Elderly after femoral neck surgery: specifics of rehabilitation in old age

Issues discussed in the material:

What does rehabilitation of the elderly after surgery for a hip fracture include?
What therapeutic exercises should elderly people do after hip surgery?
How to eat properly for elderly people after surgery for a hip fracture

The most common injuries to the lower extremities are fractures. Moreover, a quarter of them are injuries to the femoral neck. Such an injury poses the greatest danger to people of retirement age, since the likelihood of subsequent complications is high, and recovery takes a long time. You can learn from our article about what older people should do after hip surgery in order to recover faster.

How does a femoral neck fracture occur?

A hip fracture is an extremely dangerous injury that leaves an elderly person bedridden for a long time. Complications lead to high mortality, since due to the recumbent position, serious diseases such as pneumonia and bedsores occur, which provoke blood poisoning and damage to internal organs.

The peculiarity of a hip fracture is that it can occur without a fall or a strong blow to the bone. An elderly person may stumble slightly, get into a crowded vehicle, fail to see a step, and simply fail to lean on his leg. This is due to a common disease in old age - osteoporosis, which leads to brittle bones.

When a fracture occurs, the femoral neck loses its connection to the main femur and cannot grow back on its own. In this case, there is only one way out - surgery, especially in situations where the left condyle or head of the femur has been displaced. The sooner an elderly person gets into the hands of an experienced surgeon, the less likely it is to develop complications. It is even easier to undergo an operation than to remain immobilized for a long period of time. Medicine offers different ways to carry it out, and in some cases you can do without general anesthesia.

In patients with a hip injury, doctors carefully evaluate the possibility of surgery. The criterion for success is, first of all, not the person’s age, as is commonly thought, but the absence of contraindications. If an elderly patient has a diagnosis such as decompensated diabetes mellitus, severe cardiac, respiratory or renal failure, as well as serious mental and consciousness disorders, then a femoral neck fracture will have to be treated conservatively.

Care to prevent pneumonia

Yes, with prolonged immobilization a person is at risk of developing congestive pneumonia. To prevent this from happening, you need to do breathing exercises with the patient every day.

Breathing exercises:

Every half hour, take a deep breath in through your nose and exhale through your nose, repeat two or three times.
When you inhale, spread your arms to the sides - this will allow you to inhale more deeply.
As you exhale, you need to hug yourself tightly with your hands.
Instead of inhaling, you can whistle, blow bubbles into the water through a straw, or sing.

Frequent ventilation of the room in which the patient lies is also important.

Specifics of rehabilitation after surgery for a hip fracture

Of course, the consequences of a hip fracture in a young man and an elderly woman over 80 years old, and even diagnosed with diabetes or dementia, are very different. After all, a young body recovers much faster, and, accordingly, it is easier for doctors to restore the proper functioning of the neck and head of the femur. It is often difficult for older people to perform osteosynthesis (surgical comparison of bone fragments using fixation), and if the fracture does not heal for a long time, a false joint appears.

If a pensioner receives a complicated fracture of the femoral neck (a special case is a fragmentation fracture), this can immobilize him for the rest of his life. In this case, the person remains forever bedridden and becomes disabled. A hip fracture in older people can trigger the progression of dementia. And in 60% of cases, this dangerous injury ends in the death of the patient.

To restore the body after a hip fracture, a set of special physical therapy exercises are used, which are designed to rehabilitate the body in the shortest possible time and to enable the person to start walking again.

An elderly patient will have to spend at least three months in a lying position when receiving an injury to the head or neck of the femur, and in some cases this period reaches six months or more. Rehabilitation measures are applied to the patient from the first days after injury. The length of time spent in a supine position depends on the individual characteristics of the person and the complexity of the fracture. If doctors were able to surgically connect the bone fragments, the rehabilitation period may change.

If healing does not occur for a long time, especially with an impression, closed fracture, a false joint is formed, and the elderly person is deprived of the ability to move independently. This is especially common in older women.

We recommend

“How to prevent stroke using folk and medical means” Read more

First aid

After a fall, the patient must be calmed down and placed on a flat surface. It's not worth transferring. The leg is fixed with improvised material in two places: at the hip and at the knee. They do not try to reverse or correct the damage, so as not to make it worse. Provide fresh air, check blood pressure and pulse. Call the hospital immediately and call the doctors.

If the injury occurs on the street, it is recommended to move as little as possible. Immediately call an ambulance so that doctors can take the victim to the hospital, examine the damage and take an x-ray.

Massage for the elderly after surgery for a hip fracture

It begins to be used at the earliest stages. After surgery, first of all, the patient needs to eliminate pain and normalize body temperature. For this purpose, painkillers with antipyretic and anti-inflammatory effects are used. Massage is a very effective rehabilitation measure for the elderly after femoral neck surgery, as it helps to heal bones at the site of injury, normalize blood flow, and restore leg function.

The complex of massage techniques includes such methods of influence as stroking, rubbing, various types of kneading and vibration. All movements are performed above and below the site of the lesion.

The massage begins exclusively with the healthy limb; for the first time, the injured leg is not touched. All appointments for elderly people after femoral neck surgery are carried out with caution in the medial area. Deep vibration should not be used, as it can cause displacement of bone fragments, especially the femoral condyle, thus causing serious harm to the health of an elderly patient.

The first task of massage after an injury is to prevent the formation of bedsores. Already at the initial signs of manifestation, gentle rubbing of the proximal part should be applied to restore circulatory function. The formation of bedsores most often occurs in patients after a stroke. If they appear, medications are prescribed for local use, which help eliminate congestion, improve blood flow and nutrition of soft tissues.

Massage of the medial thigh should be performed with extreme caution, since this is where large vessels and lymph nodes are located closely. Therefore, the area of influence is chosen below or above the regional lymph nodes.

If an older person has previously had a stroke, their mobility is significantly reduced. In such a situation, the massage therapist needs to begin the procedure with gentle movements in the area of the proximal femur. You cannot use active methods of influence in the area of the medial surface of the thigh, where the neurovascular center is located.

We recommend

“Disposable diapers for adults: how to make the life of a loved one more comfortable” Read more

The benefits of exercise therapy

Therapeutic gymnastics helps with injuries of the femoral neck:

Improving blood flow through the vessels in the fracture area. Stagnation of blood can significantly damage the health of the limb and the entire body as a whole;
Slowing down the atrophy of muscle tissue and increasing overall tone, and special massage greatly helps;
Strengthening the muscles in the legs, in particular the hip joint;
Reducing stiffness and feeling of heaviness in the hip;
Restoring the ability to support the legs after an injury, the severity of which can vary widely;
Providing memories of correct walking skills and posture.

Walking on crutches in elderly people after surgery for a hip fracture

Only after three months is the patient allowed to start walking using crutches. In this case, you should try not to step on the injured leg. You can only lean lightly on the foot of the injured limb so as not to aggravate the condition or slow down the healing process.

If the injury is quite serious, affecting the proximal femur, the area of the head or neck of the femur is damaged, both condyles are damaged, any manipulations are performed with caution, increasing the load carefully and gradually only under the supervision of the attending physician and exercise therapy instructor, so as not to harm the patient’s health. During treatment, it is necessary to regularly take x-rays of elderly people after femoral neck surgery. Special monitoring is necessary for complex injuries, especially with closed comminuted fractures and with displacement of the left condyle or femoral head.

Full recovery in an elderly patient after femoral neck surgery will take at least six months, despite the fact that bone fusion occurs within the first couple of months. Any exercise during which a person experiences pain or discomfort must be canceled for a while so as not to harm health.

In a situation where rehabilitation fails to return the normal position of the condyle or femoral head, a repeat operation becomes necessary. In older people, another general anesthesia can provoke the development of dementia, after which the elderly person will have to register for disability.

We recommend

“How to care for a bedridden elderly person” Read more

What is included in the preparation stage?

The key to successful restoration of the victim’s activity is the choice of the optimal surgical technique. To select the most effective treatment, a high-quality and quick examination of the patient is necessary.

Computed tomography and magnetic resonance imaging data are very important.

Thanks to MRI, it is possible to determine the viability of the tissues of the femoral head: with such injuries, its blood supply may be disrupted.

CT allows you to confirm the fracture and determine its nature, which is necessary for choosing the optimal osteosynthesis technique.

In addition, the list of preoperative examinations includes:

Clinical blood and urine tests.
Biochemistry of blood.
Indicators of mineral metabolism (phosphorus and calcium).
ECG, ECHO-KG.
Digital densitometry – determination of the degree of osteoporosis.
Other methods of laboratory and instrumental diagnostics if necessary.

The data obtained are used to select the method of anesthesia, a specific method of osteosynthesis and prognosis regarding the management of the postoperative period.

If general anesthesia is necessary and time permits, the patient undergoes bowel preparation - fasting, cleansing enema. Although, in most cases, you can use regional (spinal) anesthesia and perform osteosynthesis on the day of injury

The professionalism of our clinic’s orthopedic doctors allows us to put into practice the principle of an individual approach to the health of each patient. Thanks to this, operations are carried out successfully and with constant efficiency.

Features of nutrition after surgery for a hip fracture

In order to speed up the rate of restoration of hip joint function and help the patient begin to walk again, special nutrition is recommended for elderly people after hip surgery. Food should contain a large amount of minerals, protein, vitamin D. Every day an elderly person is recommended to consume fermented milk products, eggs, seafood, preferably low-fat varieties of sea fish, as well as seaweed. It's good to eat cruciferous vegetables, especially cauliflower. To replenish the mineral composition of bones, dried fruit compote is excellent.

With a properly balanced diet, an elderly person recovers much faster after hip surgery, and the damaged bone heals well. If the patient is in a sanatorium during the rehabilitation period or is being observed in a specialized center, the nutritionist develops a special diet rich in calcium and vitamin D. Elderly people after femoral neck surgery are forced to adhere to a diet for a long time.

Contraindications

Massage is prescribed already on the third day after the start of exercise therapy or osteosynthesis, but it is necessary to monitor body temperature, preventing it from increasing.

At first, the massage is performed only in the lumbar region, then they move on to warming up the healthy lower limb. If a closed type fracture occurs and the condyles and head of the femoral bone are damaged, and the formation of a false joint begins, then the massage is carried out most carefully, since this injury is classified as severe and can lead to disability.

Important! When the temperature rises, rehabilitation in the form of massage is strictly prohibited!

If vascular dementia is detected, then massage and therapeutic exercises should be carried out in a limited manner. It is necessary to help patients in specialized rehabilitation centers.

To restore independent walking function, older people are advised to use walkers for faster rehabilitation.

FAQ

Many people who have suffered from LBP are interested in some questions regarding how to develop a hip after a fracture as quickly as possible, and other aspects relating to life during the recovery period. The most frequently asked questions and their answers are given below.

Swelling of the leg after a hip fracture - what to do?

If edema appears in the lower limb after PB, you must inform your doctor about this problem. He will conduct an examination to determine the cause of the swelling and prescribe adequate treatment to eliminate it.

When can you walk after a hip fracture?

A week after the operation, the person can get out of bed and begin to walk using crutches. After about three months, the lower limb is given full weight and the patient can move without the help of any objects. However, the timing is individual in each specific case.

How to walk correctly?

At the initial stage of rehabilitation at home after a hip fracture, or while still in the hospital and just starting to walk, it is necessary to use crutches and avoid putting stress on the injured leg. You should not lean on it and continue to use crutches or a cane until full mobility is restored.