Hip - a simple enarthrosis formed acetabular
depression pelvic bone and the femoral head. Inside the joint is
round ligament of the femoral head, which are blood vessels
and nerves to the head of the femur.
Articular capsule attached to the edge of the acetabulum, a well-reinforced
ilio-femoral, pubic-femoral and sciatic-femoral ligament. Ligament
surrounding the top neck of the femur, called the circular area. Movement
of the hip (rotation, bringing and abstraction, flexion and extension)
occurs around three axes: vertical, sagittal and frontal.
hip fracture
Under hip fractures involve three types of fractures: fractures
in the neck, head and greater trochanter. On severity of pain they
obviously different from each other. But, nevertheless, the principles of care more
or less the same in all these cases.
If the fracture plane passes above the attachment of the hip capsule
joint to the hip fractures are called medial (median). Medial
hip fractures - intra-articular. Medial fracture line may pass
near the junction of the cervix in the femoral head, or through the cervix.
If the plane of fracture passes below the attachment of the joint capsule to the neck
hip fracture is called lateral (side), or trochanteric. Bse
lateral extraarticular fractures.
How medial and trochanteric fractures occurmoreoften in elderly
age and usually come with a load (usually the fall) to the region of large
trochanter. Power of the traumatic agent may be small, since the damage
comes against the backdrop of senile osteoporosis.
most important thing - to know symptoms of hip fracture , or fractures
this area.
first symptom - it's a pain that is concentrated in the groin. It is not sharp,
therefore, the patient may not require heightened attention to his condition.
When you try to motion pain becomes stronger. It also increases if you try
Light effleurage knock on the heel of the foot, which, as you suspect
man broke.
second symptom - it is external rotation, ie a broken leg a bit
turned outwards. This can be seen on foot.
third symptom - a shortening of the limb. Absolute its length does not change,
but occurs relative shortening of approximately 2-4 cm If the legs gently
straighten out, then one leg will always be a bit shorter. This is because
that the bone is broken, and muscle, cutting, pull the leg closer to the pelvis.
fourth symptom - "adhering" heel. If you ask the victim
hold the weight of the straightened leg to do so he will not succeed, the heel is all
Time will slide along the surface of the bed, while other movements (flexion,
extension) is possible.
There are fractures in which the patients can walk for several days
and even weeks, but it is very rare. Symptoms in these cases is the same as
but the pain of the greater trochanter and groin insignificant, and the patient may
move.
First aid for fractures of the femoral neck
Do not attempt to give the leg the usual position. The first thing to do
- Put the victim on his back, fix the foot bus, be sure to capture
knee and hip joints, and only then bring in a medical
institution.
Treatment
Treatment of medial fractures of the great difficulties. Conditions for seam
unfavorable due to local anatomical peculiarities and difficulties
immobilization (to ensure immobility). Bone fracture healing occurs
after 6-8 months. At the same time, prolonged bed rest in elderly leads
to the development of congestive pneumonia, pressure sores, venous thromboembolism, which is the main
cause high mortality. Therefore, methods of treatment associated with long-term
immobilization of the patient, the elderly should not be used. Skeleton
traction and hip plaster bandage as independent therapies
not currently used.
In these fractures of the femoral neck in the most rational surgical intervention.
In those cases where it is contraindicated (severe general condition, senile
marasmus, or if the patient is still before the injury could not walk), carried out earlier
mobilization (impose skeletal extension). The purpose of this method - the salvation of
patient's life.
Operation to make emergency indications. If it does not perform
the day of admission, the preoperative impose skeletal traction.
For fixation (restoration of bone tissue) is most often used
sort trilobate nail.
elderly patients with fractures of the femoral head should be conducted not osteosynthesis
fracture and replacement polusustava (femoral head and neck) endoprosthesis.
Endoprosthesis joint with medial hip fracture patients
over 70 years gaining. Advantage of it is
the possibility of early loading on the operated limb (in 3-4 weeks
and in cases of bone cement for fixing prosthesis in the femoral
bones from 3-4 th day after surgery), which is essential for the weakened
ill elderly.
Forecast for life favorable , with respect to recovery
favorable for surgical treatment.
care of patients with fractures of the femoral neck
If you are caring for patients with fractures of the femoral neck, a number of problems ,
be addressed. The first of them - it's a pain in the groin and leg. She is not strong,
but brings with it the discomfort and, as a consequence, the violation of psychological
contact with a person - to him it is difficult to communicate.
Another problem - it incontinence in some patients during
early days. If this happens, then you should know that in the normal care
correct and timely assistance to this problem very quickly allowed
unless, of course, no functional disorders of the urinary bladder.
One of the biggest problems - sores . These people, they appear in
mainly on the sacasm and heel aching feet. Therefore, immediately after
got to the supine position, these places need to prevent bedsores.
most effective way to prevent bedsores - frequent changes
position. But only for this opportunity - to turn a healthy
one side and detach from a basin bed - very painful. It happens that the discomfort
or pain from the fracture is so severe that the patient does not fix the pain
in the sacral region, and we notice a bedsore with perestilanii.
Due to the fact that the sacasm is constantly in contact with the bed,
and the skin may be wetted, for the prevention of diaper rash must-
podsushivayuschee apply ointments or powders (talcum powder for the body, zinc ointment). Very
it is important to frequently change underwear, under the sacasm - the diaper.
Effective massage: it helps to cope with the stagnation of blood in the affected
leg, which leads tomorepain. It is best to do a light stroking
massage from foot to the body. It should also develop adaptations that help though
would raise the pelvis from the bed, giving the rest sacasm, if rotated to the side is impossible.
All patients, for a long time are lying down, suffering atony
intestine , which are a consequence of constipation. This problem is difficult to manage,
the pain, on the one hand, prevents the active movement and, on the other
hand, a negative effect on appetite - the patient eats little, and it has a hard
constipation. The pain of delays chair intensifies the pain from the fracture. Constipation - a very large
problem for those who broke the neck of the femur. Prevention is better to start immediately
from the first hour, from day one. To do this, use the products,
that cause increased peristalsis. Good result taking sunflower
oils, the use of dairy products. You can apply a variety of means,
stimulating peristalsis, such as a drop gutalaks.
prolonged stay in the supine position leads to another complication
- Pneumonia , mostly, of course, in older people. This is a fairly frequent
complication and requires active employment of respiratory gymnastics.
external rotation of the foot - the next problem. If the patient over time
able to stand and even walk after hip fracture, then inverted by
Rotation stop will stop walking. Leg should be fixed or by Longuet,
or a shoe, a heel is nailed stick, preventing rotation of the legs
on the outer side. More convenient, of course, Longuet. From her leg and easy to get,
and invest. Where possible, the first time the foot must always remain in this
Longuet or boots. In Longuet or shoes to put a piece of fur or foam
in order to avoid bedsores.
observed mental problems . Some older people develop
dementia, ie senile dementia. Pain, limited space, reducing
own opportunities - all contribute to the exacerbation of mental illness.
May develop depression, mainly in those with normal consciousness. Characteristically
feelings of depression. Assistance in such cases is to create a familiar,
comfortable environment, establishing maximum contact with such patients.
If everything proceeds without complications and the main problem of pain you are allowed, then
from 5 th or 10 th day the patient can sit up in bed. On the 10 th or 15 th day
he can stand beside the bed and stand by the chair, Walker - Walkers,
coli. With 21 days to try to move slowly. If the patient
severe pain or join any complications, then these terms can, of course,
increase. And if the patient is interested in that as soon as possible
get up and walk, time periods may also decrease.
something interesting
Osteoporosis - a depression and thinning of bone tissue. Bones become
so fragile and brittle, that is sufficient to fracture the lightest tension.
World Health Organization on the prevalence of osteoporosis equates
to such diseases century, such as cardiovascular, cancer,
diabetes.
If you have osteoporosis, and fractures do not exist, you need prevention .
Today there are many calcium supplements , which are widely
used for the prevention of osteoporosis.
Dasgs containing calcitonin increase the mobility of patients,
accelerate fracture healing. Even with a short course of treatment is reduced
risk of damage to the vertebrae and the development of peripheral fractures, because the mechanism
their actions are aimed at reducing bone loss by suppressing the activity
osteoclasts - the destroyer of bone cells. The result is increased opportunity
its occurrence.
As a result of studies conducted abroad revealed that
in patients with osteoporosis treated with calcitonin, the frequency of new fractures decreases
almost 60%.