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Closed hip fractures are considered one of the most serious injuries to the musculoskeletal system. They are most often accompanied by severe painful shock, profuse blood loss and require immediate hospitalization.

Our doctors:

Krasnov Sergey Aleksandrovich Practical work experience: 27 years.

Position held in the clinic: orthopedic traumatologist

The main specialty and specialization of the specialist for which admission is conducted: traumatology, orthopedics.

Proficient in methods of surgical and conservative treatment of acute injuries of the musculoskeletal system of an isolated, combined and combined nature.

Make an appointmentAsk a specialist a question

Moroz Kirill Sergeevich Practical work experience: 9 years.

Position held in the clinic: orthopedic traumatologist

The main specialty and specialization of the specialist for which admission is conducted: traumatology, orthopedics.

Proficient in methods of surgical and conservative treatment of acute injuries of the musculoskeletal system of an isolated, combined and combined nature.

Make an appointmentAsk a specialist a question

Proximal femur fractures (damage to the neck and trochanters)

In addition to the main causes (direct impact, road accident, fall from a height, etc.), even a banal tripping can cause injuries in older people, especially if they have osteoporosis and muscle weakness. The clinical picture is as follows:

• pain in the groin and hip joint, worsening with movement. With a trochanteric injury, the pain syndrome is so severe that the patient tries not to move at all;
• in case of fractures accompanied by displacement of bones, the injured leg becomes slightly shorter than the healthy one;
• the symptom of a “stuck heel” is the main sign: the patient cannot lift his straightened leg;
• with trochanteric fractures, swelling and hematoma appear at the site of injury, but if the femoral neck is damaged, they may be completely absent.

The diagnosis is made based on X-ray data, and for intra-articular injuries, an MRI of the hip joint is often additionally prescribed.

Caring for a patient with a hip fracture

Book by Lena Andrev. Photo: Olimp-Business Publishing House

Rehabilitation after a fracture can take more than six months , and forced immobility and helplessness have a negative impact on both the physical and psychological state of the patient. Complications following a femoral neck fracture include pressure ulcers, venous congestion, thrombosis, and congestive pneumonia. From prolonged inactivity, the muscles atrophy, and even after healing, a person cannot immediately return to his normal life - he literally has to learn to control his body all over again. However, properly organized care can not only alleviate suffering, but also speed up the process of rehabilitation of the patient.

In older people, bones become brittle, so most hip fractures occur as a result of falling from their own height. Fractures occur more often in women than in men. Apparently, this is due to the fact that women are more actively involved in household chores: they either reach for salt or slip on a wet, recently washed floor. The fracture itself is not as dangerous as the complications it can cause. Such an injury, especially in the elderly, can put a person to bed for a long time and even lead to death, since bedsores, thrombosis, congestive pneumonia, problems with the gastrointestinal tract, tissue necrosis, and heart failure occur due to an immobile lifestyle. , and the person himself often becomes depressed.

How to correctly turn a seriously ill patient We tell you how to make the movement safe for the patient and others Kristina OsotovaCaring Workshop

Care

Victims, regardless of age, undergo hip replacement, but in some cases the operation is contraindicated (for example, after a stroke).

However, after a hip fracture, regardless of whether surgery is prescribed or not, the patient’s life will no longer be the same.

A hip fracture means:

• fractures in the neck area;
• fractures in the femoral head;
• fracture in the area of ​​the greater trochanter of the femur.

The principles of caring for the victim are similar in all cases. To recognize a hip fracture, you need to know the symptoms.

Symptoms of a hip fracture

• The pain may not be sharp, but it intensifies when you try to move. It is concentrated in the groin, in the area of ​​the greater trochanter of the femur. If you lightly tap the heel of the leg where the fracture is expected, the pain intensifies;
• Unnatural position of the limb - the leg may be slightly turned outward, which is noticeable in the foot;
• Swelling and hematoma are relative signs of a fracture;
• Inability to independently lift a straightened leg up, although the ability to bend and straighten the knee is preserved; in this case, the heel constantly drags along the surface of the bed - “a symptom of a stuck heel”;
• Relative shortening of the limb by about 2-4 cm - as a result of a bone fracture, the muscles, contracting, “pull” the leg towards the pelvis.

Important If you notice these symptoms, put the patient to bed and call an ambulance!

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Care

If the fracture is not recognized immediately and the patient continues to walk despite the pain, then the sharp parts of the broken bone can injure surrounding tissues and blood vessels.

Risk factors:

• Elderly age;
• Osteoporosis;
• Metabolic disease;
• Uncertainty when walking as a result of partial paralysis, dizziness, poor vision, tremors in Parkinson's disease.

For prevention, the patient needs:

• move more to maintain muscle elasticity and strength;
• prevent falls (for this you need to properly organize your home space, remove obstacles, purchase comfortable shoes for the patient, and provide him with auxiliary technical means);
• Healthy food;
• observe the drinking regime.

For a femoral neck fracture, it is suggested:

• hospitalization followed by surgery and treatment;
• conservative treatment in hospital;
• organization of home care.

Basic principles of caring for a patient with a hip fracture

After a fracture of the femoral neck, the patient is initially limited in mobility, he mainly lies on his back. Due to the fact that he cannot turn on his sore side, the risk of developing bedsores increases.

Prevention of bedsores following a hip fracture

Important If you have a hip fracture, the use of an anti-bedsore mattress is contraindicated!

You already know that to prevent bedsores, it is necessary to change the patient’s position in bed every two hours. However, given the limitations of a femoral neck fracture, micro movements . You can also place soft bolsters under the leg and pelvis, slightly lifting the patient's side and shoulder off the bed. Then remove them one by one (in any order). Repeat the same on the healthy side. Thus, the body will constantly be in micro-movement, no part of the body will be under constant pressure, which will reduce the risk of bedsores.

Monitor the position of the foot on the side of the fracture - prevent it from turning outward.

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Care

It is necessary to turn the patient onto the healthy side carefully, slowly, while simultaneously holding the affected leg along its entire length. You need to grab the thigh with one palm, and the palm and inner part of the forearm of the other hand - the lateral area of ​​the knee joint. The healthy leg can be bent at the knee to rest on the bed.

Be sure to keep your skin dry and clean, change clothes promptly, and take care of your bed linen (exclude folds, crumbs, and foreign objects in the bed).

Prevention of pneumonia

Since congestive pneumonia is one of the most common and deadly diseases associated with a hip fracture and conservative therapy, it is necessary from the very first days after the fracture to ask the patient to consciously perform breathing exercises: take a deep breath through the nose and exhale through the mouth (once or twice every half hour -hour). As you inhale, you need to spread your arms to the sides so that the inhalation is deeper. As you exhale, hug yourself tightly with your arms. You can also whistle, sing, or blow bubbles into the water through a straw. It is necessary to ventilate the room and monitor the temperature in it.

Relieving pain symptoms

Due to the global restriction of movement, patients experience very severe pain and discomfort (it hurts even to turn on their healthy side). In this case, the doctor should prescribe painkillers. Make sure you take them on time and regularly.

Help with physiological recovery

Buy a ship of the "boat" type; The edge of such a vessel is very low, so it causes less discomfort when used.

Preventing constipation

Loss of appetite is possible, especially in the first days after the injury, since for the patient everything that happened means pain, stress and fear for the future. It is necessary to explain to your loved one that refusing fluids and food will only add to their suffering. Encourage him to eat and stay hydrated. Change your diet, introduce foods containing plant fiber. The doctor will probably prescribe medications that stimulate intestinal motility.

How to prevent depression

How to correctly transfer a seriously ill person from a bed to a chair Demonstration of the technique of correctly moving a patient Kristina OsotovaCaring Workshop

Care

Loss of independence has a depressing effect on a person. It is necessary to create a comfortable and familiar environment and surround the patient with care. A person needs reassurance and encouragement. Tell him that many people, with timely and proper rehabilitation, were able to sit and walk in the future - this will be an additional incentive for the patient.

Important Rehabilitation on your own

• It is imperative to move the toes of the sore foot - if the person himself cannot do this, help him.
• Slowly and gently, the patient should press his foot onto the caregiver's palm.
• Already two weeks after the fracture, you can begin to slowly bend the affected leg at the knee. In this case, the caregiver should support the leg with one hand above the knee, and with the other - by the calf. Be careful with pain!
• After 10-14 days, if there is no acute pain or complications, you can slowly begin to sit the patient up in bed. Each time, increase the angle of elevation of the upper body, constantly bringing the sitting position to an angle of 90 degrees.
• After 20 days, the patient should try to stand up near the bed, holding on to a chair or walker. Don't leave him alone.
• After the patient can stand confidently, you need to try to move around a little. Be sure to accompany your loved one while walking.

Diaphyseal fractures (damage to the shaft of the femur)

This type of fracture is the most severe injury of all types of injuries to the femur. In addition to the main reasons, it can be noted that athletes often receive it during intense training or competition. Symptoms of a diaphyseal fracture:

• severe pain, swelling and hematoma at the site of injury;
• deformation and shortening of the limb;
• pathological bone mobility.

To prevent the development of traumatic shock and blood loss, emergency assistance must be provided quickly. It consists of securely fixing the injured limb with a splint and administering painkillers.

Typical division

Hip injuries can be done on:

• Fracture of the upper part - due to a fall on the acetabular area, as well as due to a strong impact. Tendons and blood vessels are also injured. Osteoporosis may be the cause. A fatal outcome occurs if a person had heart failure or pneumonia before the accident.
• The diaphase zone is in turn divided into three more zones. There is a classification relative to the line of the supralum (longitudinal, transverse, splintered, crushed). Serious injury, which in 30% of cases leads to tissue necrosis.
• Condyles - are divided into several classes (from A to D) depending on the specific location. Long-term rehabilitation is required, as well as qualified treatment using fixing devices, hardware and drug therapy.

Proximal fractures (injuries to the lower femur)

Condylar fractures are the result of a strong direct blow to the knee or a fall from a height. With such an injury, bone fragments are usually displaced and bleeding often occurs. Blood can accumulate in the joint and provoke the development of hemarthrosis. Clinical picture of proximal fractures:

• severe pain in the knee joint;
• severe limitation and pain in movements in the knee;
• swelling of the knee joint;
• deviation of the tibia outward or inward (depending on which condyle is injured).

The diagnosis is made on the basis of x-rays and MRI images of the knee joint.

Treatment and recovery process

First aid for fractures to a patient in a hospital is the administration of local anesthesia. Then an x-ray of the rib is taken and an examination is carried out. When prescribing treatment, the severity of the injury, complications encountered and the general well-being of the patient are taken into account.

It takes about six months to achieve full recovery. Elderly people endure the treatment and rehabilitation process much worse than young people: their health deteriorates, and prolonged bed rest can provoke thromboembolism or pneumonia. The presence of illnesses or problems with immunity in the victim can also slow down the healing process. Poor blood supply can cause bones to fail to heal, resulting in a lifelong disability.

So, a hip fracture is still a test. It is much more advisable to prevent the occurrence of injuries in simple ways: wear comfortable shoes with stable and non-slip soles and regularly (every six months) take a course of vitamins containing calcium. Remember: you are your own best friend and worst enemy.

Treatment

The specific treatment for a closed hip fracture depends on the nature and location of the injury.

For femoral neck fractures

they resort to surgical intervention - they do bone autoplasty or fixation with a three-bladed nail. When a pseudarthrosis or necrosis of the femoral head develops, patients usually undergo hip replacement. An obstacle to surgery may be the patient's advanced age or severe concomitant pathologies. In such cases, only long-term bed rest and proper nutrition are recommended.

Trochanteric fractures

most often treated with skeletal traction for approximately 8 weeks. After this, a plaster cast is applied. You can only step on the injured leg after 3–4 months. In some cases, for trochanteric fractures, surgery is performed - osteosynthesis with plates, screws or a three-bladed nail.

In the treatment of diaphyseal fractures

at the initial stage, they usually resort to skeletal traction, external fixation devices and surgery - osteosynthesis. If surgical intervention is contraindicated (in case of severe concomitant pathologies or severe general condition caused by concomitant trauma), the patient is recommended to undergo skeletal traction for 1.5–3 months. And only after it is removed, a cast is placed on the leg, which must be worn for about 4 months.

For condylar fractures

The patient is given a plaster cast from the groin to the ankles, which he will wear for 1-2 months. Skeletal traction is used less often. If the fragments are displaced, they are repositioned; if there is blood in the knee joint, a puncture is performed. If it is impossible to assemble the fragments, an operation is indicated during which they are fixed with special screws.

First aid for a skull fracture

During various accidents, fractures of the skull bones are possible, but at first it is difficult to understand whether the brain is damaged. Therefore, the victim must be taken to the hospital as soon as possible.

The sequence of care for a skull fracture is as follows:

1. To create immobility of the head, use a cotton-gauze bag, a sling-shaped bandage or handy means (clothing, a blanket), forming them into a cushion around the head.
2. If a person is unconscious, empty the oral cavity of vomit and begin resuscitation measures.
3. To normalize heart function, if possible, give an infusion of Corvalol (up to 20 drops).

If the wound is in the back of the head or the victim is unconscious, he must be transported on his side. This position will prevent the development of suffocation due to vomit or retraction of the tongue.

If the victim has a fracture of the nasal bones, he must be transported in a “half-sitting” position. If the jaw is broken - in a sitting position, and for those who have lost consciousness - lying on their stomach. In case of a fracture, the lower jaw is immobilized with a sling-shaped bandage, and if the upper jaw is broken, a ruler or a piece of plywood is inserted between the jaws, which is fixed to the head.

First aid for fractures