Periprosthetic fractures and bone cracks during joint replacement

The hip joint and thigh help connect the upper body to the lower body. Injury to this area leads to a sharp decrease in motor activity. Moreover, with such an injury, a person’s chance of developing complications increases. And if he does not turn to a specialist in time, then such an injury can generally make him disabled. Typically, a crack in the hip appears in older people. But it can also appear in young men and older citizens. We will talk further about what kind of injury this is, what symptoms it manifests, and how to treat it.

Doctors call a femoral neck fracture one of the types of bone damage. Most often, this damage appears in the femoral neck. The neck is a thin section that connects the body of a bone to its head.

Causes of damage

A person can get a hip fracture for various reasons.

This type of injury can be caused by:

• poorly developed skeleton;
• doing heavy physical exercise;
• development of the inflammatory process in joints, bones, serious chronic diseases;
• frequent consumption of coffee;
• bad habits.

In addition, a crack in the femur, and a person’s leg in general, can crack due to strong pressure on it, a fall from a great height, a person getting into an accident, or due to martial arts training. It is precisely such activities that lead to impaired coordination and the development of neurological diseases.

Diagnostics

The only effective and accessible method for diagnosing femoral fissures is radiography. With its help, you can get a detailed picture of the condition of the bone. The procedure takes 2-3 minutes, and a picture with the results appears within 10-15 minutes. Based on the data obtained, the doctor can make a diagnosis and prescribe treatment.

During therapy, x-rays are used to monitor results.

Symptoms of a crack in the femur

But the appearance of the following unpleasant symptoms should alert the patient, because they indicate that he received a crack in the femur.

When the femur is cracked, the victim experiences the following symptoms.

Him:

• the foot turns outward when lying on its back;
• when trying to return the foot to a normal position, severe pain appears;
• severe pain occurs when trying to lightly tap the foot or lift it;
• there is severe pain in the groin area;
• the femoral artery pulsates strongly;
• Serious hematomas and bruises appear. They usually appear within 3-4 days.

Remember: if the victim has one of the above symptoms, he should consult a specialist. This injury is considered very dangerous.

What is the danger?

Many victims often wonder why this injury is so dangerous.

Its danger lies in the fact that here a person:

• remains motionless for a long time, i.e. lies in bed. And this often leads to the development of congestive pneumonia;
• suffers from venous thrombosis, pulmonary embolism, which often leads to poor blood circulation in the damaged area;
• suffers from the appearance of bedsores localized in the buttocks;
• suffers from secondary arthrosis, various deformities, which often lead to re-injury of the injured limb;
• often suffers from depression and other psychological problems;
• suffers from the formation of a false joint.

Signs of a femoral neck fissure in older people

As mentioned above, a crack in the thigh most often appears in older people.

With a crack in the femoral neck, the following unpleasant symptoms appear in older people.

They have:

• acute pain appears in the pelvic area. Such pain appears at the time of injury, i.e. when a person falls or receives a strong kick;
• aching pain occurs during physical activity or attempts to lean on the injured limb;
• motor activity does not decrease significantly, i.e. the victim can still move, but all movements will be difficult for him;
• severe pain appears in the muscles located around the site of injury. Its appearance is caused by reflex spasms;
• other symptoms arise that may not be pronounced. The femoral neck is a place that is not located on the bone, i.e. not on its surface. And the appearance of a crack in the hip may not be accompanied by any serious symptoms at all.

First aid

The occurrence of a hip injury requires an immediate call to an ambulance. Until doctors arrive, it is prohibited to move the victim or act on the wound unnecessarily. Basic recommendations for first aid:

• Lay the person on their back.
• For severe pain, give a painkiller (Ibuprofen, Ketorol). Write down the dosage, drug name and time of administration.
• Immobilize the injured limb by applying a splint. From available materials you can use a board, a piece of plywood, or a lath. All leg joints need fixation, not just the hip.
• Do not remove the patient's clothes and shoes.
• In winter, additionally insulate the limb to avoid frostbite.
• If there is bleeding, tighten the leg with a tourniquet and record the time of the procedure. If your leg starts to turn blue, loosen the bandage.

While waiting for doctors, try not to leave the victim and reassure him in every possible way. The best way to instill confidence in the recovery of the victim is to stop panicking yourself and not give in to screams and moans.

When independently delivering a victim to a medical aid point, do not exceed the speed limit and be extremely careful on the road.

First aid for hip injury

Relatives should not take the victim to the hospital themselves. It is best for him to call an ambulance, which can transport him quickly and painlessly.

In this case, the relatives of the victim must:

1. Place him in a supine position.
2. Give him painkiller medication. It could be: “Ketoral”, “Ibuprofen”, “Nimesil”.
3. Secure the damaged limb with a special splint. It can be made from boards or slats. At the same time, it must fix the ankle, knee, and thigh.
4. In case of severe bleeding, apply a special tourniquet to the injury site.

In the hospital, the victim must be examined by a traumatologist. He will examine him and make an accurate diagnosis.

Additionally, the victim will have to do:

• CT. With this diagnosis, the doctor receives more three-dimensional images of the leg, which accurately show the location of the disorder.
• MRI. With such a diagnosis, the doctor can examine the condition of the tissues. The uniqueness of this study is that it is completely safe; there is no radiation exposure to the patient.
• X-ray. With this diagnosis, the doctor receives an image of the damaged organ in several projections. And if an X-ray is taken together with an MRI, then the structure of the bone tissue is immediately visible in such an image. But when symptoms appear and x-rays do not always allow the doctor to see a crack in the patient’s hip or upper leg. Therefore, sometimes the victim needs to undergo two tests at once.
• Ultrasound. If other diagnostic methods have not helped the doctor make an accurate diagnosis, then the victim is prescribed an ultrasound examination.

Prevention and treatment of late fractures

There is no specific prevention of pathology today. However, the risk of their development can be reduced with the help of drugs that inhibit osteolysis (alendronic, clodronic, pamidronic acid). These medications slow down the destruction of bone tissue, thereby preventing aseptic loosening of the implant and disruption of bone integrity.

Non-displaced fractures of the femur and tibia are usually treated conservatively. When fragments of patients are displaced, surgical intervention is indicated. If the components of the endoprosthesis are stable and oriented correctly, doctors perform open reduction and osteosynthesis using plates, screws, etc. Otherwise, surgeons are forced to perform one- or two-stage revision endoprosthetics.

Treatment

There are several ways to get rid of a cracked hip.

But the choice of treatment method depends on the doctor.

His choice depends on:

• age of the victim;
• the severity of his injury. Remember: fractures and fissures of the femoral neck are treated differently;
• type of injury received. If a person has not a crack, but a fracture, then it can be comminuted, with or without displacement. But treating a fracture is much more difficult;
• the degree of damage to tissues adjacent to the injury.

Osteosynthesis with plates

Required for type B2 and C fractures. To restore the integrity of the femur, wide LC-DCP and DF-LCP bone plates are used. They are fixed by monocortical screw insertion or cerclage sutures. During the operation, doctors try to restore the shape of the bone marrow canal and ensure the possibility of future revision surgery (if necessary).

Previously, doctors tried to treat type B2 fractures by fixing the bone with cerclage sutures. This tactic caused serious complications in almost half of the patients. The most common of these were deep periprosthetic infections and instability of the endoprosthetic stem.

Features of conservative treatment

In general, a hip fracture is a fairly minor injury, because... with it, the femoral neck is not injured. In this case, the victim is prescribed conservative treatment methods. But it is quite difficult to treat elderly people with conservative methods, because Such injuries in these patients are very difficult to heal.

In this case, the treatment is carried out as follows.

Victim:

1. Immobilize for a long period of time using a plaster cast. Additionally, he is given traction on the injured limb with a heavy object, i.e. weighing at least 2-3 kg.
2. They are referred to physical therapy.

Remember: after the traction is removed, the victim can move on crutches.

And if an elderly citizen has a crack in the femur or hip bone, he is prescribed special medications to help him prevent the further development of osteoporosis.

Additionally, he is prescribed:

• Special diet. The victim is advised to consume more foods that stimulate the formation of new cartilage tissue. He is recommended to eat more eggs, nuts, fatty fish, and drink fermented milk products.
• Medicines enriched with vitamin D. They improve the process of food absorption.
• Biophosphates that help enrich the body with calcium. In rare cases, the victim is prescribed medications with calcitonin. This is a hormonal drug that increases the strength of bone tissue.

Remember: if the victim uses corticosteroids, which helped him get rid of rheumatological pathologies and other chronic ailments, then it is better to abandon them when treating a hip crack.

Remember: the bone is completely restored in 6-8 months. And in young patients it grows together after 4-5 weeks.

Osteosynthesis with long revision legs

It is performed for fractures of type B2 (which were preceded by cement fixation of the prosthesis) and B3. Nowadays, surgeons use revision implants with a Wagner stem, which make it possible to fix bone fragments without the use of additional structures. Their installation is required in cases where the primary stability of the endoprosthesis leg is impaired.

Note that in some cases, doctors are unable to restore the integrity of the femur with the help of a revision stem alone. In such situations, they also perform bone grafting. Distal blocking of the prosthetic leg allows for its stability and prevents its further subsidence.

For type B3 fractures, some foreign authors recommend the use of endoprostheses with an artificial proximal femur. This treatment method is suitable for older patients who need to quickly get out of bed and start moving.

Surgical intervention

Mostly, it is older citizens who have suffered a hip fracture who are prescribed surgery. Only after it can the victim return to a full life. Conservative treatment methods are not prescribed to such patients, because they are ineffective. Rarely are they actually prescribed, but only if the victim has no contraindications.

Osteosynthesis helps get rid of hip cracks. In this case, fragments of damaged bone are attached to each other with special knitting needles or medical nails.

And if the victim’s joint is very worn out, then he undergoes endoprosthetics. It is usually performed on elderly citizens. This is a rather complicated procedure, which often even frightens the victim. But it is endoprosthetics that gives a person a chance that in the future he will be able to walk without crutches.

In general, the operation is carried out in several main stages.

During it, the doctor:

1. Removes a neck with a crack localized in the head of the femur.
2. A special prosthesis is installed at the site of injury.
3. Changes several skewers.

In this case, the victim:

1. On the 2-3rd day after surgery, the victim can do breathing exercises, simple exercises that help develop the muscles of the legs.
2. On the 3rd day after the procedure, the victim is put on his feet. At first he is allowed to move with the help of crutches. This recovery stage lasts 2-3 months.
3. Antibacterial drugs and blood thinners are administered for 1 week in the hospital.
4. A pillow is placed between the legs to help keep the limbs at a safe distance from each other.
5. On days 12-14 after the procedure, the victim’s stitches are removed and he is sent home.

Osteosynthesis with cerclage sutures

It is performed for intraoperative periprosthetic fractures of type A. The separated lesser or greater trochanter is fixed with 1-2 cerclage sutures made of titanium wire. This treatment gives good long-term results and ensures satisfactory functioning of the prosthesis in the future.

Osteosynthesis with cerclage sutures

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Rehabilitation

A person who has suffered a hip fracture definitely needs rehabilitation.

The following help restore activity in an injured limb:

• physiotherapeutic procedures;
• therapeutic exercises, walking. They speed up the process of restoring mobility in the damaged limb;
• massage.

Such procedures improve nutrition of damaged tissues and blood circulation in the limbs.

Some patients undergo rehabilitation in a sanatorium.

Remember: the rehabilitation program is assigned to each patient individually.

In general, it includes:

1. Pain-relieving measures. Patients often experience very severe pain during recovery. Local anesthesia, sedatives and painkillers help get rid of them.
2. Mechanotherapy. The victim is prescribed a set of special exercises, which are performed with special devices. Such exercises help to develop the damaged joint and restore the previous motor activity in it.
3. Physiotherapeutic procedures. Without them, the victim will not be able to recover quickly. Such procedures relieve swelling, pain, and the spread of infection. They also speed up the healing process of wounds that often remain with the victim after surgery. Moreover, some procedures help get rid of hemorrhage and prevent the development of complications.

For example, the victim is prescribed:

• electrophoresis;
• ultrasound;
• paraffin applications;
• magnetic therapy;
• UHF therapy;
• healing mud.

During the recovery period, massage also plays an important role. It improves blood circulation and increases muscle tone. It also relieves bedsores, osteoporosis, congestive pneumonia, and muscle atrophy.

In addition, massage has a positive effect on the functioning of the cardiovascular and respiratory systems.

The victim is also recommended to engage in physical therapy. It speeds up the patient's recovery process.

But remember that only a doctor can choose a truly effective set of exercises.

During recovery, experts recommend that the victim combine breathing and movement exercises. As the patient recovers, his workload also changes.

During recovery, the victim must follow a diet. He should eat tasty and high-calorie food. It is recommended to eat more foods rich in calcium and other microelements that improve the process of bone tissue restoration. That is why the victim is recommended to drink more dairy products, eat more cheeses, meat broth, and jelly.

Such trauma also has a very negative impact on the human psyche. That is why he is recommended to make an appointment with a psychotherapist.

Traditional methods

The use of folk remedies must be agreed upon with the attending physician.
Folk remedies for hip injuries are effective as a complement to traditional therapy. They accelerate the process of bone fusion, promote the restoration of bone and cartilage tissue, and prevent complications.

Ingredients that can be used to prepare strengthening decoctions:

• willow bark;
• burdock root;
• birch leaves;
• parsley root;
• linden flowers.

Pour boiling water over the dry mixture, put on fire and cook for 3-5 minutes over medium heat. Cool the liquid brought to a boil, strain and take twice a day before meals.