Hip fracture in older people: symptoms, treatment and rehabilitation

A hip fracture is one of the most difficult injuries to treat and rehabilitate. Most often occurs in older people over 60 years of age. This is facilitated by age-related changes: a lack of calcium and phosphorus in bone tissue, a decrease in muscle tone due to a decrease in motor activity. The femur breaks at its thinnest part, at the junction of the bone and the head. The peculiarity of the injury is that a person becomes bedridden for a long time. Modern surgery offers surgical treatment using osteosynthesis and endoprosthetics.

How does a hip fracture occur in older people: symptoms

Bones are injured due to exposure to brute mechanical force. For this reason, a pertrochanteric fracture of the femur occurs. One of the main causes of this type of injury is car accidents on the roads. Most often young people are injured in this way. The most dangerous is considered an open fracture of the femur, in which the broken parts come out, breaking through the soft tissue.

A fracture is characterized by sharp pain, change in leg length, and deformation. There is a possibility of a displaced fracture. In this situation, it is necessary to take an x-ray, where the image determines whether only the femur is broken or whether the pelvic bones are also affected.

The main goal of therapy in this case is to restore the original length and axis of the damaged limb. Undoubtedly, it is also necessary to normalize the functioning of the joints (hip and knee).

In modern treatment of hip fractures in elderly people, conservative treatment methods are practically not used. If they are used, it is only because it is impossible to perform surgery and anesthesia.

Elderly patients diagnosed with a hip fracture and prescribed conservative treatment must remain in bed for many weeks, and possibly months. A sick person bound in plaster must endure a skeletal traction procedure, after which hypostatic complications often occur.

The methods of surgical intervention used in modern medicine have practically no such disadvantages. Surgical treatment allows you to recover from injury as quickly as possible.

It is impossible to immediately determine whether a femoral neck has been damaged or not, focusing only on the sharp pain in the groin and the inability to get up. It may well be that you just seriously bruised or sprained your leg. In this case, an accurate diagnosis will be made by taking an x-ray. Sometimes the symptoms are not so clearly expressed, so the elderly person is in no hurry to go to the doctor, thereby aggravating a serious injury. After all, if a femoral neck fracture occurs, this can lead to dangerous complications, such as:

punctures of large blood arteries with bone fragments;
blood accumulates in the joint capsule;
development of necrosis of the articular head.

Painful sensations, which were weak at first, become increasingly intensified. As a result, the elderly person ends up in the hospital in critical condition.

A reliable sign is considered to be external rotation of the foot, which is unnaturally turned out.

The photo shows what a hip fracture looks like in older people.

This becomes clearly visible when the elderly patient lies on his back. If a person tries to move his foot, he immediately feels severe pain in the broken joint. The same thing happens with tapping movements on the heel. Due to the contraction of the gluteal muscles, the injured limb becomes shorter by 2-3 centimeters.

Another symptom, called a “stuck heel,” is the inability to lift your leg off the bed, although it bends and straightens easily at the knee. In addition, if a person tries to turn the body, characteristic crunching sounds will be heard.

By ignoring these signs, a person can become disabled or die.

Therefore, if an elderly person has symptoms of a hip fracture, it is necessary to urgently contact a medical facility.

Anyone can face this problem, so it is very important to be informed about first aid for fractures. The classic first step is to apply a splint and administer pain medication (if available) to the victim.

The next method is to apply a Dieterichs splint. If you don't have it, you can use two items with suitable parameters. Apply the splint like this:

the one that is longer is located from the armpit to the ankle on the outside;
the shorter one should be on the inside in the area from the groin to the ankle;
the foot must be fixed at a right angle.

These measures are temporary, only until doctors arrive. Qualified assistance can only be provided in a hospital setting.

There are three types of femoral neck fractures: body, head (intra-articular and extra-articular), and greater trochanter. A fracture of the upper end of the bone is characterized by pain in the joint area, external rotation of the leg, and inability to move. This type of injury is accurately determined using x-rays.

The peculiarity of a hip fracture is that it most often affects older people. The cause may be awkwardness when falling. This injury seriously affects not only the health, but also the human psyche, as all plans collapse.

It’s sad, but absolutely anyone can get such an injury. Therefore, all people over 50 years of age should be aware of the danger that threatens them.

According to statistics, women during menopause are more susceptible to injury. However, other categories of people should also think about it, since the main cause of damage is osteoporosis, which occurs in older people.

Osteoporotic changes are manifested by structural damage to bone tissue due to a decrease in its density. The bone becomes thinner, so even with weak mechanical stress it breaks easily.

What are the causes of this condition and who is at risk? Prerequisites that provoke the disease are diabetes, rheumatoid arthritis, and infectious diseases of bone tissue. The risk of falling increases if an older person has poor vision, multiple sclerosis or senile dementia.

A factor such as genetic predisposition also influences the likelihood of the disease occurring. People who have relatives with a similar disease and people of thin build (asthenic type) are at risk of developing osteoporosis.

Taking certain medications that cause bone loss (such as blood thinners and diuretics) may make the situation worse. Some medications cause drowsiness and loss of coordination, leading to falls.

An important condition for preventing the disease is lifestyle. If a person eats improperly, has bad habits, and moves little, all this can lead to bone diseases. Young people can be injured in car accidents, as well as in gyms performing strength exercises (especially if they are addicted to steroids).

Femur injuries

According to statistics, this pathology is detected in 80% of women over 50 years of age and almost all men over 75 years of age. In females, osteoporosis develops much earlier, which is due to the massive loss of calcium during menopause.

If a person does not compensate for calcium deficiency with the help of vitamin-mineral complexes, vitamin D, calcium- and phosphorus-containing preparations, then he begins to demineralize his bones. Simply put, the minerals Ca and P are washed out, enter the bloodstream and are distributed throughout the body. Once they enter organs and tissues, they perform a number of vital functions there.

Trauma to the left hip joint.

Since the neck is the thinnest part of the femur, it is the one that suffers most often. Pertrochanteric fractures and head injuries are much less common. The latter are usually combined with a violation of the integrity of the pelvic bones.

In orthopedics and traumatology, several classifications of femoral neck fractures are used. Different types of fractures have completely different prognosis. For example, in people under 50 years of age, transcervical fractures with an angle of less than 30 degrees heal relatively well. In older age groups, subcapital injuries and fractures with an angle of more than 50 degrees heal extremely difficultly and have an unfavorable prognosis.

From left to right: subcapital, transcervical, basicervical fractures.

Subcapital. Located on the border between the head and neck of the femur. Least favorable prognosis.
Transcervical. It is localized in the most vulnerable place - in the area of the femoral neck.
Basiscervical. Located at the junction of the neck with the body of the femur. It grows together much better than the previous two options.

The fracture angle is of great prognostic significance. In a vertical position, there is a high risk of displacement with subsequent disruption of blood circulation in the tissues of the femur. Such fractures have the most unfavorable prognosis.

Fractures of the femoral neck may be accompanied by impaction, stretching, compression, displacement or rotation of bone fragments. All this aggravates the patient’s condition and worsens the prognosis for recovery.

Conservative methods of treating hip fracture in the elderly

Skeletal traction

The principle of this type of treatment is to fix the injured leg with a cast and skeletal traction using a load (less than 10 kg). This creates the possibility of gradually moving the bone in the desired direction. This position of the patient should be maintained for approximately 7 weeks, followed by a rehabilitation period (3 months).

During recovery, the patient needs to move around using crutches and perform physiotherapeutic procedures. Elderly people should be especially careful to prevent complications by preventing them in time.

During the rehabilitation period, it is recommended to take painkillers, diuretics, as well as drugs that restore the structure of bone tissue and replenish the lack of calcium.

In combination with drug treatment, breathing exercises, massage and static exercises are used. Food should be rich in vitamins and minerals found in fish, fruits, vegetables and cereals. It is useful to eat jellied meat, jelly, aspic, jelly and jelly.

If the problem is aggravated by the patient’s physical and psychological illnesses or he was not in skeletal traction for the prescribed period, he may remain disabled for life. This happens because the bones have not had time to heal.

It happens that complications arise after conservative treatment:

due to prolonged immobility, bedsores form;
pneumonia (pneumonia);
thrombophlebitis;
disruption of the intestines, manifested in the form of constipation;
atrophic phenomena in muscles;
mental disorders.

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Surgical methods for treating hip fracture in the elderly

It happens that even with good care after conservative therapy, the bones do not heal. In this case, to avoid complications with a hip fracture in older people, surgery is performed. Rehabilitation after surgery will last up to 1 year. With conservative methods, the exact timing is unknown, as many factors influence this.

The operation involves replacing the joint with an implant if a proximal fracture is diagnosed.

Other types of fractures are treated by matching the fragments and securing them with pins and wires.

Both types of operations are performed under general anesthesia. Soft tissues are excised and artificial joints or pins are installed in the injured areas. Finally, they are treated with an antiseptic and stitches are placed on the wounds.

The operation is mandatory for those patients who have a refracture (or recurrent fracture) or already have a prosthesis.

For reference!

With the surgical method, the risk of infection of bone tissue increases significantly (almost 20%). After surgery, the patient must take medications.

Regardless of which treatment method is chosen, a recovery period is required, which begins earlier after surgery and lasts less.

The time after injury and before the start of walking on crutches with conservative treatment will be approximately a year, and with the surgical method – six months.

No matter what age the injured person is, a fracture equally causes a lot of inconvenience and pain. Therefore, it is very important for the speedy recovery of an elderly person and for comfortable treatment to provide psychological support for loved ones, as well as for the work of doctors to be of high quality.

The process of diagnosing a hip fracture in an elderly person

During the process of admitting a person to a hospital, a mandatory initial examination and examination is carried out, during which the patient is interviewed to identify symptoms, sensations and consequences. Based on the results of the current clinical picture, doctors can make a probable (presumptive) diagnosis . However, you can’t limit yourself to just these! To ensure that the circumstances are assessed correctly, doctors prescribe radiographic examinations. Even with the slightest suspicion of the presence of pathologies in the causes of damage, a CT scan is performed.

In cases where the diagnosis is confirmed, as well as the need for surgical intervention, the patient is referred for additional examination procedures:

MRI.
Ultrasound
Cardiogram.
Submission of general laboratory tests.

Also during the period of examination and diagnosis, an obligatory aspect is the accurate determination of the patient’s allergic reactions to any medications.

Rehabilitation after a hip fracture in the elderly

Due to their advanced age, it is more difficult for older patients to choose medications, therapy and rehabilitation methods. If surgery is needed, the issue of tolerability of general anesthesia, as well as other associated ailments, is decided. An operation cannot be performed on an elderly person if he has a diseased heart, lungs, or kidneys.

It is unknown how long treatment and rehabilitation will last for a hip fracture. Sometimes old people don’t recover at all.

When the body is immobilized and constantly remains in a horizontal position, all body functions are disrupted and other diseases develop.

Due to this lifestyle, an elderly person, forced to endure constant pain and dependence on outside help, develops psychological problems. Both physical and emotional states suffer from complete immobility of the body.

However, it must be said that not all situations are hopeless; there are cases of recovery.

Rehabilitation measures include treatment, physical exercise, and therapeutic massage. To restore full blood circulation, massage both legs.

Examples of exercises:

strengthening muscles with the help of a gymnastic stick suspended above the patient’s bed, which he will reach.
in the second stage of the recovery period, it is allowed to move the lower limbs, gradually increasing the amplitude.
Before lifting the patient out of bed, he is taught how to turn from different sides and how to lift the pelvis.

You can use folk remedies to speed up recovery:

To improve blood circulation, prepare an ointment with linden honey, dry mustard, salt (it’s good if it is obtained from the Dead Sea). Rub the mixture into the injured area.
Oak bark mixed with butter and black poplar buds (2:7:1) will help cope with bedsores. Place the prepared composition in a dark place overnight. The next morning, keep the mixture in a water bath. Drain everything into a jar. Lubricate bedsores with ointment.
If a person lies for a long time, he may develop pneumonia. Prepare the following mixture: mix warm cheese with honey. Apply the mixture to the cloth and then to your chest. Cover the top with thin paper and a fine woolen cloth.
Cough is treated with warm milk and figs.
Shilajit with the addition of rose oil perfectly restores bone tissue.
Eating foods high in calcium is helpful for faster bone healing.

The rehabilitation period is more easily tolerated by people who have adhered to a healthy lifestyle all their lives, performed therapeutic physical exercises, and ate foods with calcium. In addition, rapid healing of the fracture is guaranteed with timely treatment and high-quality qualified care.

Restorative measures include regular massage, which should be used in conjunction with physiotherapy and therapeutic exercises. Psychotherapeutic prevention is successfully used to eliminate depressive conditions in older people associated with immobility, helplessness and pain.

The initial set of exercises, prescribed a week after the fracture, includes simple exercises.

The patient flexes and extends the healthy limb and rotates the foot. The same movements are repeated with the injured leg, reducing the load and making sure that it does not hurt.
An elderly patient sits on the bed with his feet on the floor. The patient should, slightly straining his muscles, press his feet onto the floor.
While resting, the patient leans slightly towards the healthy leg. It is necessary to try to straighten and bend the other limb at the knee.

After the cast is removed, the exercises become increasingly more difficult. Exercise includes walking with crutches, a walker, or a cane. A positive result is possible only with desire, perseverance and confidence in success.

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Recovery time after a hip fracture in older people

Unless surgery is performed, the recovery time following a hip fracture in older adults is unknown. This is influenced by:

nature of the injury;
complexity of the fracture;
age of the victim;
the state of the injured;
bone diseases;
other diseases.

The best treatment option is surgery, which is performed in most cases. It is surgical intervention that will speed up recovery and restore limb mobility without causing complications.

Rehabilitation lasts approximately 6 months on average. However, this period may be longer in older people (a year or more). It also happens that a person remains motionless for the rest of his life. The healing period depends on the state of the person’s immune system.

Due to poor blood supply in old age, there are cases of not only unfavorable, but also fatal outcomes. There is no exact answer to the question of how long older people live after a hip fracture. All we can say for sure is that this injury significantly reduces performance and quality of life in general.

The one who will care for the sick bears great responsibility, because recovery depends on it. Therefore, it is necessary to follow all the doctor’s recommendations.

First of all, you need to follow the patient’s hygiene rules, changing bedding in a timely manner and wiping the skin with a special washcloth. It is necessary to prevent the process of muscle atrophy. To prevent this from happening, massage, physical therapy, and special gymnastics are prescribed. The training program is selected individually and depends on the type of fracture and its severity.

Proper lung function is ensured by training in the form of inflating a balloon.

Remember that the constant lying position of an elderly person for a long time can lead to the development of heart failure, pneumonia, bedsores and other complications. If you do not follow the necessary care rules, a hip fracture in older people can lead to the following consequences:

necrosis of the femoral head;
arthrosis, characterized by degeneration of bone tissue and joints;
the formation of a false joint (movable joint) due to improperly fused bones.
arthritis that develops as a result of infection of the joint.
vein thrombosis, which can occur due to prolonged immobility. Venous outflow is disrupted and the tone of the vascular walls decreases.
pneumonia caused by infection of stagnant sputum. Pneumonia can cause death in a patient.
complications are a consequence of an incorrectly performed operation and imperfect structures.
consequences caused by the general condition of a person (impaired functioning of the heart muscle, various bleeding, etc.)
bedsores, as well as their infection.

All these consequences can lead to a sad outcome.

Injuries in the younger age group

In the younger age group, trochanteric, subtrochanteric, pertrochanteric, and fractures of the acetabulum and femoral neck occur. The latter usually have a transcervical or basalocervical localization and belong to types II and III according to Pauwels.

Osteosynthesis.

The main method of treating hip fractures in the younger age group is internal osteosynthesis.

The essence of the internal osteosynthesis technique is the reposition of bone fragments and their fixation. For this purpose, pins, screws, plates, knitting needles, etc. can be used. Implants are usually made of titanium, molybdenum-nickel, or other alloys that are resistant to oxidation in body tissues.

Successful osteosynthesis requires:

absence of severe osteoporosis;
maintaining normal bone mineral density;
no disturbances in the blood supply to the bones of the hip joint;
accurate and durable comparison of bone fragments by the surgeon;
minimal trauma to periarticular tissues during surgery;
mechanical compatibility of the implant and bone tissue;
early physical activity in the postoperative period.

There are different osteosynthesis techniques. When choosing a method of surgical intervention, doctors take into account the individual anatomical and physiological features of the structure of the human femur, the location of the fracture, its direction and type according to Pauwels.

A type of osteosynthesis.

According to statistics, nonunion of hip fractures is observed in 10-30%, avascular aseptic necrosis of the femoral head – in 10-40% of patients. Typically, these patients end up undergoing total hip replacement.

In case of severe comminuted fractures of the hip joint, accompanied by impaired blood circulation in the femur, it is better to refuse internal osteosynthesis. Most likely, it will not help restore the integrity and functional activity of the joint.

Preventing hip fracture in older people

Modern medicine has made progress in treating hip fractures in older people. However, it is important to prevent injury by taking preventive measures:

Eliminating the possibility of falling (do not walk in icy conditions, avoid uneven roads, use handrails, railings, etc. when moving).
Maintain normal body weight.
Move more.
Take necessary medications if you are at risk of fainting.
Menopausal women should take hormone replacement therapy.
Take medications that strengthen bone tissue.
Nutrition should be balanced, rich in vitamins and calcium.

Having received such an injury, an elderly person may remain permanently disabled and lose the ability to move independently. Complications can be fatal. The treatment will be quite long, and in almost all cases surgery will be prescribed.

Therefore, in order to avoid injury and not lose physical activity, you need to follow preventive measures.