treat a fracture?

At obvious manifestations If you suspect a hip fracture, the first thing you should do is call an ambulance. While the specialists are in a hurry, the patient needs to be immobilized and a rigid splint applied to the damaged area, which will fix the position of the sore leg. The tire can be built from 2 flat objects, for example boards of the required size.

The first item will need to be placed on the outside, so its length should be equal to the distance from the armpit to the ankle. The second item will be applied from the inside, and its length should be enough to cover the distance from the foot to the groin. You can secure the boards using an elastic belt.

Treatment of a femur fracture involves a traction procedure. Tight bandages and plaster splints will not provide correct position joint fragments.

In case of a transverse type of injury, skeletal traction is used with the help of a Kirschner wire, which is often passed through the proximal metaphysis of the tibia below its convexity and, less often, through the lower end of the femur. An important condition effective treatment serves as early application of traction and reposition of the formed fragments.

It is not only very difficult to correct the disturbed position of fragments with late treatment, but often it is completely unrealistic. Only in rare cases do doctors use immediate reposition under a local anesthetic.

This reduction is prescribed for patients with a transverse fracture of the femur with significant displacement of the fragments, as well as for trauma to the lower third of the femur, when the distal fragment is retracted, moving forward and upward. In the latter case, the affected limb, bent at the knee, is secured with a plaster cast after reposition.

After removing the traction devices, the doctor allows the patient to walk on crutches, but rehabilitation must be followed, which means massage, physical therapy and physiotherapy. As an example, you can familiarize yourself with the set of rehabilitation exercises on video.