Hip fracture is a serious injury that almost does not respond to conservative treatment. The hip fracture is most common in elderly people, due to osteoporosis when bony tissue becomes fragile. Among young happens it occurs most often due to severe trauma (eg, fall from a great height).
For all categories of patients, hip replacement is the best option. Due to the surgical treatment, elderly people are able to avoid long, painful and almost always futile expectations of natural healing of the bones. Younger patients reduce the risk of improper fusion and necrosis.
Depending on where the fracture line is, there are capital (fracture of the femoral head), subcapital (at the base of the head) and transcervical – (cervical) medial fractures.
They all intraarticular, but blood flow of the proximal fragment can be broken in many ways. Thus, when capital and subcapital hip fracture occur, the head is usually in avascular conditions, that is, its blood supply is completely disrupted. When transcervical fractures occur, blood supply of the proximal fragment is partially preserved and it suffers the less, the closer to the base of the femoral neck the fracture occurred.
Despite the fact that pain in these three cases is different, therapeutic measures are very similar. If the fracture was higher the attachment to the hip joint capsule, it is called medial. Extra-articular fractures (lateral) are below the point where the capsule of the hip is attached to the hip.
Hip fracture symptoms
The first symptom – is a pain in the groin, aggravated by movement. The pain is not necessarily severe, and the patient can feel relaxed and even argue that he is healthy. There are rare cases, when the patient moves independently for several days or weeks, almost without pain. But all the other symptoms point to a fracture of the femoral neck.
- Increased pain when tapping on the injured foot heel.
- Minor foot inversion, which is visible in the position of the foot.
- Relative shortening of legs. That is, its usual length remains the same, the shortening is caused by muscle contraction, which pulls the leg closer to the pelvis. If the patient tries to straighten the leg, it will be seen that the injured limb is shorter than the other by 2-4 cm
- The patient in lying position can not keep a straight leg in the air. He is able to bend and straighten the leg, but can not lift straight legs (a symptom of “stuck” heel).
Methods of treatment
Conservative. Late initiation of treatment can lead to disability. Treatment measures should be started immediately after the discovery of an injury. The structure of the femoral neck is so that it heals very seriously itself, and, as a rule, only in children. The rest will have a surgery.
However, conservative treatment in patients under 30 years can lead to a good result. The surgeon draws up damaged bone fragments without penetration, restoring their original position. The method of skeletal traction is most frequently used, but as a separate type of assistance it is still outdated.
Therapeutic exercise should be started as soon as possible. Patients need to be physically active from the first day of treatment. First they move in the bed, sit, turn, then go with the support. Merging of bones occurs within 6-8 months. Conservative treatment is not prescribed for elderly people due to the very high risk of pressure ulcers, venous thromboembolism, pneumonia, occurring due to prolonged immobility.
Operational. There are two types of operations that can help with the trauma of the femoral neck: osteosynthesis of femoral neck and total hip arthroplasty.
In osteosynthesis, femoral bone fragments are fixed with metal screws. This creates good conditions for the restoration of the initial state of the bones that grow together in 4-5 months. It should be noted that this surgery does not guarantee the absolute guarantee of bone healing. Therefore, this surgery is not carried out for patients older than 60 years.
A more efficient way – hip replacement, ie hip prosthetics. Broken bones are replaced with prosthesis. This method makes it possible to actively move the injured leg from 3-4 weeks, and if the bone cement was used, the physical activity is possible after 3-4 days.