Why is this injury special?
The femoral neck connects the head of the femur to its body and is located inside the joint capsule. The vessels supplying the head run along the neck, and when fractured they are often damaged. Because of this, the head may become dead, and the fracture may not heal even with prolonged fixation. Therefore, in elderly patients, they often choose not fusion, but replacement of the joint with a prosthesis, which allows them to get back on their feet in the first days after surgery.
- Poor blood supply to the fracture area
- Risk of avascular necrosis of the femoral head
- Intra-articular location of the fracture
- Low probability of fusion without surgery
- High risk of complications from prolonged lying down
Symptoms and first aid
A typical picture: after falling on his side, an elderly person cannot get up, complains of pain in the groin, the leg is turned outward and looks shorter. However, with an impacted fracture, the pain is moderate, and the person may even walk with a limp - such cases are especially dangerous because the fracture displaces later. Before the ambulance arrives, there is no need to lift the victim, sit him down, or try to straighten his leg. Place a cushion under the knee, cover the person and call 103.
- Pain in the groin and outer thigh
- Inability to lift a straight leg out of bed
- External rotation of the foot
- Apparent shortening of the leg
- Do not move the victim yourself
- Do not eat or drink until examined by a doctor
- Call an ambulance by number 103
Diagnostics
The diagnosis is confirmed by x-rays of the pelvis and hip joint. If the image is normal, but the pain is severe and it is impossible to lean on the leg, further examination is necessary: hidden fractures are clearly visible on CT and especially on MRI. Before the operation, standard preparation is carried out: blood tests, coagulogram, ECG, examination by a therapist and anesthesiologist. At the same time, the condition of the bone tissue is assessed, because a hip fracture is almost always a signal of osteoporosis, which needs to be treated to prevent another fracture.
- X-ray of the pelvic bones and hip joint
- CT scan with questionable x-ray
- MRI to detect occult fracture
- General and biochemical blood tests
- Coagulogram and blood group
- ECG and examination by a therapist before surgery
- Vitamin D and osteoporosis risk assessment
Treatment
The choice of surgery depends on the patient's age, type of fracture, and activity level. For young people and for non-displaced fractures, osteosynthesis is performed - fixation with screws or a plate while preserving the own femoral head. Elderly patients with a displaced fracture are usually fitted with a prosthesis: unipolar or total. It is optimal to operate in the first 24–48 hours, if the condition allows. Conservative treatment is rarely used when surgery is contraindicated due to severe concomitant diseases, and it is associated with a high risk of complications.
- Osteosynthesis with screws for non-displaced fractures
- Unipolar endoprosthetics in weakened patients
- Total arthroplasty in active elderly
- Surgery within the first day or two if possible
- Prevention of thrombosis as prescribed by a doctor
- Pain relief and prevention of bedsores
- Conservative treatment only if surgery is contraindicated
Rehabilitation and prevention of recurrent fractures
They begin to get up in the first days after surgery, first with a walker and under the supervision of a specialist. Classes include breathing exercises, exercises for the healthy leg and arms, and a gradual increase in the load on the operated side. A nutritious diet with sufficient protein, calcium and vitamin D and treatment for osteoporosis prescribed by a doctor are important. At home, remove slippery rugs and cords, install grab bars in the bathroom, ensure good lighting, and have your eyes checked—most recurrent fractures are associated with new falls.
- Lifting with a walker in the first days after surgery
- Breathing exercises and prevention of pneumonia
- Therapeutic exercise with gradual load
- Protein, calcium and vitamin D in the diet
- Treatment of osteoporosis as prescribed by a doctor
- Eliminating home hazards: rugs, wires, thresholds
- Bathroom grab bars and night lighting
- Vision examination and review of sleeping pills