A hip fracture is a common serious injury that occurs in old age. It can cause a number of dangerous complications and exacerbation of chronic diseases. Pertrochanteric fracture of the femoral neck in old age sometimes leads to death. An impacted fracture of the femoral neck in older people compromises the integrity of the most fragile part of the femur. The cause of the damage is a minor injury that occurs against the background of osteoporosis and other diseases accompanied by a decrease in bone strength.
Rehabilitation of patients using innovative methods of restorative therapy is carried out by specialists from the Yusupov Hospital. The rehabilitation clinic is equipped with modern devices. Rehabilitators take an individual approach to choosing a set of physical therapy exercises, physiotherapeutic procedures, and use various types of massage. With the help of effective medications that have a minimal range of side effects, they reduce the severity of pain and improve the structure of bone tissue. Medical staff provide professional care for elderly people with a hip fracture.
From your height
“Reached for a jar on the top shelf,” “bent over for a stick,” “climbed out of the bathroom” - in old age, these simple everyday situations can result in injuries, the worst of which is a hip fracture.
It must be said that a femoral neck fracture occurs at 40 and 50 years of age, in both men and women. However, according to data from open sources, about 90% of those injured with a hip fracture are people over 60 years of age and, most often, women. The injury is particularly problematic due to the fact that in old age bones heal much less well.
The bones of the elderly are fragile, so most femoral neck fractures in the elderly occur as a result of falling from their own height while walking, running, carelessly moving on stairs, ice, etc.
At the same time, experts point out that the fracture itself is not as dangerous as the complications it can cause. As already mentioned, quite often this injury in the elderly is accompanied by an exacerbation of various diseases, which can put them to bed for a long time and even lead to death.
An accident happened to my grandmother’s sister on the eve of the new year 2021, on December 31 - she tripped and fell at home. An X-ray at the emergency room showed a femoral neck fracture. I had to refuse the operation: severe hypertension and age 84 years. Despite the care of a professional doctor (her niece), the injury literally broke the previously strong-willed woman - she became depressed, became very weak, stopped eating, and died just six months later.
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.
Neck or skewer?
The upper end of the long femur has a complex structure. The rounding at the end is the head of the bone, the narrower part connecting the head with the body of the bone is the neck, and on both sides of this neck there are bone protrusions - trochanters (the outer one is especially noticeable), muscles are attached to them. The neck is the most fragile part of the femur.
“A neck fracture is one of the fractures of the upper thigh in the elderly, but not the most common,” says Dmitry Khryapin, an orthopedic traumatologist at the traumatology department of the V.V. City Clinical Hospital. Veresaeva. — The most common fracture in older people is a pertrochanteric hip fracture: there were 250 such patients in our department last year. In 2016, 185 people were admitted to the department with hip fractures. Most people call all these fractures fractures of the femoral neck, although the difference between them is very big: a pertrochanteric fracture heals better - the bone always heals - both with and without surgery, but the neck does not always.”
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:
- Simple pertrochanteric. One fracture line that runs in the area between the greater and lesser trochanter.
- Multicomminuted pertrochanteric. Several bone fragments are formed in the trochanteric zone. Breaking bone into pieces.
- Subtrochanteric. They are located in the proximal femur below the lesser trochanter, but no further than 5 centimeters from it.
Subtrochanteric fracture.
We need to operate!
Geriatricians insist that an elderly person with a hip fracture should be operated on. “In the civilized world, almost 100 percent of older people with a hip fracture undergo surgery,” says Andrei Ilnitsky, head of the department of therapy, geriatrics and anti-aging medicine at the Institute for Advanced Studies of the Federal Medical and Biological Agency. — Risks, of course, exist, as with any other operation. But the risk from not performing the operation and from complications associated with limited mobility is disproportionately higher.”
According to Dmitry Khryapin, about 2/3 of injured patients undergo successful surgery.
“Of the older people admitted to the department with both types of fractures, approximately 70-80 percent were operated on,” says the practicing traumatologist. — The operations were different - this included osteosynthesis, when the bones are connected with screws, and endoprosthetics. Last year we had about two hundred quotas for them and all of them were chosen.” He explained that osteosynthesis operations for the remaining patients were financed from other sources, and for endoprosthetics, according to a planned procedure, patients were sent to other hospitals according to quotas.
Grandmother fell: our actions
If the grandmother has fallen and complains of pain, but can walk, albeit with difficulty, complaints about girdling pain around the hip joint, severe pain in the groin, acute or, conversely, dull pain in the joint when walking should alert loved ones. A fracture of the femoral neck may also be indicated by symptoms such as increased pain when moving and tapping on the heel of the injured limb, a slight inversion of the injured leg to the outside, which is noticeable in the foot, the inability to hold the leg in a straightened position (with the ability to bend and straighten the leg) , shortening the leg by several centimeters.
Trouble has happened. An elderly man is in painful shock, then depressed, confused, scared that he will now die forever. What to do?
First of all, he needs to be morally supported and encouraged. In the 21st century, a hip fracture is not a death sentence. Director of the Medical Research Institute Kirill Proshchaev advises: “An elderly person must be told that medicine has changed in almost one generation, and now people with hip fractures undergo surgery and the operation can restore their mobility and their previous way of life.”
Immediately after the injury - before the doctors arrive - you need to provide first aid: place it on a flat surface, fix the leg with a splint so that both the hip and knee joints are captured at the same time. ATTENTION: Doctors prohibit trying to bring the injured leg into a normal position.
It is important to get an injured elderly person to the hospital as quickly as possible, because the faster the necessary medical care is provided, the more effective the treatment will be. For example, during a fracture, hemoglobin drops significantly, blood clots or fatty tissue enter the blood, which can cause complications in the first day or two.
Resolve the issue of surgery with doctors. Typically, they try to perform the operation in the first two weeks after the injury. Unfortunately, in district and regional centers the issue takes longer to resolve - we must try to do everything possible to speed up the day of the operation.
If there is no risk that an elderly person will simply die on the operating table from heart or kidney failure, a sharp drop and surge in pressure, etc., surgical intervention is necessary - fastening the joint or bones with screws (osteosynthesis) or installing a joint prosthesis (endoprosthetics).
“The issue of timing of the operation is decided in each case individually, but we try to operate in the coming days,” explains Dmitry Khryapin. - As I already said. operations are carried out free of charge, for Muscovites according to quotas.”
Treatment Options
Approaches to the treatment of femoral neck fractures have changed along with the development of traumatology and surgical orthopedics. Initially, there were no alternatives to conservative treatment. The surgeon's arsenal included immobilization, i.e. immobilization of the joint with the help of various bandages and skeletal traction, which makes it possible to compare fragments during long-term implementation. All these methods slightly increased the chance of healing of the femoral neck fracture and were accompanied by a large number of complications. Gradually, techniques began to appear that made it possible to fix bone fragments. These methods, as they improved, found more and more supporters. Currently, the “golden” standard for the treatment of such fractures, with rare exceptions, is the surgical method.
Conservative treatment of femoral neck fractures can only be used if the patient has serious concomitant diseases, such as, for example, a recent myocardial infarction. Another exception is if for some organizational reasons it is impossible to perform the operation (for example, there is no equipment or a competent surgeon) and if the femoral neck is fractured without displacement, and the fracture line is located at an angle of less than 30 degrees, i.e. almost horizontally and such a fracture of the femoral neck does not tend to shift.
In general, conservative treatment of femoral neck fractures is a method of despair, and one must clearly understand that often surgery in elderly patients is aimed at saving lives, because being bedridden for many months, such patients gradually “fade away” and cases of death are not uncommon.
Possible complications with conservative treatment
The main complication of conservative treatment of fractures of the femoral neck (“femoral neck”) is nonunion of the fracture. As we have already noted, this occurs due to the fact that the head is often deprived of blood supply and the fracture of the femoral neck simply cannot heal.
Ununited fractures of the necks of both femurs after unsuccessful conservative treatment. Lysis has occurred, i.e. resorption of the femoral necks. Subsequently, with this variant of the course, lysis of the femoral heads will also occur.
The main reason for possible complications during conservative treatment of a femoral neck fracture is the patient’s loss of ability to move independently. Combined with advanced age, forced bed rest becomes fatal for many patients.
Elderly people on bed rest due to a hip fracture often develop congestive pneumonia, which is difficult to treat. Pneumonia leads to respiratory failure and can lead to the death of the patient.
When forced to stay in bed for a long time, elderly patients with hip fractures often develop bedsores, which are usually located in the sacrum and buttocks. Development of pressure ulcers, i.e. areas of tissue necrosis are associated with impaired blood circulation in them, caused by prolonged pressure on the skin and underlying tissues.
Patients with a hip fracture often experience various psycho-emotional disorders, including the development of psychosis and depressive states.
A serious complication of a femoral neck fracture is the development of deep vein thrombosis of the lower extremities, also caused by prolonged immobility of the patient, which occurs during both surgical and conservative treatment of femoral neck fractures. The danger of thrombosis is that blood clots formed in the veins can travel through the bloodstream to the lungs, causing pulmonary embolism, a fatal complication.
The most effective method of preventing or reducing the likelihood of all these complications is to quickly mobilize a patient with a hip fracture - the person needs to be put on his feet!
Thus, surgical treatment for hip fractures, which allows the patient to be activated, put on his feet and begin to walk with additional support on crutches or a walker, often saves the patient’s life and is carried out for health reasons. In young patients with hip fractures, surgery can reduce the likelihood of fracture nonunion, achieve better functional results, and more quickly return to their normal lifestyle.
Surgical treatment
Currently, there are several options for surgical treatment of femoral neck fractures. The choice of a specific technique depends on the patient’s age, concomitant diseases, and the patient’s general health.
This table provides approximate criteria that can guide a doctor when choosing a particular treatment method for fractures of the femoral neck. It must be borne in mind that each patient requires an individual approach, taking into account a much larger number of criteria, and this table shows only approximate and possible options.
| Biological age (years) | Functional status before femoral neck fracture | Treatment |
| <65 | Moves freely, goes outside | Reposition, internal fixation |
| >65 | Moves freely, goes outside | Endoprosthesis replacement with a bipolar endoprosthesis |
| >75 | Moves limited, within the house | Endoprosthetics with unipolar (unipolar) cement endoprosthesis |
Let us tell you in more detail about each of the possible treatment methods for a femoral neck fracture.
Reposition is the comparison of bone fragments. Before fixing bone fragments from a femoral neck fracture, they need to be compared. In some cases, in order to increase the chances of healing of a femoral neck fracture, the reduction is performed non-anatomically, i.e. do not restore the original, pre-fracture position of the bone, but the special one – i.e. the fragments are shifted so that the fracture becomes more “simple”. In particular, they try to give the femoral neck fracture lines a more “horizontal” position, which reduces the risk of displacement in the postoperative period. After reduction is completed, the fracture is fixed.
Special reduction, in which the displacement of fragments is given a more “horizontal” position
In young patients with femoral neck fractures, fixation is most often performed with three large screws. The screws can be cannulated, i.e. have a hollow channel inside it, like an injection needle. When using them, several thin metal wires are first inserted into the bone, the most well-positioned ones are selected, screws are placed on these wires and screwed into the bone, as if using a guide.
Osteosynthesis with three screws for femoral neck fractures in young patients. This introduction ensures the speed and accuracy of the operation. Screws inserted in this way compress the bone fragments between themselves, which increases the stability of fixation and the likelihood of fusion.
Fixation of fragments in a femoral neck fracture can be performed with more massive metal structures (compression femoral screw DHS, compression condylar screw DCS), but these are quite bulky fixators, and if only the femoral neck is broken, traumatologists prefer to use several separate screws.
Osteosynthesis of a femoral neck fracture with the DHS system (Dynamic Hip Screw)
The previously used fixation for femoral neck fractures using a bundle of thin pins and a three-blade nail is now practically not used as unreliable, and preference is unconditionally given to more modern and stable methods of fixation.
You can watch videos of rehabilitation exercises after osteosynthesis of the femoral neck on our website (click to go to the article on rehabilitation).
In cases where, after a femoral neck fracture, the risk of complications such as nonunion of the fracture, osteonecrosis of the head and neck of the femur (avascular or aseptic necrosis), which is more common in elderly patients, with significant displacement of the fragments, complex fracture of the femoral neck, optimal The treatment is hip replacement.
When hip arthroplasty is performed for a femoral neck fracture, only the neck and head of the femur are replaced (unipolar arthroplasty) or both the neck and head and the acetabulum are replaced (bipolar or total arthroplasty).
When both components of a joint (head and socket) are replaced, endoprosthesis replacement is called total. The components of the endoprosthesis can be fixed by hammering into the bone during surgery - the so-called cementless press-fit fixation. Subsequently, the bone grows into the porous surface or special grooves of the endoprosthesis. The cup of the endoprosthesis (the pelvic component that replaces the acetabulum), when fixed without cement, also has a porous coating for subsequent bone growth. The cup can be additionally fixed with screws.
The cementless fixation method is more preferable for young patients: it provides good fixation due to high bone density and is more favorable in relation to re-operation to replace the endoprosthesis. Although the service life of endoprostheses is constantly increasing due to technological developments, they still remain limited and young patients may require elective replacement of the endoprosthesis in the future.
Total (bipolar, i.e. both the femoral neck and the acetabulum are replaced) cementless endoprosthesis replacement for a femoral neck fracture. On the left is a postoperative radiograph. On the right is the appearance of a cementless endoprosthesis with a porous coating. One of the most common arrangements of a cementless endoprosthesis is presented, consisting of a cup, an insert made of high molecular weight polyethylene, a metal head and a leg.
In elderly patients with femoral neck fractures, fixation of endoprostheses is often chosen using a special polymer cement, which provides quick and reliable fixation even in the face of decreased bone strength and density, often observed in this group of patients. However, if concomitant diseases in an elderly patient with a femoral neck fracture are not critical, and the bone condition is good, then a cementless endoprosthesis can be installed.
Cemented endoprosthesis
The difference between cemented and cementless models of hip joint endoprostheses lies in the principle of their fixation. The cementless components of the endoprosthesis are covered with a porous or hydroxyapatite coating, installed into the bone using the “tight fit” method, and subsequently the bone grows into the surface of the implant. Cemented endoprostheses are fixed in the bone with special polymer cement, usually made from polymethyl methacrylate.
Cemented and cementless fixation of endoprosthetic legs
In patients with femoral neck fractures who are even more advanced in age, physically weakened, and who need to undergo a more sparing operation, only the neck and head of the femur are usually replaced, preserving their own acetabulum. This reduces the duration of the operation, reduces blood loss and improves the tolerability of the operation.
When choosing this method of treating a femoral neck fracture, unipolar (unipolar) endoprostheses can be used, the head of which is in direct contact with the surface of the cartilage of the glenoid cavity. This is the most gentle operation; it is performed on elderly patients in the most serious condition. The disadvantage of this operation is that direct contact of the head with the endoprosthesis leads to fairly rapid wear of the articular cartilage.
Its wear can be reduced by reducing friction between the cartilage and the head of the endoprosthesis. To do this, the head is made in the form of two hemispheres, nested one inside the other (like nesting dolls), and movements in such a joint occur between the hemispheres of the head, which reduces wear and destruction of the articular cartilage. Such endoprostheses are called bipolar.
Bipolar and monopolar hip replacements, used in elderly, weakened patients with femoral neck fractures and a high risk of complications - with this model, cup replacement is not performed, i.e. the cup of the endoprosthesis is not installed and the head of the endoprosthesis slides along the cartilage of the acetabulum
X-ray of the hip joint of a patient who underwent bipolar arthroplasty for a femoral neck fracture. The cup was not installed, the head of the endoprosthesis slides along the cartilage of the acetabulum
You can learn about how to prepare for endoprosthetics, what are the rules and features of the postoperative and rehabilitation period after hip replacement in a separate article on our website.
You can watch a video of rehabilitation exercises after hip replacement in another article on our website.
What happens after the operation
Treatment of a hip fracture is a long process; it makes sense to imagine in advance what and how you will need to plan:
After the operation, the patient is sent to the intensive care unit for some time.
He is given antibiotics and blood thinners for a week.
A pillow is placed between the legs to keep the legs apart.
Almost immediately after the operation, the patient is recommended to move: sit up in bed, do breathing exercises, and perform simple muscle exercises.
3-7 days after the operation, the patient is helped to get to his feet with the help of crutches and begin to move with the assistance of a specialist.
On days 10-12 after surgery, the sutures are removed and the patient is discharged home.
Rehabilitation - it’s important not to be lazy
After discharge, the elderly person and his relatives must continue rehabilitation procedures according to the recommendations of the attending physician. A person must learn to walk again and return his life to normal. You can recover at home under the supervision and care of relatives and caregivers, or in a boarding house for the elderly.
In any case, experts are convinced that an elderly person should become an active participant in rehabilitation.
“In addition to the maximum possible physical activity - breathing exercises, exercises for the arms with and without weights, and others, an elderly person should lead a lifestyle as close as possible to normal: watched the evening news - continue to watch it, used the Internet - continue to use it, studied a foreign language - continue to teach him, crafted, created with his hands - continue these studies. Our task is to create an environment around an elderly person during the period of restrictions on movement that maximally simulates his previous lifestyle,” advises Andrei Ilnitsky.
It happens that older people with similar fractures are lazy to do the exercises prescribed for them to straighten their legs, etc. It is not always possible to motivate and organize them. In this case, specialists will help. “In addition to active movements, you can use passive ones, when a rehabilitation specialist or a person performing his functions takes the limbs of an elderly person in his hands and performs the necessary movements with them,” says Ilnitsky.
Caring for older people with a hip fracture
In the Yusupov Hospital, patients after a hip fracture are placed on a functional bed with an anti-decubitus mattress. Medical personnel provide professional care, the purpose of which is to prevent dangerous complications: constipation, bedsores, pneumonia, thrombophlebitis.
The most common consequence of a hip fracture is bedsores - wounds that form in places where the patient's body is in close contact with the bed (on the sacrum, buttocks and heels). To prevent bedsores, exercise therapy instructors activate the patient early: they sit him up in bed, teach him to turn slightly, “unloading” first one or the other buttock. The skin of the heels, back, and buttocks is wiped with camphor or salicylic alcohol twice a day. Junior nurses make sure there are no crumbs or wrinkles on the bed. In some cases, anti-bedsore circles are used.
Prevention of pneumonia includes:
- early activation of the patient;
- regular ventilation of the room;
- breathing exercises (patients are asked to inflate children's toys or rubber balls).
To prevent constipation, the patient is fed fractionally, every 2-3 hours, in small portions, without overusing fried and fatty foods. The diet includes a sufficient amount of liquid, including vegetable and fruit juices, fermented milk products. If necessary, use laxatives.
To prevent the development of thrombophlebitis, the following measures are taken:
- elastic bandaging of the lower extremities;
- soft foot massage (stroking the lower limbs from bottom to top);
- make sure that the patient regularly moves the ankle joints;
- The legs are periodically given an elevated position.
When preventing complications, do not forget about preventing the development of asthenic syndrome, which occurs as a result of prolonged immobility. The best preventive measures in this case are early physical activity and a set of special exercises.
How to reduce complications
At home, for 6-8 months after surgery, an elderly person must adhere to several rules that reduce the risk of various complications:
- do not allow full flexion (or more than a right angle) in the hip joint.
- while sitting, place a pillow on the chair so that your knees are lower than your hips;
- do not cross your legs - neither sitting nor lying down;
- do not lean forward - always stand with a straight, even back;
- sit on a chair with your legs slightly apart,
- hold on to the railing when going up or down stairs;
- Use shoes with non-slip soles and low heels.
When visiting any doctor, you need to inform him about the presence of an endoprosthesis. If you experience pain at the surgical site or fever, you should contact your surgeon immediately.
Do not forget that the endoprosthesis is a mechanism and is subject to wear and tear. It can be made of metal, plastic, ceramics. Depending on the material and load, the prosthesis can last up to 15 years. How to extend its “service life”? It is advisable not to gain weight and try not to lift heavy objects.
In addition, it is better not to engage in active sports (tennis, skiing, etc.), but swimming and walking will not harm an elderly person with an endoprosthesis.
It is impossible to operate, to treat
At the V. Veresaev City Clinical Hospital, as Dmitry Khryapin notes, hip replacement is contraindicated for patients who lead an inactive lifestyle and suffer from senile dementia. “We perform osteosynthesis for pertrochanteric fractures for almost everyone,” says the traumatologist. “The contraindications here are acute heart attacks or strokes that occurred simultaneously with the fracture.”
Treatment without surgery consists of caring for the patient - preventing bedsores, pneumonia, etc., as well as activating him - first in bed, and after some time - with the help of a walker.
The main difficulties in treating such fractures are that bone healing takes a very long time (six to eight months), very long bed rest leads to bedsores, varicose veins and other complications, which is why doctors try to reduce it as much as possible.
In the postoperative period and if surgery is not possible, the most effective care can be provided by specialists from boarding houses for the elderly and nurses with medical education.
Treatment of femoral neck fractures: conservative and surgical
When the injury is uncomplicated, the fragments have not shifted and the general condition is not aggravated by chronic diseases, you can try to manage the patient using a conservative method.
Special gymnastics and drug treatment are prescribed, and after a while the patients become more active. Then the leg will have a rehabilitation period; recovery will take a lot of time. The period is long, up to a year.
Surgical treatment of a fracture is more often used. In relatively young patients (up to 60-65 years old), with fresh fractures, fragments are fixed with screws after closed reduction (matching) on an orthopedic table.
Schematic illustration and radiograph after osteosynthesis with screws
A high degree of reposition is achieved, but there is a risk of false joints. The rapid return of joint mobility and leg support is very important for the elderly.
Drugs to combat osteoporosis must be added.
Contact rehabilitation assistants
Care by relatives almost always loses to professional care, experts say.
At home, after being discharged from the hospital, elderly people often just lie there for a month or two, since relatives cannot care for them. This causes muscle atrophy in the elderly, which provokes a whole chain of problems: the foot may drop, people drag their leg, the load on the knee increases, and since the leg is not fixed, problems with the knee joints begin.
When an elderly person does not get out of bed at all, does not exercise, contracture begins - ossification of the joints, curled legs that cannot be straightened by anything.
If relatives have time to care, then without special knowledge and skills, they often understand their task only in feeding and hygiene procedures. “But an elderly person, first of all, needs not a nurse, but a tireless assistant in activation, who knows at least its simplest methods - physical exercises, intellectual training, methods of auxiliary and substitutive movement, and so on,” says Kirill Proshchaev. – We need to decide whether one of the relatives or a hired specialist will perform the role of such a specialist. And if it is decided that this will be a relative, make the same demands on him as on a hired specialist: he should not show his negative emotions, fatigue, should not be overly compassionate, lament, ooh and ah, and he should always be in front of the elderly person neat, cheerful and energetic. At the same time, the caring relative should have the right to leave and weekends - and the family should provide for these moments - because he has an increased risk of emotional burnout.”
Recovery time after a fracture
Recovery time cannot be accurately calculated, since everything depends on its severity, nature, age of the patient and other factors. But on average they are at least six months. Only after this time will a person be able to stand on the injured limb, completely transferring his body weight to it.
In most cases, the treatment stage is accompanied by the following terms:
- On the third day after applying the plaster cast, the patient must begin to massage the lumbar region. Then you should move to the uninjured limb. After a week, you can begin to massage the hip that was injured. This should be done carefully, following the doctor's recommendations.
- After two weeks, if the cast is removed, you can begin to move your knee. It is best to do this under the supervision of a doctor and only after his permission. Moreover, in the initial stages the patient will need outside help. After about a month, you can begin to perform flexions and extensions on your own. After 2 months, the patient can attempt to sit down. This must be done according to specialized instructions.
- After 3 months, the patient will be allowed to stand up using crutches and begin to move independently. In this case, the support should be on the healthy limb; you can only step lightly on the sore leg.
- Gradually, the load on the hip should be increased and after six months you can make attempts to return to a full life.
Going again after surgery is realistic
The speed of rehabilitation, says Sergei Sadovsky, executive director of the “Care and Care” network of boarding houses for the elderly, depends on the condition of the elderly person preceding the injury - whether he was independent.
“Usually, if a person was fully self-sufficient before the injury, then lying down is not normal for him and he will try to get up faster. But even elderly people who are already walking can be greatly “slowed down” by the fear that the same thing will happen to the second leg, and they begin to subconsciously feel sorry for the healthy leg and avoid activity.”
As the expert said, at the beginning of summer, a grandmother was brought from the hospital to one of the network’s boarding houses for rehabilitation after surgery on the femoral neck. “A week later she started walking, but overall she stayed with us for less than a month and went home on her own two feet,” says Sadovsky. “And this is one example of many when patients in private boarding houses and nursing homes show more positive dynamics of recovery,” says Sadovsky.
According to him, this grandmother’s stay, along with all consumables, cost the relatives 55 thousand rubles. This is half the price of staying at any resort. “We start with a set of physical exercises, then we help the elderly person sit up, and after a week we put him on a walker, and at the same time a psychologist works with the elderly person,” explains Sadovsky. — Recovery can take from two weeks to 4 months. Early rehabilitation, in a certain sense, is the guarantee that an elderly person will quickly return to normal life, and its duration will be significantly reduced, which is the advantage of professional care in private boarding houses.”
Drug therapy
Drug therapy is prescribed to elderly patients after surgery and conservative treatment. Medications help relieve pain spasms, relieve inflammation and reduce hematoma, and speed up the recovery process.
To eliminate sharp pain, a Novacoin blockade is performed.
It is not prescribed during the period of deterioration in the patient’s well-being, when blood pressure decreases, or when the patient develops a state of shock.
3-4 days after the exacerbation period, injections with non-steroidal anti-inflammatory drugs - Diclofenac or Ibuprofen - are prescribed. After 3-4 days, the injections are replaced with oral medications.
Such medications not only effectively eliminate painful spasms in the area of the injured joint, but also inhibit the further development of the inflammatory process. For complete regeneration of damaged bone elements, drugs from the group of chondroprotectors are prescribed - Dona, Alflutop.
Complivit Calcium D3, Kalcemin, Calcium D3 and other complexes that contain calcium help strengthen bone tissue and stimulate recovery processes. Additionally, diuretics may be prescribed to relieve swelling - Furosemide, Mannitol.
To keep grandma from losing heart, we set small goals.
Sometimes rehabilitation and treatment do not go as quickly as the elderly would like and he loses heart. In this case, Kirill Proshchaev recommends setting the elderly person not the final goal - to walk the same way as before the fracture, but to clearly identify and talk through intermediate goals with him and achieve them.
“Don’t forget to praise for achievement and motivate to move on: for example, this week we managed to walk through a room or ward, let’s go out into the corridor or another room from the windows of which the sunset is visible next week,” explains the expert.
Another equally important question: what to do if for some reason the elderly person did not undergo surgery or he himself refused the operation and he developed apathy and lost the meaning of life and self-confidence.
As Andrey Ilnitsky says, a person who cannot walk on his own can move with the help of substitute means, for example, a stroller. “Many people have moved and are moving this way – from famous politicians, for example, US President Roosevelt, to Paralympians and ordinary people who are in every city,” the expert sums up. “The main thing is to provide an elderly person in a wheelchair with access to go for a walk, to the store, on excursions, to the garden, and so on.”
Reducing the risk of another fall: a safe home, a stick, a familiar route
During the rehabilitation process, it is important to protect the elderly person from another fall. It is believed that a person who has suffered a fracture is already at risk of repeated falls. Experts recommend using a wand and under no circumstances being ashamed of it, remembering the fashion for this accessory in the 19th century.
“The most important thing is to create safe conditions in the house where an elderly person who has undergone trauma and surgery lives, to eliminate risky moments,” Andrei Ilnitsky points out. “These are, for example, carpets with curved corners, poor lighting in the corridor or pantry, furniture on wheels without locks that can move at any time, thresholds between rooms, and so on, and make auxiliary devices - handrails in the bathroom and toilet.”
He also advises relatives to walk with the elderly person several times along the usual routes to the store, to the park, and so on, so that he is convinced that he can go the same way. But next to him, at first, until the person has adapted after the fracture and surgery, is his assistant, who will not let him fall.