Fracture of the neck of the hip - Causes, symptoms and treatment. MF.

According to the literature, fractures of the proximal femur are encountered in every eighth case from injuries of the bones of the skeleton and account for 68% of all fractures of the femur. In this case, patients over the age of 60 are found in 68-80 cases out of 100.

The structure of the femur and hip joint:
The femur is a large and long tubular bone in the human structure.

Femur consists of:

• Body.
• Two ends( epiphysis).

The upper epiphysis ends with a round head of the femur, which connects to the pelvic bone.

The femur is connected to the femoral head, using the narrowed part of the cervix.

In the joint zone of the femoral neck and the body there are two powerful bone protuberances:

• large spit above the neck.
• small spit at the lower edge of the neck.

The skewers are connected by an interstitial line and an interstitial crest.
Hip joint - has a cup-like shape, formed by the acetabulum of the pelvic bone and the head of the femur. Inside the joint is a round ligament of the head of the femur, in which the blood vessels pass, and nerves to the head of the femur.

All types of fractures in most cases are observed in the elderly and are usually formed by falling.

Symptoms for hip fracture

• The first symptom is pain, it concentrates in the groin, it is not sharp, but when you try to move, the pain becomes stronger. The pain also increases, if you try to knock lightly on the heel of the foot.
• The second symptom - a broken leg turns slightly outwards. This can be seen from the foot.
• The third symptom is limb shortening, about 2-4 cm. This symptom arises from the fact that the bone has broken, and the muscles, contracting, pull the leg closer to the pelvis.

There are also such fractures, in which patients can walk for several days and even weeks.

Diagnosis for hip fractures

Diagnosis for hip fractures, usually not difficult. The diagnosis becomes clear during a clinical examination. The patient complains of pain in the region of the hip joint. The injured limb is shortened, rotated outward, the patient can not tear the heel from the bed. And all this is usually confirmed when doing radiographs.

First aid for a fracture of the neck of the femur

• to lay the injured on the back.
• to fix the leg with a tire, with the knee and hip joint being seized.

to deliver to a medical institution.

Treatment of hip pearl neck fractures

Conditions for fusion unfavorable due to local anatomical features and difficulty of immobilization( maintenance of immobility).Bony fusion of the fracture occurs in 6-8 months. At the same time, prolonged bed rest in the elderly leads to the development of congestive pneumonia, decubitus, thromboembolism, which is the main cause of high mortality. Therefore, the treatment methods associated with prolonged immobilization of the patient, in the elderly, should not be applied. Skeletal traction and gypsum hip bandage as independent methods of treatment are not currently used.

With such fractures of the femoral neck, surgical intervention is the most rational. In those cases when surgical treatment is contraindicated, resort to conservative, more often functional treatment, which consists in the early activation of the patient. With conservative treatment, it is often impossible to achieve a fusion of the fracture. The purpose of this method is saving the life of the patient.

The operation is performed on urgent indications.
For osteosynthesis( restoration of bone tissue), three titanium screws are most often used.

In elderly patients with fractures of the femoral head, it is more expedient not to perform osteosynthesis of the fracture, but to replace the joint with an artificial one. Endoprosthetics of the joint with fractures of the femoral neck in patients older than 70 years is becoming increasingly common. Its advantage is the possibility of early loading on the operated limb( in 2-3 months, and in cases of bone cement application for fixing the endoprosthesis in the femur, the load on the limb is possible from the first day after the operation), which is of considerable importance for the weakened elderly and senile patients.

The prognosis when using the operative method of treatment in relation to life is favorable. With conservative treatment, the mortality rate reaches 50-70%.

Care for patients with fractures in the femoral neck

When caring for patients with fractures in the region of the femoral neck, a number of problems need to be addressed. The first of these is pain in the groin and leg. She is not strong, but brings with her discomfort and, as a consequence, a violation of psychological contact with a person - it is difficult to communicate with him.

One of the most important problems is pressure sores. In such people, they arise mainly on the sacrum and on the heel of the sore leg.

Due to the fact that the sacrum is constantly in contact with the bed and the skin is moisturized, it is necessary to use drying ointments or powder( talc for the body, zinc ointment) to prevent its diaper rash. It is very important to change clothes frequently, under the rump - diapers.

Effective massage: it helps cope with stagnation of blood in the affected leg, which leads to increased pain. It is best to do an easy stroking massage from the foot to the body. You should also adjust the devices that help at least raise the pelvis from the bed, giving rest to the sacrum, if you can not turn on your side.

All patients who are in a lying position for a long time, suffer from intestinal atony, the consequence of which are constipation. It is difficult to cope with this problem, because the pain, on the one hand, prevents the active movement and, on the other hand, negatively affects the appetite - the patient eats little and has constipation. Pain from stool delay increases the pain from fracture. Constipation is a very big problem for those who have broken the neck of the hip. It is better to start prevention at once, from the first hour, from the first day. To do this, use products that cause increased peristalsis. A good result is the reception of sunflower oil, the use of fermented milk products. You can use various means that stimulate peristalsis, for example, drops of gutalax.

Long stay in a lying position leads to another serious complication - pneumonia, mostly, of course, in old people. This is a rather frequent complication and requires active respiratory gymnastics.

External rotation of the foot is the next problem. If the patient can eventually get up and even walk after a fracture of the neck of the hip, the turn turned out due to rotation will stop walking. Under the knee joint, a retortion roller should be inserted.

There are problems with the psyche. Some elderly people develop dementia, that is, senile dementia. Pain, limited space, a decrease in one's own abilities - all this contributes to the aggravation of mental illness. Depression can develop, mainly in those who have normal consciousness. A sense of depression is characteristic. Help in such cases is to create a familiar, comfortable environment, establishing the maximum communication with such a patient.

In order to avoid most of the problems described, from the first days of the patient it is necessary to sit in bed. From the first days, you need to get up near the bed and stand with a chair, a walker, walkers, crutches. From the first days, you need to move slowly, with the help of walkers without support for a sick leg.