Transport immobilization for hip fracture

Before going through the detailed instructions, let’s remember the basic concepts of this topic.

Immobilization is the creation of immobility of a damaged (injured) part of the body.

Transport immobilization is a temporary measure, immobilization while the victim is being transported to a medical facility.

Proper transport immobilization for a hip fracture is of utmost importance for the further outcome of this severe injury. Let us remember that femur fractures are divided mainly into 2 types:

fractures of the proximal femur;
femoral shaft fractures.

Type 1, fractures of the proximal part (neck and trochanteric region) of the femur are more common in older people. The cause is usually a fall on one side. In this case, an impact occurs with the area of the greater trochanter, or a sharp rotation of the hip outward or inward.

Signs of a fracture of the femoral neck or trochanteric region are:

pain in the hip joint;
change in joint shape;
shortening of the limb;
turning the leg outward;
inability to actively lift the leg.

Type 2, femoral shaft fracture , is the most common type of injury to the femur. Causes and mechanism of occurrence:

direct trauma (fall on the outer thigh, direct blow to the thigh);
indirect injury (fall from a height with landing on straight legs, screw fracture in skiers).

Most often, hip fractures are accompanied by significant displacement of bone fragments due to contraction of the muscles attached to the thigh.

Anatomy of the hip joint

The hip joint is the largest joint in the human body, which performs a supporting function and participates in the process of movement. It consists of the acetabulum, formed by the pelvic bones, and the head of the femur. The hip joint has a spherical shape, is limited by the articular capsule and is strengthened by powerful ligaments and muscles. In front of the joint are the muscles of the anterior thigh, and behind are the gluteal muscles.

The head of the femur is covered with a thick layer of hyaline cartilage, normally its thickness is about 4 mm. The acetabulum is lined with cartilage tissue. When moving in a joint, cartilage prevents friction between the bones relative to each other, which causes shock absorption and prevents premature destruction of the joint. To enhance the strength of the articulation, there is a round ligament between the femoral head and the bottom of the acetabulum.

The head is connected to the body of the femur through the neck. This area is a vulnerable area for damage in old age. In young people, the blood supply to the femoral head occurs through vessels that are located deep in the bone, penetrate the joint through its capsule and are located in the round ligament. From the age of 30, these arteries gradually become obliterated and almost completely close in older people after reaching 60 years of age.

Schematic representation of a fracture in the femoral neck.
Insufficient blood supply to the femoral head leads to non-union of fractures in elderly patients during conservative treatment. Femoral neck injury is an intra-articular fracture, which increases the risk of poor consolidation of the damaged bones. Displacement of bone fragments is an indication for surgery at a young age, and trauma in older people of any complexity requires surgery. Conservative treatment is prescribed when absolute contraindications to surgery are identified for health reasons. The operation is not performed for paraplegics of the lower extremities, when restoring the patient’s motor activity is not advisable.

Transport immobilization for hip fracture (immobilization technique)

For injuries in any area of the thigh, immobilization is carried out in such a way as to ensure immobility of 3 (three) joints:

hip:
knee;
ankle

When providing assistance for fractures and other injuries to the extremities, anesthesia is administered as prescribed by a doctor to prevent pain shock.

The best standard splint for immobilization of femoral neck and hip injuries is the Dieterichs splint.

Application of the Dieterichs splint a - medial strap of the splint; b - lateral bar; c - plantar part of the tire; g - twist; d — fixation of the sole; e — fixation of the splint with a belt to the torso and thigh; strengthening the twist after stretching the limb; h — immobilization of the limb with a splint in its finished form.

Rehabilitation after a hip fracture

Recovering from an injury involves not only doing physical exercises, but also normalizing your psychological state. Even after a person begins to move independently, he still feels vulnerable and may be depressed. If loved ones cannot help him get out of depression, then it is better to send the person to see a psychotherapist.

For the rehabilitation stage, normal sleep, proper nutrition, massage and treatment of exacerbated chronic diseases are important. An integrated approach will help the former hostage of the bed to quickly recover and gain strength.

Author of the article:

Kaplan Alexander Sergeevich |
Orthopedist Education: diploma in General Medicine received in 2009 at the Medical Academy named after. I. M. Sechenov. In 2012, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City Clinical Hospital named after. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery. Our authors

The order of applying the Dieterichs splint:

Preparing the splint: spreading the jaws to such a length that the outer half rests with the crutch in the armpit, the inner half rests against the victim’s perineum, and both halves protrude beyond the edge of the sole by 10-12 cm.
Fixing the achieved position of the jaws using pegs: the peg of one half of each jaw is inserted into the corresponding hole in the other half. The halves of the tire are tied together with a bandage at the level of the peg.
Bandaging a cotton-gauze pad or a thick layer of cotton wool to the inner (medial) surface of both halves of the splint, to the perineal and axillary crutches.
Covering the ankle joint with a thick layer of cotton wool, followed by bandaging the sole to the foot. In this case, it is important to fix the heel very firmly, otherwise the bandage will slip and traction by the foot will not be achieved.
Passing the inner (medial) and outer (lateral) halves of the splint with the lower ends through the wire staples of the wooden sole and attaching them to the lateral surfaces of the torso and limbs. In this case, it is necessary to additionally wrap the splint with cotton wool in the area of the ankles, knee joint and greater trochanter.
Laying a ladder or plastic splint along the back surface of the immobilized area. Goal: better immobilization, creating some flexion in the knee joint, relaxing the muscles of the limb.
Attaching the splint to the body with special straps, a belt, or woven material passed through the cracks of the upper branch.
By carefully pulling the foot, the limb is stretched until the axis of the damaged surface is corrected. In this case, the transverse bars of the branches should rest against the groin and armpit. In this position, the foot is fixed with a twist to the transverse lower crossbar.
Final fixation of the splint to the body using circular strokes of the bandage. At the level of the torso, thigh and lower leg, the fixation should be the strongest. For long-term transportation (evacuation), plaster rings are used, made from 7-8 layers of plaster bandage. A total of 5 rings are applied: 2 on the torso and 3 on the limbs (as in the figure in part “g”).

In the absence of Dieterichs tires, it is better to use ladder tires.

Transport immobilization of the lower limb in case of hip injury a - assembly of a ladder splint; b - application of a splint.

Caring for patients with a hip fracture

What is a femoral neck fracture?
Clinical picture
Causes of fracture and risk groups
Hygiene procedures and selection of diapers
Types of femoral neck fractures and first aid
Fracture treatment and possible complications
Proper home care for an elderly person with a fracture
Prevention of complications

What is a hip fracture in older people?

The femoral neck is located in the socket of the hip joint, formed by the pelvic bone. It connects the head and body of the femur. It is surrounded by a reliable sheath of muscles, so a fracture of the femoral neck at a young age is extremely rarely diagnosed.

The risk of this pathological condition increases significantly in old age, when bones become more porous and fragile every year. A femoral neck fracture can be caused by an accidental fall from a small height, in which the greater trochanter is bruised.

The main danger of this injury is that the bone fragment, due to the lack of blood supply due to rupture of blood vessels, can completely resolve over time. This will lead to the fact that the femur will not heal and the person will never stand on his feet again. A hip fracture is confirmed by x-rays and, in some cases, by MRI. This type of injury has clear symptoms and signs that require immediate medical attention.

Clinical picture of a femoral neck fracture in elderly people

A hip fracture in older people cannot go unnoticed. This type of injury to the femur is accompanied by vivid symptoms, forcing you to immediately seek emergency help, namely:

severe pain in the groin;
girdling pain around the hip joint of varying intensity;
inversion of the limb outward, clearly visible along the foot;
inability to keep the leg hanging straight;
inability to tear the heel of the injured limb off the surface.

Almost immediately, the specific symptoms of a hip fracture are joined by general signs of severe limb injury - general weakness, dizziness, nausea, pale skin, swelling and bruises.

Causes of hip fracture in older people and risk groups

A fracture of the femoral neck provokes a severe bruise of the greater trochanter in an unsuccessful fall from a height. Elderly people need to be especially careful during icy conditions. The main factors that increase the risk of receiving this serious injury include:

menopause;
osteoporosis;
oncopathology;
physical inactivity;
excess weight;
vegetarianism;
neurological pathologies in which there is a lack of coordination of movements.

People suffering from diabetes mellitus and other endocrine pathologies are predisposed to hip fracture.

Types of femoral neck fractures and first aid

In modern traumatology, the following types of femoral neck fractures are most often diagnosed in elderly people:

open;
closed, with or without offset;
hammered in;
pertrochanteric.

All types of hip fractures require emergency medical attention. Before the doctors arrive, it is recommended to place the patient on a flat surface, fix the injured limb with a splint, placing it on the area from the hip to the heel. The patient may only be carried on a hard surface.

Treatment of hip fracture in older people and possible complications

Conservative treatment of a hip fracture in older people is extremely rare, since it does not always have the desired effect. A more common surgical method, which in some situations can literally save a person’s life by restoring his ability to move independently. Elderly people facing this formidable injury are advised to:

osteosynthesis of the femoral neck, that is, fastening damaged joints with screws;
hip arthroplasty, which involves complete replacement of the joint.

Surgical treatment will have to be abandoned if the patient has serious concomitant pathologies, for example, a recent myocardial infarction. In this case, the only choice will be conservative therapy, sometimes requiring immobilization of the patient, that is, immobilization of the limbs to save his life.

Both surgical and therapeutic treatment of a hip fracture in older people can be accompanied by complications. Their likelihood increases if medical assistance was not provided immediately. These include:

bedsores;
pneumonia;
amyotrophy;
thromboembolism;
urinary tract inflammation and enuresis.

Post-traumatic stress and forced bed rest can lead to a sharp deterioration in health in elderly patients, so it is extremely important to provide them with proper and complete care. It is extremely difficult for untrained people to cope with it on their own.

Medical statistics are disappointing - in more than 50% of elderly patients, death after a hip fracture occurs several months later. Its cause is complications resulting from improper care. To prevent this, the right decision would be to place the patient in a boarding house, where he will be provided with round-the-clock care, regular medical supervision and adequate rehabilitation.

Proper home care for an elderly patient with a hip fracture

If you decide to care for your elderly relative with a hip fracture on your own, get ready for the fact that you will have to radically change your life and routine. People with this injury are completely helpless - the injured joint cannot be bent or unbent.

To care for such a patient at home, you need to properly equip the bed in order to minimally disturb him while performing the necessary actions. An orthopedic mattress should be placed on it to prevent bedsores, and a longitudinal arch with a movable handrail should be installed, on which the patient will lean if necessary, to substitute a bedpan, remake the bed, or change a shirt. Later, the installed arch will be needed to perform physical therapy exercises.

Proper home care for an elderly patient with a hip fracture includes:

regular massage, during which the patient should be lifted and turned over onto the healthy side;
massaging the injured leg - foot, leg and thigh muscles, holding it in an elevated state;
regular replacement of underwear and bed linen, especially if the patient suffers from uncontrolled urination;
treatment of bedsores when they appear;
proper nutrition and ensuring optimal drinking regime;
regular wet cleaning of the room in which it lies and quartzing it.

Psychological support that can be provided to the patient by loved ones, aimed at preventing apathy and falling into a depressive state, is extremely important. In particularly severe cases, you may need the help of a specialist.

Prevention of complications

Proper care for a patient with a hip fracture includes the prevention of complications that can seriously worsen life and even lead to death. These include:

Severe pain syndrome.

To relieve it, oral and injectable drugs approved for use at home are recommended.

Urinary incontinence.

This phenomenon with such injuries is most often temporary. During enuresis, it is recommended to use diapers and nappies, which should be changed regularly.

Bedsores.

To prevent them, the patient must be constantly moved and regularly massage the injured limb, with the exception of the injured area.

Pulmonary complications.

They are dangerous because when infections occur they turn into pneumonia, which is extremely dangerous in old age. To prevent this, the patient is prescribed drugs to thin the sputum, it is recommended to regularly ventilate the room in which he is lying, and do breathing exercises and chest massage.

After 3.5 months, in the absence of contraindications, the patient is recommended to resume physical activity without putting stress on the injured joint. Initially, you should begin to move your body on the bed, leaning your hands on the arch installed above the bed, then carefully sit down, stand up and gradually move around the room, holding on to the support, and then switch to crutches.

Caring for elderly patients with a hip fracture in a private boarding house in the Leningrad region

Caring for an elderly patient with a hip fracture requires serious time investment - one of the relatives will have to quit their job to do it. A patient with this severe injury cannot be left alone and must be cared for around the clock. This is very difficult to do alone; turning over, pulling up, bathing, changing clothes of a helpless person requires special skills and physical strength.

Not everyone can afford the services of a private nurse, but there is a way out - a private boarding house for the elderly “Vita” in St. Petersburg or the Leningrad region. This is not just a nursing home, but a full-fledged rehabilitation center, where there is everything that is needed to meet the needs of elderly people with a serious injury to the hip joint. At your service:

bright, spacious and equipped with all necessary rooms;
polite, friendly and well-trained medical staff;
comfortable living conditions;
full nursing care;
proper and nutritious nutrition;
carrying out rehabilitation according to an individually designed program, including physical therapy and massage.

Full professional care in a boarding house will provide a patient with a hip fracture with a quick recovery. Your elderly relative will be able to walk and care for himself again. Trust our qualified staff to care for you after a serious injury.

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Full medical care and health monitoring 24 hours a day (accompaniment, assistance in eating, carrying out hygiene procedures).
Providing specialized equipment and technical care.
Regular change of bed linen, washing of clothes.
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Use of ladder splints for hip fractures (technique):

2 tires are tied together along the length, bending the lower end of one of the tires in the transverse direction at a distance of 20 cm from the edge. You will get an elongated splint for application along the outer surface of the damaged limb, as well as along the side surface of the body to the armpit.
1 splint is prepared for application on the inner surface of the thigh.
1 splint is modeled with a recess for the heel, calf muscles, with a footrest and a slight flexion angle at the knee joint.

Plastic splints are applied in a similar way.

If there are no standard splints, transport immobilization for a hip fracture is carried out using available means: slats, skis, bundles of brushwood and other objects of sufficient length to immobilize three joints (hip, knee, ankle).

What is the risk of hip fracture in older people?

When you receive a hip injury, especially in old age, there are some additional risks that are associated with:

The occurrence of severe complications. They are associated with both physical and psychological health of a person.
Due to decreased immunity, there is a risk of developing other diseases not related to joints. The cardiovascular and respiratory systems are most often affected.
Spending a long time in bed undermines the health of an elderly person and aggravates existing chronic diseases.
The greatest danger is that the person may die. The most common causes of death after such a fracture are heart failure, thromboembolism and pneumonia.
Sometimes an elderly person, deciding that he is becoming an unbearable burden for his family, decides to commit suicide.
Refusal of surgical intervention and complete immobilization of the patient.

Classification of injuries

According to the location of the fracture - on the greater trochanter, neck or head of the femur.
Along the fracture line - middle and side.
By the nature of the displacement - varus (the head moves down and in), valgus (up and out), impacted (one fragment is driven inside another).
The nature of the damage includes open and closed fractures.

Separately, it is worth mentioning pertrochanteric trauma with displacement. It is especially dangerous because it causes extensive tissue damage, severe bleeding, hematoma, intense pain and a sharp deterioration in the general condition of the body.

A comminuted fracture is dangerous in its own way. The name says it all: trauma results in many bone fragments that need to be reassembled. This requires complex surgery.

Finally, the most severe injury is open, with bones coming out. As a rule, this is the result of a bullet wound.

Features of injury

The femoral neck is the thinnest and most mobile part of the femur. It is this that gives us the opportunity to move quickly. In old age, when bone tissue becomes fragile and vulnerable, such parts of the skeleton are at greatest risk. It is enough to trip or slip on ice and a fracture is guaranteed.

There are other factors that increase the likelihood of this complex fall injury:

overweight;
osteoporosis;
alcoholism;
prostate adenoma in men, menopause in women;
chronic diseases of the legs and spine (arthrosis, osteochondrosis, hernia, etc.);
cirrhosis of the liver;
diabetes;
renal failure.

The bone takes a very long time and is difficult to heal. For almost all this time, the victim becomes a bedridden patient: as a rule, after a fracture of the femoral neck, he completely loses the ability to walk and needs constant care.

But that’s not all. Bone fragments can rupture muscles and blood vessels, and this, if not treated in a timely manner, will cause further complications, including severe somatic diseases, including death.

First aid

An ambulance must be called immediately. If this is not possible, transport the patient to a medical facility yourself:

lay him on his back;
give him a painkiller if you have one on hand;
put a splint on your leg and fix all the joints - in the groin, knee and heel;
Do not under any circumstances try to remove the victim’s clothes and shoes;
if this happens in winter, if possible, insulate the injured leg;
to move, use a stretcher or something similarly flat and comfortable to carry together;
if the fracture is open and bleeding begins, apply a tourniquet;
try to talk to the patient as much as possible in order to get him out of the state of shock and distract him a little from the pain;
act calmly - carry the victim carefully, and when transporting in a car, be sure to observe the speed limit.