Femoral neck: femoral neck fracture, signs, symptoms and treatment

Bone fractures are a serious injury that occurs quite often among patients of different ages and requires careful and long-term treatment. Femoral neck fracture accounts for about 6% of the total number of bone injuries.

This injury can be caused by a fall, a blow, or an unsuccessful sudden bend. Older people are most at risk of getting a fracture in the hip area, because with age, bone tissue weakens and thins. This type of injury is extremely dangerous for older people and can be fatal if left untreated.

Types of femoral neck fractures

In medical terminology, hip fractures are divided into three types:

in the area of the femoral neck;
in the area of the femoral head;
in the area of the bony prominence.

Each of these cases differs in severity and symptoms, but the treatment plan and first aid options will be almost identical.

Depending on where the femoral neck is broken, fractures are classified into:

middle or medial;
trochanteric or lateral.

A midline fracture is located over the area where the hip joint capsule attaches to the femur.

A trochanteric or lateral fracture occurs under the area where the femoral neck connects to the joint capsule.

Based on the degree of displacement, there are three types of femur fractures:

crack;
impacted fracture;
fracture with divergence of fragments.

A hip fracture can go undetected for a long time. It is important to diagnose the injury in the early stages and take the necessary measures to eliminate the disease, otherwise there is a risk that the crack will turn into a fracture.

Also, the fracture can be open or closed, depending on the nature of the injury.

Radiologists classify this injury depending on the degree of angle formed by the fracture line and the horizontal line above the acetabulum:

horizontal type - the angle is less than 30 degrees;
intermediate type - angle from 30 to 50 degrees;
vertical type - the angle exceeds 50 degrees.

By correctly identifying the types and types of fractures, a specialist can make a correct diagnosis and prescribe the most effective treatment.

The femoral neck is a vulnerable spot in our body

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Causes

A femur fracture is an injury that is common in both young and elderly patients. Based on statistics over the past few years, older adults and middle-aged women are the most likely to suffer hip injuries.

The causes of hip fracture vary depending on the age of the patient. Thus, young people can suffer such bone damage as a result of a strong blow after falling from a great height or as a result of a transport accident. In other words, a fracture or fracture of the femur at a young age is a high-energy injury and occurs relatively infrequently.

Older patients may suffer a femoral neck fracture as a result of thinning bone tissue and a decrease in its strength. The cause of bone weakening can be osteoporosis, as well as diseases of the nervous system, poor vision, oncology, lack of proper physical activity, and lack of vitamins and minerals in the body. A thinned bone can be injured even as a result of a slight push or unsuccessful movement.

It is important to notice the injury in time and take the necessary treatment measures. The fact is that pain during such an injury in the first days can be tolerable, and the patient may simply mistake it for an exacerbation of osteoporosis.

Hip fracture in the elderly, treatment, symptoms, photos. | Medical portal

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Femoral neck fracture

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Hip fracture symptoms

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Femoral neck fracture treatment

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Symptoms of a fracture

A hip fracture in older people may not be noticed immediately, and in the case of previous arthrosis, it may even be confused with an exacerbation of the disease. However, delay in treating an injury often leads to disability or even death, so at the first suspicion of a possible fracture, it is recommended to undergo the necessary diagnostics.

The following symptoms of a femoral neck fracture are distinguished:

tolerable pain in the groin area, which intensifies over time with sudden movements or while placing emphasis on the injured leg;
inversion of the foot outward, which indicates a fracture with divergence of fragments;
crunching when trying to move a leg that is in a horizontal position;
a slight decrease in the length of the diseased leg relative to the healthy one;
increasing pain when pressing on the injured area;
increased intensity of pulsation of the femoral artery.

An advanced state of injury is characterized by the following symptoms:

sharp and unbearable pain in the hip joint;
pain when pressing or tapping on the heel;
blueness and swelling of the skin over the injured area;
inability to walk or stand.

Classification

There are three types of anatomical fractures:

basicervical - this type of damage is considered to be the most distant from the head of the hip bone;
transcervical - this type of injury passes directly through the femoral neck;
subcapital - damage when a bone very close to the head of the femoral joint breaks.

The latter type of injury has the least chance of complete bone recovery. This is due to the fact that the closer to the head a fracture occurs, the greater the likelihood of osteonecrosis.

These damages are also divided depending on their angle of inclination:

first degree - inclination no more than thirty degrees;
second degree - the angle of inclination ranges from 30 to 50 degrees;
third degree - the angle of inclination is more than 50 degrees.

The more horizontal the fracture of the femoral neck, the greater the chance of proper fusion of the fragments. In older people with a third-degree fracture, the chances of proper and complete bone restoration are minimal.

Diagnostics

It is not recommended to endure even minor pain in the hip joint. At the first suspicion of a fracture or crack, you should immediately contact a medical facility for diagnosis.

Diagnosis of a femur fracture is a necessary but accessible method of studying the disease, which is impossible without the use of the necessary equipment. The most common diagnostic option is an x-ray of the hip area. This method does not require additional preparation, does not take much time and is low in price (and in some cases it is completely free). The resulting X-ray image allows you to accurately assess a femoral neck fracture and make a correct diagnosis.

The X-ray procedure may be prescribed several times during the treatment of a fracture so that the specialist has the opportunity to assess the effectiveness of treatment and the dynamics of recovery.

If the cause of the fracture is unclear, the patient may have a blood test taken to identify hormonal imbalances or inflammatory processes in the body.

If a fracture of the femur is accompanied by damage to muscle tissue and blood vessels, a specialist may prescribe magnetic resonance imaging.

Consequences of a fracture

The consequences of a hip fracture in old age can be extremely severe:

aseptic necrosis is a condition when the head of the bone dies due to impaired blood circulation, which can lead to its complete decomposition. To eliminate this consequence, it is necessary to resort to prosthetics;
development of a false joint - develops in the case of non-union of bone fragments. In the case of such a disease, a person experiences discomfort while moving. To treat this pathology, surgical intervention is necessary;
vein thrombosis - occurs due to the patient remaining in one position for a long time, which can lead to blood stagnation. Such a pathology can be fatal for the patient, so careful prevention of the disease is necessary;
pneumonia is a lung disease that can develop due to stagnation of sputum. Due to the patient's constant lying down, the lungs cease to function properly;
possible formation of osteoarthritis and osteomyelitis;
bedsores - appear due to insufficient care for the patient during his rehabilitation;
arthrosis - develops when the joint begins to deteriorate and ceases to function.

Some complications and undesirable consequences may occur after the operation:

infection entering the body during surgery;
incorrectly installed screws in the joint;
accidental damage to nerves or blood vessels during surgery.

Due to long and difficult treatment, the patient may develop depression and other psychological complications. To eliminate such consequences, you will need the help of a psychiatrist or psychologist.

Is it possible to sit if you have a hip fracture?

There is a misconception that a fracture of the femoral neck indicates complete immobility. However, staying in the same position for a long time is dangerous for a person’s health and life, especially if the patient belongs to the group of elderly people.

It is possible and necessary to sit down periodically during the rehabilitation period, but you must follow some rules:

you need to take a sitting position extremely carefully and slowly;
You can sit down after surgery only with the permission of the attending physician;
to make it easier for the patient to sit down, it is recommended to install a special crossbar above the bed;
the patient should sit down only in the presence of an assistant.

10 days after the operation, the patient can carefully sit on the bed with his legs dangling. In this case, the help of a nurse or a loved one is needed.

Common complaints from victims

Most patients with a fracture note slight pain in the groin and pelvis area. At rest they subside, but when a load occurs they appear again. If a person is unable to independently lift the affected leg, then this may be stuck heel syndrome. Changes in the position of the injured limb and its length are invisible to the patient, but also serve as markers for diagnosis. Symptoms of a hip fracture are not immediately noticeable, but you should be very careful about even the slightest manifestations.

If the fragment is significantly shifted, this greatly complicates the fusion process. The patient's recovery will be longer. Usually the shift is accompanied by severe pain, profuse hemorrhages, and tissue ruptures. It is important to contact a specialist in time so that he can determine the degree and direction. Only under this condition can qualified surgical assistance be provided, which will help speed up the healing process

This is a type of surgical pathology in which a fragment is firmly driven into the bone, forming an almost monolithic ligament, until a certain time. The difficulty with this variety is that it is very difficult to diagnose at an early stage. The patient may experience only mild pain in the groin area while walking, and not pay attention to it.

Differences from bruise

Signs of a hip fracture in the elderly and its differences from a simple bruise:

the limb does not change in length when injured;
the patient can raise his leg in a supine position;
There is no pain on palpation.

However, a 100% guaranteed diagnosis can only be made after an X-ray examination or computed tomography.

How to distinguish a dislocation

A dislocated joint is accompanied by sharp pain immediately at the moment of injury. Painful manifestations are increasing and intensify with load on the leg. Dislocation is always accompanied by joint deformation. In any case, it is recommended to consult a doctor.

The types of hip fractures in older people can only be determined after diagnostic measures. The main stage is radiography in various projections to determine a hidden impacted injury. Sometimes more complex procedures may be required, such as a CT scan, testing for inflammation, and diagnosing osteoporosis

Symptoms

The sooner a surgical problem is identified, the greater the likelihood of a successful recovery for the patient, so it is very important to know the signs by which pathology can be determined.

Moderate sensitivity in the groin area, which increases with increasing load.
A slight blow to the heel causes pain in the leg.
Probing the area provokes pain.
The length changes slightly.
The foot is turned out and it is difficult to return it to its original position.
In a supine position, he is unable to lift a limb.
In rare cases, a crunching sound may be heard when moving the injured leg.

With such a hip fracture, signs and symptoms may not be noticeable at all. Functioning will be full, and the only marker - slight discomfort in the groin when walking - may not be taken into account. Over time, the detachment of the broken section from the bone begins, and all the phenomena described above begin to appear.

First aid

A hip fracture is life-threatening, so if you have the slightest suspicion of an injury, you should immediately call an ambulance.

If circumstances require independent transportation of the patient to the hospital, it is recommended to follow a number of rules:

the victim should lie on his back;
in case of severe pain, you should take a painkiller;
the injured limb must be immobilized by fixing it with a splint;
the splint should be applied to the inside of the injured leg, starting from the groin and ending at the heel;
there is no need to remove clothes and shoes from the victim;
the patient must be carried on a hard surface, for example on a stretcher;
in case of bleeding, it is necessary to lightly tighten the limb with a tourniquet;
do not panic and calm the victim.

It should be remembered that a hip fracture in the elderly is especially dangerous, therefore, if the situation allows, it is better to entrust the transportation of the patient to an ambulance team.

First aid for a fracture

Patients with a femoral neck fracture should be hospitalized as early as possible. First aid should be provided as soon as an elderly person experiences pain in the hip joint or perineum, the inability to stand up independently, or noticeable shortening of one leg.

The algorithm of actions is as follows:

It is necessary to lay the elderly person down without allowing him to get up. If you have the ability to move independently, you can allow him to go to the toilet once in the usual way.
Call an ambulance, reporting that there are signs of a femoral neck fracture.
Before the doctors arrive, you need to reassure the patient and convince him of the need for treatment.
It is necessary to warn the victim that he cannot move his leg; if the person is cold, wrap him up. You can give some warm tea.
In case of severe pain, you can give an anesthetic - "Analgin", "Ketanov", "Nurofen" or another of what is available.

Emergency doctors will fix the leg with special splints and, if necessary, administer an anesthetic.

Treatment

Treatment of a femur fracture is a necessary condition for the patient's recovery. Surgery is often indicated for the victim, but if the fracture is localized in the lower part of the thigh or is impacted, surgery can be done without surgery. In addition, the operation is prescribed in accordance with the physical condition of the patient: if he cannot tolerate surgery, the procedure will be contraindicated.

Femoral neck fractures in older people require some consistency in the implementation of therapeutic actions:

The victim must be in a hospital setting. To comply with this point, special traumatological institutions have been organized.
Bone traction is used for two months after injury.
Massage is an integral part of therapy.
After the tension is relieved, the patient can move with the help of crutches, avoiding relying on the injured limb.
You can use the injured leg after 4 months of treatment and strictly under the supervision of a specialist.
The patient will be able to move independently after 6 months of therapy.

Conservative treatment

Treatment for a hip fracture often involves complete immobilization of the injured limb.

Non-surgical treatment is used if:

the patient is unable to undergo surgery due to the serious condition of the body;
in case of mental disorders in the patient;
The patient did not move independently before the injury.

Immobilization or immobilization of a limb requires the following steps:

Local anesthetics, in particular lidocaine and novocaine, must be injected into the joint.
Traction can be used for up to 10 days.
After 10 days, the traction structure must be removed.
It is necessary to turn the patient from one side to the other to prevent bedsores and ensure minimal physical activity. You can also carefully sit the patient on the bed with the permission of the attending physician.
After 20 days, the victim can try to get up using crutches.
Discharge occurs if the patient's condition is satisfactory.

Surgery

Treatment of a femoral neck fracture in most cases cannot be done without surgery.

Before the operation, the patient must undergo the necessary instrumental diagnostics. Most often, the doctor prescribes an x-ray procedure.

Depending on the type of injury, pins, screws, or rods may be inserted into the fracture. In some cases, replacement of a part or an entire joint, i.e. prosthetics, may be indicated.

Surgery takes place only with the use of local or general anesthesia. Before fixing the fragments, the specialist carefully compares them.

Depending on the severity of the fracture, the operation can be open or closed. In mild cases, the surgeon works under X-ray control without performing an opening. Open surgery is indicated for complex fractures.

Exercises after a hip fracture

A specialized set of exercises is a necessary condition for recovery from a hip fracture in old age. Exercise avoids unwanted side effects caused by insufficient activity and promotes faster recovery. The algorithm for performing a set of exercises is as follows:

Mentally visualize the mechanism for performing the movements.
Gradually begin to squeeze and relax the muscles of your back, abs, arms, legs and buttocks.
Proceed to slow flexion and extension of the moving limbs.
From the first days, special breathing exercises are shown.
After the cast is removed, you can perform more complex exercises, actively using healthy limbs.
Once the patient begins to stand, it is recommended to walk short distances using a stick or stilts.

Physiotherapy

The exercise therapy complex is developed directly by the specialist treating the patient. However, there are a number of exercises that you can independently include in a complex of physical therapy without fear for your health.

Patients who are prescribed strict bed rest are recommended to perform special breathing exercises while lying on their back.

When performing breathing exercises, you must adhere to the following rules:

breathing should be smooth;
inhale and exhale as deeply as possible;
while inhaling, you can spread your arms to the sides to maximize the use of your lungs;
When performing breathing exercises, you can carefully do rotational exercises with your healthy leg;
make sure you don’t feel dizzy;
increase the number of repetitions every few days starting from 4-6 times.

For semi-bed rest, a set of exercises for supination and pronation of joints in a sitting position is recommended. Slowly and carefully, the patient should bring and spread the joints in and out under the supervision of a doctor.

When the victim is able to get to his feet, it is recommended to combine breathing exercises with simple yoga asanas.

Massage

Starting from the 3rd day after a hip injury, you can massage the muscles of the whole body and the injured limb in particular. The massage should be carried out starting from the lower back and smoothly moving to both legs. A more thorough massage is recommended in the thigh area.

Massage must be done with the help of a professional massage therapist or in accordance with his recommendations.

What happens after the operation

Treatment of a hip fracture is a long process; it makes sense to imagine in advance what and how you will need to plan:

After the operation, the patient is sent to the intensive care unit for some time.

He is given antibiotics and blood thinners for a week.

A pillow is placed between the legs to keep the legs apart.

Almost immediately after the operation, the patient is recommended to move: sit up in bed, do breathing exercises, and perform simple muscle exercises.

3-7 days after the operation, the patient is helped to get to his feet with the help of crutches and begin to move with the assistance of a specialist.

On days 10-12 after surgery, the sutures are removed and the patient is discharged home.

Rehabilitation - it’s important not to be lazy

After discharge, the elderly person and his relatives must continue rehabilitation procedures according to the recommendations of the attending physician. A person must learn to walk again and return his life to normal. You can recover at home under the supervision and care of relatives and caregivers, or in a boarding house for the elderly.

In any case, experts are convinced that an elderly person should become an active participant in rehabilitation.

“In addition to the maximum possible physical activity - breathing exercises, exercises for the arms with and without weights, and others, an elderly person should lead a lifestyle as close as possible to normal: watched the evening news - continue to watch it, used the Internet - continue to use it, studied a foreign language - continue to teach him, crafted, created with his hands - continue these studies. Our task is to create an environment around an elderly person during the period of restrictions on movement that maximally simulates his previous lifestyle,” advises Andrei Ilnitsky.

It happens that older people with similar fractures are lazy to do the exercises prescribed for them to straighten their legs, etc. It is not always possible to motivate and organize them. In this case, specialists will help. “In addition to active movements, you can use passive ones, when a rehabilitation specialist or a person performing his functions takes the limbs of an elderly person in his hands and performs the necessary movements with them,” says Ilnitsky.

Rehabilitation period

Recovery after a fracture does not only involve physical therapy, breathing exercises and massage. It is equally important to pay attention to the psychological state of the victim. After surgery and a long period of rehabilitation, patients often withdraw into themselves, feel vulnerable and depressed.

To prevent the patient from falling into a state of depression, you need to give him as much attention as possible, communicate on abstract topics, and entertain him. If the patient nevertheless falls into a depressed state, it is recommended to undergo treatment with a psychotherapist.

During the recovery stage, the patient needs quality sleep, proper diet, massage and treatment of chronic diseases that have worsened due to the trauma.

It is important to pay attention to the prevention of femoral neck fractures in order to prevent possible complications and recurrence of injury.

Recovery period

For each patient, recovery time takes different periods of time. All this depends on the lifestyle during the illness, on concomitant diseases, timely treatment, the operation performed and the morale of the patient.

Treatment most often takes about 6 weeks, after which the patient must rehabilitate. Gymnastics, massage, physical activity - all this is the key to quick recovery and recovery.

The return to full motor activity after surgery and with conservative treatment occurs after six months or more. The patient’s relatives must put themselves in his position and do everything necessary for a speedy recovery.

Exercises and massage

A week after the injury, when the pain has already subsided, the patient is recommended to engage in physical therapy. You need to start with breathing exercises. The easiest way is to buy a lot of balloons and inflate several of them every day. This exercises your lungs and chest muscles.

Next, you can make movements with the upper body. Swing your arms, turn your head, work your shoulders; you can learn more about these exercises in our article. At first, exercises must be carried out under the supervision of a doctor or relatives.

In addition to exercises, physiotherapeutic methods and massage are prescribed to promote bone healing. As a rule, a specialist from the clinic comes to the patient every day to carry out these procedures (if the patient is at home).

After two weeks, a special physical therapy exercise is selected for each patient for the damaged part of the leg. All this helps restore blood circulation in the pelvic area, strengthen muscles and gradually restore joint mobility.

Possible complications

If conservative treatment methods are used due to the impossibility of surgery, there is a risk of the following complications:

Non-union of bones;
loss of functions necessary for independent movement;
bedsores that occur due to prolonged stay in one position and improper treatment;
psycho-emotional disorders;
development of thrombosis.

To avoid undesirable consequences, it is necessary to resort to surgical treatment, unless it is contraindicated, strictly follow the recommendations of the attending physician and gradually provide the patient with the necessary physical activity.