Fracture of the femoral neck of the hip joint: types, treatment of the elderly and consequences of surgery

Among elderly people, in 30% of cases such a fracture leads to death within a year after the injury. The cause of death is inactivity of a person, leading to the development of deadly complications.

X-ray of a fracture

In more than 90% of cases, fractures in the hip joint area occur in people over 70 years of age with grade II-III osteoporosis. Their femur breaks due to a fall. Such fractures heal very poorly due to low bone mineral density and poor blood supply to the hip joint. At a young age, hip bones break less often, which is due to their high strength and resistance to traumatic factors.

Types of fractures

A hip fracture is a broad and vague concept. In fact, the hip joint is formed by several bones and any of them can break.

Among hip joint fractures, the leading position is occupied by injuries to the femoral neck and intertrochanteric zone. Violations of the integrity of the acetabulum are much less common.

Anatomy.

In the international classification of diseases ICD-10, hip fractures are assigned code S72.0. Damage to the acetabulum is coded S32.4.

The proximal part of the femur, which participates in the formation of the hip joint, consists of a head, neck, body and two trochanters connected to each other by the intertrochanteric ridge. According to statistics, in 57% of cases, a violation of the integrity of the bone occurs in the femoral neck area. In 36% of patients, doctors identify pertrochanteric fractures.

Fractures can be non-displaced, partially displaced and displaced (in the photo you can see the difference between them). Fractures accompanied by displacement of femoral fragments have the most severe course and prognosis. They lead to impaired blood circulation in bone tissue, which is why they grow poorly. Treatment of such fractures is most often carried out by endoprosthetics.

Types of injury.

Acetabular fractures usually occur as a result of road accidents or falls from height. The pelvic bones break and are often displaced.

Fracture of the right acetabulum (left in the picture).

First aid for any type of fracture is to immobilize the lower limb. The injured leg and pelvis are fixed in the position in which they are located. For immobilization, special tires are used, and if they are not available, long boards or sticks are used. If the patient is bleeding, a tourniquet is applied to him. In this condition, the person is immediately taken to the hospital for emergency care.

Minimally invasive endoprosthetics in the Czech Republic: doctors, rehabilitation, terms and prices.

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Main complex

Most girls dream of a sporty and slim figure. To achieve the desired result, you do not need to visit gyms. You can work on yourself at home by doing it for 20 minutes. simple physical exercises.

Tilts

To complete the exercise, you must follow the following step-by-step instructions:

1. Initially, you need to take a straight position with your feet shoulder-width apart.

2. Next, you should bend down while maintaining your posture.
3. You need to bend over so that the body is aligned with the floor. It is imperative to bend your knees.
4. Then you should take the original position.

The workout consists of 4 sets of 10 repetitions. During exercise, you need to pay attention to the fact that you should not pull the body upward due to the back muscles. This type of bending is considered incorrect. This may result in injury. The back muscles should keep the body straight, and the gluteal muscles should lift it.

Squat

For the effect of this exercise to be noticeable, you need to squat deeply. In order for the muscles to be more involved, you need to go as low as possible. In this case, the back should be straight, and the knees should not protrude beyond the toes.

The exercise is as follows:

1. Feet should be placed shoulder-width apart or slightly wider than shoulder-width apart.
2. Inhaling, you need to sit down and push your buttocks back, as if trying to sit down on a chair. You need to squat until your thighs are parallel to the floor.
3. As you exhale, you need to take the original position. Squats must be performed 12 times in 4 sets.

Jump Squats

To perform the exercise correctly, it is recommended to follow these steps:

1. Initially, you will need to straighten your back and place your feet shoulder-width apart.
2. Squats must be performed while inhaling, lowering to parallel with the floor. It is permissible to perform a squat a little lower. However, this requires control over your feelings.
3. As you exhale, you should make a strong jump up. To do this you will need to push off with your feet. You must try to jump as high as possible so that your hips spring as much as possible.
4. When your feet finally touch the floor, you need to go into a squat again. The workout consists of 4 sets of 12 reps.

When doing squats, you need to watch your landing. It is necessary to stand on the floor with both feet at the same time. It is advisable to land with slightly bent legs. In this case, you must immediately go into the next squat.

Bulgarian squat

To perform the exercise you will need to use a chair, sofa or armchair.

The Bulgarian squat is as follows:

1. You need to stand with your back to the chair.
2. Next, you will need to put one leg on the chair, stepping the other forward. You should sit down until your thigh is in line with the floor. You need to keep your body straight. The working leg acts as the center of gravity and should bend at an angle of 90°. The non-working leg should be relaxed. You will need to transfer the load to the heel.
3. Then you need to take the starting position. Each leg will need 12 repetitions with 4 sets.

When performing the exercise, you need to take a long step to transfer the weight from the front thigh to the buttocks. When squatting, the knee should not protrude beyond the line of the toes.

Plie squats

To carry out the lesson, you must do the following:

1. Your feet will need to be set slightly wider than your shoulders. Toes should be turned out at a 45° angle.
2. You need to squat very slowly and also take the starting position. The back should always be straight. In addition to the inner thigh muscles, the gluteal muscles are also trained.
3. The exercise should be done in 4 sets with 12 repetitions.

During exercise, your knees should be positioned along the line of your feet and should not touch your toes. The back should remain straight at all times.

Lunges

When performing this exercise, you must ensure that your back is always straight and does not lean forward. The training process will involve the anterior thigh and gluteal muscles.

When performing the exercise, you must adhere to the following steps:

1. The legs should be slightly narrower than the shoulders, and you need to stand straight.
2. You need to step forward and squat so that your thigh matches the floor. Shoulders should be straightened and arms down. Lunges must be performed in steps using 2 legs. The leg that is in front acts as the center of gravity, bending at an angle of 90°.
3. After the lunge, you need to stand up, pushing off with your heel and moving your back leg forward.
4. The procedure consists of 20 steps of 4 sets.

Swing back on the floor

To perform back swings, you need to focus on the following steps:

1. The palms must be placed on the floor while kneeling.
2. The leg needs to be bent and raised up. Then you will need to take your starting position. For loading, it is permissible to use any weighting agent.
3. The exercise must be performed in 4 sets and 30 repetitions.

Gluteal bridge

When performing the exercise, you need to rise and hold at the top point, trying to squeeze the muscles of the buttocks as tightly as possible.

The lesson is as follows:

1. You need to lie on the floor, squeezing your legs and placing them shoulder-width apart.
2. In this form, you need to raise and lower the pelvis. To make the workout more challenging, you can stretch your leg or place some weights on your thigh.
3. The exercise consists of 4 sets of 30 repetitions.

Burpee

To get a good effect, the exercise must be performed correctly and very quickly. However, it is necessary to monitor your well-being. If your heart rate is strong and you feel nauseous, you should stop training.

The burpee exercise is based on the following actions:

1. Initially, you need to stand up straight, holding your arms along your body. It is necessary to perform a full squat so that the center of gravity moves to the toes.
2. Then you should take a lying position, and then return to a full squat and to the starting position with a jump.
3. It is necessary to perform 4 approaches. The number of repetitions will depend on personal capabilities.

Femur injuries

According to statistics, this pathology is detected in 80% of women over 50 years of age and almost all men over 75 years of age. In females, osteoporosis develops much earlier, which is due to the massive loss of calcium during menopause.

If a person does not compensate for calcium deficiency with the help of vitamin-mineral complexes, vitamin D, calcium- and phosphorus-containing preparations, then he begins to demineralize his bones. Simply put, the minerals Ca and P are washed out, enter the bloodstream and are distributed throughout the body. Once they enter organs and tissues, they perform a number of vital functions there.

Trauma to the left hip joint.

Since the neck is the thinnest part of the femur, it is the one that suffers most often. Pertrochanteric fractures and head injuries are much less common. The latter are usually combined with a violation of the integrity of the pelvic bones.

In orthopedics and traumatology, several classifications of femoral neck fractures are used. Different types of fractures have completely different prognosis. For example, in people under 50 years of age, transcervical fractures with an angle of less than 30 degrees heal relatively well. In older age groups, subcapital injuries and fractures with an angle of more than 50 degrees heal extremely difficultly and have an unfavorable prognosis.

From left to right: subcapital, transcervical, basicervical fractures.

1. Subcapital. Located on the border between the head and neck of the femur. Least favorable prognosis.
2. Transcervical. It is localized in the most vulnerable place - in the area of ​​the femoral neck.
3. Basiscervical. Located at the junction of the neck with the body of the femur. It grows together much better than the previous two options.

The fracture angle is of great prognostic significance. In a vertical position, there is a high risk of displacement with subsequent disruption of blood circulation in the tissues of the femur. Such fractures have the most unfavorable prognosis.

Fractures of the femoral neck may be accompanied by impaction, stretching, compression, displacement or rotation of bone fragments. All this aggravates the patient’s condition and worsens the prognosis for recovery.

Diagnostics

The diagnosis of a fracture is made based on:

• The patient's complaints (inability to lean on his leg, pain in the groin).
• History.
• The clinical picture is when the injured limb is shortened, turned outward, and the injured person cannot lift the heel off the surface (symptom of a stuck heel).
• X-ray data.

Trochanteric, intertrochanteric and subtrochanteric views

The second most common place among fractures of the hip joint is occupied by injuries in the trochanteric region of the femur. They come with or without displacement. Violation of bone integrity can have varying severity and severity. Fractures in the trochanteric area are more common in relatively young people. They arise as a result of a fall or the action of a tear-off mechanism.

The most favorable course is for fractures of the greater and lesser trochanter, which are not accompanied by displacement of bone fragments. They do not cause serious damage or complications. Their treatment usually does not require surgery. Surgery and internal fixation of bone fragments are needed only if they are displaced.

AO classification of trochanteric zone fractures:

1. Simple pertrochanteric. One fracture line that runs in the area between the greater and lesser trochanter.
2. Multicomminuted pertrochanteric. Several bone fragments are formed in the trochanteric zone. Breaking bone into pieces.
3. Subtrochanteric. They are located in the proximal femur below the lesser trochanter, but no further than 5 centimeters from it.

Subtrochanteric fracture.

Why are they needed?

A girl's figure, located in the hips and buttocks area, may have various types of deviations from the norm.

The most common problems are described in the following list:

• a large amount of deposits in the thigh area;
• sagging and flabbiness in the gluteal region and hips;
• very thin thighs;
• thin and weakened gluteal muscles.

With regular fitness classes and careful training of the thigh muscles, the processes listed in the following points are triggered:

• fatty tissue on the thighs decreases in volume;
• lymph flow and blood circulation are normalized, which has a beneficial effect on the reduction of cellulite;
• physical indicators of leg muscle strength increase;
• the silhouette of the figure becomes more attractive;
• the articular-ligamentous apparatus increases its functionality;
• The core and muscle tissue of the lower extremities are strengthened and acquired relief.

Destruction of the acetabulum

According to statistics, pelvic bone fractures occur in people aged 21-40 years. Their main causes are car accidents and serious domestic injuries. Acetabular fractures account for about 15-20% of all traumatic injuries to the pelvis. They are accompanied by fractures and dislocations of the femoral head.

Comminuted fracture.

Uncomplicated acetabular fractures in young people are treated without surgery. Surgery is required for T-shaped fractures, interposition of fragments in the joint, unreduced fracture-dislocations and massive fractures of the posterior edge of the cavity.

Vessels

Look at the anatomical diagram or photo of the thigh in an anatomy textbook - you can clearly see that the thigh is densely entwined not only with muscles, but also with various arteries and vessels. They are very powerful, since they have to provide blood to a fairly large “sponsored” area. The thigh is entangled with the following main arteries:

1. External iliac artery. Its task is to supply blood to the aerial muscle and peritoneum.
2. The pubic network of arteries forming the obturator vascular network. Its main task is blood circulation from the abdomen to the thigh. Damage to these vessels is extremely dangerous, as it can lead to fatal bleeding.
3. Femoral artery - begins in the anterior thigh and goes to the popliteal notch. In the upper part, the artery is located superficially, so it can be easily felt through the skin.
4. The deep artery is a network of literal, medial and perforating vessels. They supply blood to the thigh - joint, muscles and other soft tissues.
5. The popliteal artery divides into the posterior and anterior tibial plexuses. These vessels are located deep under the skin and fat layer.

Injuries in the younger age group

In the younger age group, trochanteric, subtrochanteric, pertrochanteric, and fractures of the acetabulum and femoral neck occur. The latter usually have a transcervical or basalocervical localization and belong to types II and III according to Pauwels.

Osteosynthesis.

The main method of treating hip fractures in the younger age group is internal osteosynthesis.

The essence of the internal osteosynthesis technique is the reposition of bone fragments and their fixation. For this purpose, pins, screws, plates, knitting needles, etc. can be used. Implants are usually made of titanium, molybdenum-nickel, or other alloys that are resistant to oxidation in body tissues.

Successful osteosynthesis requires:

• absence of severe osteoporosis;
• maintaining normal bone mineral density;
• no disturbances in the blood supply to the bones of the hip joint;
• accurate and durable comparison of bone fragments by the surgeon;
• minimal trauma to periarticular tissues during surgery;
• mechanical compatibility of the implant and bone tissue;
• early physical activity in the postoperative period.

There are different osteosynthesis techniques. When choosing a method of surgical intervention, doctors take into account the individual anatomical and physiological features of the structure of the human femur, the location of the fracture, its direction and type according to Pauwels.

A type of osteosynthesis.

According to statistics, nonunion of hip fractures is observed in 10-30%, avascular aseptic necrosis of the femoral head – in 10-40% of patients. Typically, these patients end up undergoing total hip replacement.

In case of severe comminuted fractures of the hip joint, accompanied by impaired blood circulation in the femur, it is better to refuse internal osteosynthesis. Most likely, it will not help restore the integrity and functional activity of the joint.

Rehabilitation

All patients after a particular operation are indicated for rehabilitation. It implies approximately the same set of measures, which are introduced at different times after surgery.

A massage is required, which helps to activate blood and lymph circulation in the thigh, helps reduce the risk of blood clots and bedsores, as well as pneumonia. In addition, therapeutic massage helps to avoid muscle atrophy. But its duration and intensity for each patient is determined individually by a specialist.

Also, all patients are prescribed exercise therapy in accordance with the patient’s physical capabilities, the speed of his recovery and the characteristics of the operation performed. Therapeutic exercise helps reduce the likelihood of complications, avoid a decrease in muscle tone and achieve the restoration of normal motor activity. Initially, breathing exercises and exercises are performed in the supine position, using the muscles of the arms, neck, abdominals, and healthy leg. Gradually, the exercises become more complicated, but their implementation, especially at first, is allowed only under the supervision of a specialist, and only after complete mastery of the technique are independent exercise therapy sessions allowed.

It is also important to provide adequate nutrition to patients, although a decrease in appetite is often observed after a hip fracture. Therefore, it is necessary that the portions correspond to human needs, but the menu includes sufficient quantities of fruits and vegetables rich in fiber, as well as milk and dairy products. It is better to limit meat food.

Thus, although a hip fracture is not a common injury, almost every elderly person can experience it. Moreover, it often causes the development of life-threatening complications leading to death. Therefore, after falls and other traumatic factors on the hip area, especially if symptoms of a femoral neck fracture occur, you should contact an orthopedist and, when diagnosing an injury, do not be afraid of surgery. Modern methods of surgical treatment allow us to count on a favorable outcome and restoration of normal motor activity without complications.

Features of the elderly

In 90-95% of cases, fractures in the hip joint occur in elderly people over the age of 60 years. Almost all of them have concomitant osteoporosis (decreased bone density). Also, in older people, there is a deterioration in blood circulation in the bone structures of the hip joint. All these factors interfere with normal bone fusion and make internal osteosynthesis ineffective.

Physical activity with light weights of 5-7 kg is very suitable for maintaining bone density.

After osteosynthesis, complications may develop in older people. The incidence of nonunion of fractures with subsequent resorption of the femoral neck and the formation of a pseudarthrosis is 18-40%. Aseptic necrosis of the femoral head occurs in 17-25% of patients.

If one of the vessels is damaged, the nutrition of the bone tissue stops.

Risk factors for falls in old age:

• poor eyesight;
• residual effects after strokes;
• taking medications with hypnotic or hypnotic effects;
• muscle atrophy;
• parkinsonism;
• lack of crutches or other walking aids;
• improperly arranged living conditions (carpets sliding across the floor, electrical wires strung across the room, etc.).

The main goal of treating hip fractures in old age is getting out of bed early. It is necessary for the prevention of bedsores and congestive pneumonia - severe complications that often lead to the death of the patient.

Early activation of older people can be achieved through endoprosthetics - replacing the hip joint with an artificial implant. If there are no complications during the operation, a person can get out of bed on the second or third day. After the end of the rehabilitation period, he is able to move normally without any outside assistance.

Minimally invasive endoprosthetics in the Czech Republic: doctors, rehabilitation, terms and prices.

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Causes

In more than 90% of cases, hip fractures occur in people, and 4 times more often in women over 65-70 years of age, who already have grade 2-3 osteoporosis. In such situations, a fall from one’s own height is enough to cause such a dangerous injury. Since in such cases the bones have a low degree of mineralization, and blood circulation is usually impaired due to the development of other concomitant diseases, the fractures heal very poorly.

Osteoporosis is a chronic disease accompanied by a decrease in bone mineralization, causing them to become more porous and fragile.

Also predisposing to getting a hip fracture in older people:

• presence of cancer;
• maintaining a sedentary lifestyle and pathologies of the nervous system leading to limited mobility or coordination of movements, including Parkinson’s disease, residual effects after a stroke;
• obesity;
• poor nutrition, starvation, leading to a deficiency of nutrients of different groups in the body;
• hormonal changes characteristic of menopause;
• atherosclerosis and other vascular pathologies;
• decreased visual acuity, which increases the risk of falling and injury.

At the same time, hip fractures are rare in young people, since the femurs are highly durable and resistant to various traumatic factors. In such situations, fractures are usually the result of:

• road accident;
• work injury;
• falls from great heights;
• participation in armed conflicts.

Endoprosthetics as a treatment method

Due to poor blood supply and osteoporosis in older people, almost all fractures heal poorly. Moreover, the implantation of metal pins or plates activates the processes of osteolysis - destruction of bone tissue. As a result, after internal osteosynthesis, the condition of many patients only worsens.

Nowadays, the most effective method of treating hip fractures is endoprosthetics. Replacing fragments of the hip joint with artificial implants ensures early getting out of bed, can significantly shorten the rehabilitation period and restore the supporting function of the lower limb. This, in turn, makes it possible to avoid life-threatening complications from which many elderly people die in the first year after injury.

Fixing the components of the prosthesis with special cement ensures their reliable attachment to the surfaces of osteoporotic bones.

As practice has shown, total arthroplasty for femoral neck fractures gives favorable results in 90% of cases. This means that total hip replacement is much more effective than internal and external osteosynthesis.

Interesting Facts

At the end of the topic “What is a hip”, let’s get acquainted with interesting facts:

1. The skin on the medial part of the thigh is thinner, more mobile and elastic than on the outside.
2. The subcutaneous tissues in the thigh area are more developed in women than in men.
3. Depositing fat in the thighs and buttocks will help prevent diabetes. Lipids located here produce leptin and adiponectin, which prevent the development of this disease and a number of others.

The thigh is one of the areas of the human body, the upper part of the leg. Like all other areas of the body, it has a unique and complex structure.

Indications and contraindications

Doctors recommend hip replacement for all patients over 70 years of age with fractures and pseudarthrosis of the femoral neck. Endoprosthesis replacement is also performed for all patients who have developed aseptic necrosis of the femoral head. Planned replacement of the hip joint can be performed in patients with deforming osteoarthrosis and grade III coxarthrosis. Indications for surgery are also tumor processes in the hip joint.

Contraindications to endoprosthetics:

• severe heart failure and heart rhythm disturbances;
• chronic respiratory failure of the ІІ-ІІІ degree;
• a person’s inability to move independently;
• inflammatory process in the hip joint;
• the presence of unsanitized foci of chronic infection in the body;
• past generalized infection (sepsis);
• absence of a medullary canal in the femur.

If there are contraindications, it is dangerous to perform hip replacement surgery. Due to severe diseases of the cardiovascular or respiratory system, the patient may simply not tolerate anesthesia. The presence of infection in the joint cavity or in any other part of the body can lead to the development of purulent-inflammatory complications in the postoperative period. And the patient’s inability to move without assistance will greatly complicate rehabilitation.

Muscle structure

When considering the structure of the human thigh, one cannot ignore the muscles. It is she who helps this part of the body perform rotational and flexion movements. The muscles envelop the femur on all sides, dividing into the following groups:

• front;
• medial;
• rear

Let's look at each in a separate subheading.

Femoral neck osteosynthesis or endoprosthetics?

The duration of rehabilitation after internal osteosynthesis is on average 12 months, after endoprosthetics - 5-6 months. In the early postoperative period, all patients who have undergone hip replacement surgery are given antibiotic prophylaxis and prevention of thromboembolic complications.

Patients after osteosynthesis are on bed rest for the first 3-5 days. After this, they are allowed to move the limb and get out of bed. Later, patients are prescribed massage, physiotherapeutic procedures, exercise therapy, and swimming in the pool. Physiotherapy for hip fractures helps improve blood circulation in the joint area and thereby speed up recovery. The fixing plates or pins are removed only after the fracture has completely healed and the functional activity of the joint has been restored. Typically, this occurs 12-18 months after surgery.

In the case of endoprosthetics, the recovery period lasts much less. With the help of medical staff, a person can get out of bed on the second day after surgery. Soon he begins to move independently, with the help of crutches or a special walker. After another 2-3 months he may refuse them. If all the doctor’s recommendations are followed and proper rehabilitation is performed, the patient returns to his usual lifestyle within six months.

Conservative

The femoral neck (where the injury is located in a person is determined using hardware diagnostics) is treated in some cases using a conservative method. In this case, an incomplete fracture occurs without displacement and the rupture line does not exceed an angle of 30˚.

It includes:

• fixation of the hip joint;
• sprain (according to medical indications);
• rehabilitation therapy with medications;
• physical therapy complex.

To relieve pain, an anesthetic is administered to the nerves of the thigh. The procedure is called a nerve block.

Drugs used in treatment:

All patients, after seeking medical help, are given thromboprophylaxis, which is an emergency measure. The risk of developing venous thrombosis is present from the moment of injury.