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.
Features of hip fracture in older people
A hip fracture is an injury that occurs mainly in the elderly and senile. A distinctive feature of the injury is the lack of fusion, which is caused by insufficient blood supply to the neck and head of the femur, and a high probability of developing various complications associated with the forced immobility of an elderly patient, often suffering from severe somatic diseases. Hip fractures occur 4 times more often in men, which is due to a higher tendency to develop osteoporosis in postmenopause.
The paucity of clinical manifestations and unexpressed pain syndrome cause some patients to seek medical help late. Some patients suspect arthrosis of the hip joint, bruise or osteochondrosis with pinched nerve. They unsuccessfully self-treat for these diseases. In the absence of qualified assistance, fragments can become displaced, which leads to serious consequences of a femoral neck fracture in old age and worsens the general condition of the patient. In this case, restoration of motor function becomes less possible.
Conservative therapy
Traditional treatment involves completely immobilizing the hip joint. This can be done in several ways:
- For young patients, the skeletal traction method is used.
- For most elderly people, doctors choose the so-called “boot” - a derotational plaster cast.
- The second method takes much longer. Its essence is that doctors are simply waiting for the broken bone to heal and the damaged joint to begin to perform its functions again. The situation is further complicated by the fact that until the femoral neck is completely restored, the patient is forced to lie down all the time. Because of this, complications such as bedsores, thrombosis or congestive pneumonia may occur.
Due to possible side effects, conservative methods are practically not used in modern conditions. They are prescribed only to those patients who have serious contraindications to surgery.
Causes of hip fracture in older people
In most cases, a fracture of the femoral neck in elderly people occurs when they fall on their side. Less commonly, the injury is caused by a blow to the joint area. In patients suffering from severe osteoporosis, an awkward turn in bed may be enough to cause a fracture.
Factors that increase the likelihood of hip injury include:
- female;
- age over 55 years;
- excess body weight;
- osteoporosis;
- sedentary lifestyle;
- smoking;
- alcohol abuse;
- prostate hyperplasia (adenoma) in men and menopause in women.
The chances of getting a hip fracture are higher in people who suffer from chronic diseases that limit the mobility of the lower extremities and spine:
- arthrosis of the knee joint;
- arthrosis of the ankle joint;
- osteochondrosis;
- spondyloarthrosis;
- disc herniation;
- spondylolisthesis.
Another risk factor is diseases that are accompanied by dysfunction of internal organs and endocrine glands: liver cirrhosis, diabetes mellitus, pyelonephritis and glomerulonephritis with the development of renal failure.
No. 4. What needles are used for intra-articular injections?
The choice of needle depends on the location of the affected joint. For arthrosis of the hand or other small joints, doctors select thin and short needles, similar to an insulin syringe. Injections into the shoulder or knee joint require a longer needle that will reach into the cavity. For the hip, it should be even larger, and if the patient is overweight, the instrument is selected individually.
For intra-articular injections into different joints, needles of various thicknesses and lengths are used.
Symptoms of a hip fracture
Older people experience moderate pain after an injury, which is localized in the hip joint or groin area. When you try to move and tap the heel of the injured limb, the pain intensifies. Palpation of the damaged area causes pain. In the supine position, a slight shortening of the limb is determined. When comparing freely lying straight legs, it is clear that the diseased limb is 2-4 cm shorter than the healthy one.
The foot is turned outward and rests its outer edge on the bed. The inguinal fold on the injured side is slightly higher than on the healthy limb. A characteristic sign of a femoral neck fracture is the symptom of a “stuck heel” - when moving in a lying position, the patient cannot independently “tear” the heel from the surface.
During movements, a bone crunch may be heard. A femoral neck fracture is diagnosed using an x-ray of the hip joint. Radiographs allow us to determine the level of the fracture, the presence and nature of the displacement. If necessary, an additional computed tomography scan of the hip joint is performed.
Types of injuries
All fractures of this type take a long time to heal and require proper treatment and care. The following types of violations of the integrity of the femoral neck are distinguished:
- incomplete without displacement;
- full without displacement;
- full with partial offset;
- full with full offset.
At the same time, the more the femoral neck moves, the more difficult it will be to heal the fracture.
Treatment and prevention of femoral neck fractures
In older people, as in young patients, femoral neck fractures often do not heal due to poor blood supply to the central fragment. With age, a fairly large vessel located in the ligament between the femoral head and the neck of the acetabulum ceases to function. Such fractures do not heal even with adequate conservative treatment. The only way to ensure complete fusion of fragments in a femoral neck fracture in old age is surgery.
For femoral neck fractures, 3 types of surgical interventions are used:
- osteosynthesis of the femoral neck with screws, a plate, a three-blade nail and other metal structures that are used in the treatment of active patients under 65 years of age;
- installation of a bipolar endoprosthesis used for fractures in active patients aged 65-75 years;
- installation of a unipolar cement prosthesis, which is used in the treatment of limitedly active patients over 75 years of age.
Traumatologists choose the treatment option individually, based on the patient’s condition. If surgery is contraindicated for the patient, but he is sufficiently active and preserved, skeletal traction is applied to the tibial tuberosity. After the formation of a connective tissue callus, the traction is removed and the patient is sent for outpatient follow-up treatment.
Many patients, especially the elderly, are too weak to undergo skeletal traction. In such situations, they are put on a derotational boot - a light plaster splint with a transverse stick, which eliminates rotational movements of the lower limb. Such immobilization provides good conditions for the formation of connective tissue callus, facilitates care and allows for sufficient activity of the patient. After the boot is applied, the patient is discharged for outpatient treatment. Prevention of hip fracture in old age involves moving carefully, preventing falls and impacts, eating a diet rich in calcium, and treating osteoporosis.
Treatment
Therapeutic measures in this case are organized in 3 stages:
- prehospital;
- stationary;
- rehabilitation.
At each of them, important procedures are performed, without which full recovery is impossible.
Pre-hospital stage
The doctor’s main task at this time is to give the victim pain relief and securely fix the injured leg. If this is not done, then displacement of bone fragments may occur, which will significantly complicate the process of fusion of the femoral neck and the further recovery process.
After the first measures are taken, the doctor decides how the treatment will be carried out. It may include conservative techniques or surgery. The specific choice depends on the age of the victim, his general condition and the type of fracture.
Stationary stage
At this stage, active measures are taken to help the bone heal properly. They will differ according to what type of treatment was prescribed by the doctor.
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.
We provide first aid
Splinting (photo)
If you suspect a fracture of the collum femoris, the victim must urgently call an ambulance and leave him motionless until the medical team arrives.
Sometimes it happens that the arrival of doctors is impossible and it is necessary to independently transport the patient to the emergency room; in such a situation, certain transportation rules should be followed:
- lay the victim on his back;
- in case of severe unbearable pain, the victim should be given ibuprofen-based analgesics - this will make it easier to endure transportation and serve as a prevention of painful shock;
- the injured limb should be immobilized as much as possible - for this, the limb is fixed using a splint, it can even be made from improvised material (boards, plywood, slats), and all joints of the injured limb should be fixed, and not just the hip;
Important! The splint must be applied correctly. To do this, it begins in the groin area on the inside of the thigh and ends at the heel. Fix the splint with a bandage in the groin, knee and heel area.
- do not try to remove the victim’s clothes (trousers) - on the contrary, try to additionally insulate the injured limb, especially if it is cold outside, since the blood circulation in it is impaired;
- the victim should be transported on a stretcher or on a flat, hard surface;
- in case of an open fracture and bleeding above the site of the vessel rupture (2 fingers above), a tourniquet or any pressure bandage should be applied - make sure that the limb does not turn blue, this indicates that the tourniquet is too tight and needs to be loosened;
- try to calm the victim - his screams and moans are an absolutely normal reaction to pain and injury, so do not fall into a state of panic.
Important! If you had to take the victim to the hospital, remain calm in any situation, your worries and hysterics will not help the patient, moreover, in such a state you can forget important things - loosen the tourniquet, correctly fix the limb, etc. The cost of your anxiety and panic may be too high for the victim.
Consequences of a hip fracture in old age
A hip fracture is a very dangerous injury. If treated incorrectly, serious complications can occur that cause the patient's disability. The most severe consequence of a femoral neck fracture is necrosis of the femoral head. Due to an immobile lifestyle, bedsores appear, acute venous congestion and deep vessel thrombosis occur. Frequent complications include congestive pneumonia, which is not easily cured with modern antibiotic therapy.
The patient’s recovery time largely depends on his positive attitude and proper care. On average, rehabilitation takes from six months to one year. To combat the trauma, psychologists at the Yusupov Hospital are working to bring a patient with a hip fracture to a normal emotional state. Thanks to the individual work of a psychotherapist, the causes of depressed mood are clarified and measures are taken to eliminate them.
Diet therapy plays a major role in speedy recovery. Many patients refuse to eat due to depression. This negatively affects their physical and mental health. To restore appetite, the cooks at the Yusupov Hospital offer patients a tasty and nutritious menu that is rich in vitamins and minerals. All of these methods can significantly reduce the recovery period.
No. 10. What drugs are injected into the joint and for what purpose?
There are several types of drugs that are injected into the joint for different therapeutic purposes. Anesthetics quickly and briefly relieve pain, so they are used in combination with other medications. Glucocorticoids relieve inflammation for a period of a week to a month. They can be injected into the joint no more often than 3-5 times a year.
Chondroprotectors restore cartilage tissue, and synovial fluid prostheses based on hyaluronic acid or its synthetic substitutes expand the friction surfaces. The patient's blood plasma, enriched with platelets, has a complex effect, but plasma therapy for arthrosis is not used very often due to the high cost of the method.
More and more practicing orthopedists and rheumatologists recommend this method to their patients. If injections of anesthetics are short-term, then intra-articular injections of synovial fluid prostheses provide long-term relief and relieve pain for a year and a half. The most effective drugs are those with high molecular weight, among which Noltrex occupies a leading position.
Rehabilitation after a hip fracture
The subsequent rehabilitation period plays a decisive role in the patient’s recovery, regardless of whether the treatment is conservative or surgical. Some patients, after hip surgery, decide to stay at home until their mobility is fully restored. They believe that their loved ones will provide them with good care and attentive attention. Only specialists from the Yusupov Hospital can provide qualified and timely medical care.
The rehabilitation programs used in the rehabilitation clinic fully comply with European standards. The staff has extensive experience in treating immobilized patients. The Yusupov hospital is located in a picturesque ecological zone; on its territory there is a park where people are taken for a walk after a hip fracture.
Staying in the rehabilitation clinic of the Yusupov Hospital is not only about taking medications and performing a set of therapeutic exercises. Patients undergo daily massage and physiotherapeutic procedures:
- magnetic therapy;
- laser therapy;
- UHF therapy.
Reflexologists perform acupuncture.
#2: Are there studies that support the effectiveness of this method?
Despite the fact that the method has not been used for the first year, its research is regularly carried out all over the world, namely testing old and new drugs. Particular attention is paid to drugs based on hyaluronic acid and its synthetic substitutes, since the method of restoring synovial fluid in the joint is considered one of the most effective in the treatment of osteoarthritis.
From year to year, the drugs confirm their high effectiveness compared to tablets that relieve pain and inflammation. Synthetic analogues, for example Noltrex, which does not cause allergies or adverse reactions, are considered safer and more effective.
Rehabilitation
Recovery after injury
Rehabilitation is not only about doing exercises and doctor’s instructions. For a successful outcome of an injury, a positive attitude is extremely important, because if the patient is in a state of constant depression and apathy, then recovery will proceed more slowly.
It is very important to provide the patient with adequate nutrition, healthy sleep, access to fresh air, and leisure (books, TV) so that he does not feel unwanted, abandoned, and a burden to his family.