Fractured femoral neck

Injuries are a common nuisance that can await us at every turn: on the way to work, on vacation or at home. One of the most dangerous traumatic injuries is considered a violation of the integrity of the femur bone, which can happen in the form of a complete or partial fracture: the latter refers to a bone fracture. For example, what is a femoral neck fracture? How serious is it, and what is the essence of such an injury?

Epidemiology

Femoral neck injuries, and in particular bone fractures, are more common in elderly patients and elders, and particularly common in postmenopausal women. Young patients with femoral neck fractures are rare.

According to statistics, femoral neck injuries are recorded in 6% of patients who visit a traumatologist. Among these patients, almost 90% are elderly people over 65 years of age, and most of them are women. [1]

Causes of the femoral neck fractures

A cracked femoral neck can occur in a variety of circumstances - for example, in a traffic accident, at work or in the home, during a fight, during sports, when walking on a slippery or uneven surface. [2] Additional causes can be:

• Improperly chosen intensity of sports training;
• exercising too intensely without prior preparation, warming up or stretching;
• Wearing uncomfortable shoes or clothing, which increases the risk of falling.

In general, in young and middle-aged patients, femoral injuries occur due to a severe impact - it can be a car accident, a fall from a height. In the elderly, the cause is often a direct impact or a hard landing on the hip joint. In the elderly, femoral neck fractures occur with a trivial stumble, when transferring the weight of one's own body to a particular limb. [3], [4], [5]

Risk factors

Such conditions and circumstances are considered to be risk factors:

• vitamin D deficiency in the body;
• hypodynamia, low physical activity;
• calcium deficiency in the body;
• Deficiency of trace elements (copper, zinc, manganese), leading to impaired bone formation;
• vitamin K deficiency;
• protein deficiency;
• Age over 50.

Pathogenesis

In most cases, femoral neck fractures are a consequence of osteoporosis, bone demineralization, as well as other pathological processes in which there is an increase in the fragility of bone tissue.

The force factor in the development of an injury cannot be disregarded, but sometimes a minor force is enough to cause a fracture. For example, elderly people, even after an ordinary fall, can get both a fracture and a fracture. [6]

It is worth mentioning the so-called pathological secondary damage, which occurs against the background of other diseases due to unfavorable changes in the bone tissue. For example, we can talk about tumor processes with bone metastases, in which cracks appear without any forceful influence.

In medical practice, the presence of a specific cause is not always obvious, and many patients initially attribute hip pain to other factors. This greatly complicates both diagnosis and treatment. As a rule, a fall or other trauma followed by pain in the groin (especially when moving the leg) is a reason to urgently visit a traumatologist. [7]

Symptoms of the femoral neck fractures

It is not always possible to identify femoral neck fracture by symptoms, as they are not specific in all cases and can be mistaken for another pathology. The nonspecificity of the clinical picture is a problem because patients delay visiting the doctor and the injury worsens.

The negative aspect is that a femoral neck fracture sometimes does not manifest itself in any way. This is especially common with minor injuries in people suffering from arthritis or osteoporosis.

In general, traumatologists distinguish such first signs of partial bone damage:

• Acute soreness at the time of a fall or blow (it may subside later).
• Aching pain when moving the leg, or when trying to lean on it.
• The injured person is able to walk on his own, but it is quite difficult to do so.
• The muscles in the groin become painful and tight.

If a person has had problems with the hip joints in the past - for example, arthritis - they may mistake a cracked femoral neck for an exacerbation of a chronic condition. In such a case, it is important to connect the moment of the first signs with an injury, a fall, etc. Another important detail: the painful symptoms accompanying a femoral neck fracture do not go away during the treatment of osteoarthritis, because conventional anti-inflammatory drugs cannot affect the healing of the damaged bone.

If the injury is ignored, the crack may well transform into a fracture, especially if the victim continues to lead a normal lifestyle, subjecting the leg to regular loads. In favor of a fracture are such symptoms:

• The foot is unnaturally turned to the outside.
• A hemorrhage (bruise) or severe redness occurs.
• The leg is somewhat shortened.
• A person in an upright position is unable to lift the heel and hold the limb in weight.
• Sometimes there is an increase in body temperature.

In complex cases, the identification of the lesion is done with the help of X-rays.

Cracked hip in the elderly

Older adults who have sustained a femoral neck injury are subject to additional risks due to the following points:

• The older the patient, the more the risk of complications is present, both physically and psychologically.
• Older people often have reduced immunity, there are chronic pathologies of the cardiovascular, respiratory system, which can be exacerbated against the background of trauma and prolonged sedentary state.
• People who are older almost always have joint problems, which can negatively affect the healing process of a crack.
• Prolonged bed rest negatively affects the cardiovascular and respiratory system, muscles atrophy, congestion occurs.
• The elderly may become depressed, neuroses may develop. Lack of motivation and depressed mood of the patient can negatively affect the prognosis of healing.

Stages

The healing of a femoral neck fracture is conventionally divided into several stages - these are the bone injury itself, the reconstructive and remodeling stage.

So, the first stage is the moment of injury, at which the blood supply is disrupted and a pathological process develops. Various mechanisms are activated - from inflammation to tissue necrosis. The less the circulatory system in the injured area suffers, the better the healing will be.

The reconstructive stage is accompanied by the ossification of new cellular structures. If osteosynthesis is adequate, the damaged area will be replaced by young tissue: this process is referred to as contact healing.

A bone callus is formed, which is a significant factor in bone fusion. The new tissue covers the fracture site and acts as a base like a biomatrix. This is necessary for quality fusion and remodeling of the fragment.

The formation of the callus occurs as follows: new cell structures begin to actively divide in the area of the crack, there is an overabundance of them, which then serves as the callus base. Gradually, the callus changes its structure, - from this point on, we speak of the beginning of the "fusion" of the crack. The bone callus is transformed into a spongy fragment, calcium accumulates in it and strength increases.

Forms

Femoral neck fracture happens:

• single;
• plural;
• through-and-through;
• superficial.

Relative to the axis, cracks can be oblique, spiral or longitudinal.

Complications and consequences

The period of bone repair in femoral neck fracture can last up to six months or more. Forced restriction of mobility, change of lifestyle, prolonged inactivity negatively affects the psycho-emotional state of patients: people often become hostages of depressive states and neuroses. The problem also affects the physical condition of patients: for example, against the background of prolonged bed rest develop bedsores, increasing blood stasis in the venous vessels, constipation is observed. The development of vascular thrombosis and congestive lung inflammation is not excluded.

All of the above complications are especially characteristic of elderly patients. For them, forced hypodynamia quickly "becomes a habit", they lose the desire to recover, ignore the necessary physical exercises. This, in turn, further aggravates the problem: lung congestion develops, heart failure, and a person may die.

The period in which the patient can fully recover depends entirely on his positive mood, as well as on adequate care, patience and understanding on the part of loved ones. [8]

Diagnostics of the femoral neck fractures

The main diagnostic technique for suspected femoral neck fracture becomes instrumental diagnosis:

• review radiographs;
• MRI and CT.

Radiography is performed in the anteroposterior and lateral projection, across the table. If a neck injury is identified, a radiograph of the entire femur is taken. In some cases, it is quite difficult to see the injury - for example, if the patient has a severe form of osteoporosis.

If the problem is not visualized on X-ray, but the clinical picture suggests a fracture or fissure, magnetic resonance imaging is recommended. This method is considered to be 100% sensitive and specific.

Laboratory tests are prescribed to assess the general condition of the body. As a rule, general clinical blood and urine tests are performed, and if necessary, a biochemical blood test.

Differential diagnosis

Differential diagnosis is carried out with a fracture of the femoral neck, with dislocation or contusion of the hip joint, with a subluxation fracture of the upper third of the femur.

Treatment of the femoral neck fractures

What should you do if a person is injured? You cannot know for sure the extent of the injury - for example, whether it is a fracture, a contusion or a fracture. Therefore, it is important to give competent first aid so as not to harm the injured person. [9] And it is necessary to do this before the medics arrive:

• the injured person should be placed on his or her back;
• In severe pain, give an Ibuprofen or Ketoprofen tablet;
• It is not possible to move the injured leg, so it is advisable to fix it with a splint;
• there is no need to remove shoes and clothes from the victim: on the contrary, it is better not to touch the limb until the arrival of medical professionals;
• If a person falls in the street in cold weather, he or she should be covered to avoid frostbite;
• If it is necessary to transfer the victim, it can be done only after immobilization of the limb, and only on a rigid stretcher;
• it is important to reassure the person who has fallen and not allow them to panic or move.

Thus, it is necessary to wait for the arrival of the medical team, or take the person to the trauma center yourself, using a stretcher (can be improvised - for example, knocked down boards or plywood).

Treatment of femoral neck fracture is mandatory, and sometimes surgical intervention may be necessary. At first, the patient will be admitted to a hospital and the necessary examinations will be carried out. Then they will prescribe the necessary procedures - in particular, massage, assess the possibility of movement on crutches. It is forbidden to lean on the damaged leg: the attending doctor will decide when the victim will be able to walk independently again. [10]

Certain medications are prescribed to accelerate healing and to make the patient feel better.

Medicines that your doctor can prescribe

Analgesic drugs
Ibuprofen	The drug is used for quick elimination of acute pain, as it should not be taken for a long time, due to the negative effect on the digestive system. The dosage of Ibuprofen is up to 400mg per administration, but not more often than once every 4-6 hours.
Ketanov	Tablets are taken 1 pc. Tablets are taken 3-4 times a day, but not more than five days. Injections are performed intramuscularly, in an individually selected dosage, also not more than five days. Side effects can be digestive disorders, head and abdominal pain. With prolonged treatment, the risk of bleeding increases.
Solpadeine	Analgesic preparation based on paracetamol, caffeine and codeine. It is not allowed for use for more than 3 consecutive days. In severe pain, take 1-2 capsules every 5 hours, but not more than eight capsules per day. Side effects are often abdominal pain, nausea with vomiting, allergies, psychomotor agitation or drowsiness, renal failure.
Diuretics
Verospiron	It is prescribed to relieve swelling of the injured area. The drug is taken 1-2 times a day, adhering to the daily dosage of 50-100 mg. The course of administration - 2 weeks. Side effects: heart rhythm disturbances, nausea, menstrual irregularities or metrorrhagia in women.
Furosemide	Take before meals, taking into account the maximum daily dose of 1500 mg. Side effects: metabolic disorders, dehydration, hypercholesterolemia, allergies, arrhythmia, loss of appetite, general weakness, visual disturbances.
External ointments and gels
Anesthesia ointment	The remedy is applied to the affected area daily, can be under a bandage. If you are allergic to anesthesin ointment is not used.
Diclofenac	Diclofenac ointment or gel is often used for inflammation and pain associated with injuries. It is applied to the painful area up to 4 times a day, rubbing gently. The term of treatment is no more than two weeks. Possible side symptoms: dermatitis, itching, rashes, erythema.
Indovazine	Gel with analgesic and capillar-stabilizing effect. It can be applied externally up to 4 times a day, the term of treatment - no more than 10 days. As a rule, the drug is well tolerated, rarely skin irritation occurs in the area of application.
Chondroitin preparations
Teraflex	Combined preparation of D-glucosamine and chondroitin, stimulates the regeneration of cartilage tissue. Teraflex is taken orally, 1 capsule three times a day, for a long period of time (minimum - 8 weeks). Side symptoms occur rarely and are expressed mainly in dyspeptic disorders or allergic reactions.
Chondroitin complex	The drug accelerates the formation of bone callus. Capsules are taken orally, one piece three times a day for a month, then switch to the mode of intake twice a day, for a long time. Side effects can be constipation, diarrhea, dizziness, general weakness, allergic reactions.

Vitamins and minerals

Vitamin and mineral preparations with calcium are a great way to improve bone structure, provide the body with all the necessary substances to accelerate fracture fusion of the femoral neck. With any bone damage, doctors advise taking calcium-containing remedies. And the assimilation of this trace element is significantly increased if taken together with vitamins D and ascorbic acid. Such complex preparations can be recommended:

• Calcemin Advance;
• Feminex calcium;
• Calcemin Silver;
• Calcium _D3 Nicomedes;
• Sea Calcium Biobalance with vitamins C and _D3.

In addition to taking pharmacy remedies, it is also necessary to make adjustments in the diet. It is good if the following products are present in the daily diet:

• dairy products, nuts and seeds, white cabbage (sources of calcium);
• Greens, bananas, seafood, sprouted wheat grains (sources of magnesium);
• legumes, hard cheese, buckwheat and oatmeal, eggs (sources of phosphorus);
• Seafood, sesame seeds, pumpkin seeds, nuts (sources of zinc);
• Fish oil, citrus, kiwi, berries, bell peppers (sources of vitamins D and C).

Physiotherapy treatment

Physiotherapy is connected only at the stage of recovery after femoral neck fracture. The following procedures are recommended:

• magnetotherapy;
• laser therapy;
• ultra-high-frequency therapy;
• massage;
• reflexology;
• hydrotherapy, balneotherapy.

Any of the proposed methods is applied in courses, from ten to twelve procedures. It is advisable to repeat the treatment 3-4 times a year.

Folk treatment

Patients are willing to go to great lengths to speed up healing and return to their normal lives faster. Traditional methods of treatment are also widely used.

• To improve the "binding" of the bone, a powerful magnet is used to drive it over the injury site in a clockwise direction for 20 minutes daily. The number of treatments is up to 20. After 6 weeks it is allowed to carry out such treatment again. Contraindications to the use of the magnet can be tumors, blood diseases, recent heart attacks or strokes.
• Onion decoction helps well (a couple of medium onions fried and then boiled in 1 liter of water for ten minutes). The potion is not strained, used between meals 200 ml three times a day.
• Daily treat the area of damage with fir oil, as well as eat ½ tsp. Crushed eggshells (twice a day, before breakfast and dinner).
• Eat 2-3 walnuts daily. Often include in the diet cold (pouring, jelly, but without salt and sugar), at least 2 times a week, for a long time.

Herbal treatment

• Field horsetail is a well-known diuretic plant, but few people know that it is rich in silicon, a necessary component for healing bone cracks. To prepare the medicine take 1 tbsp. Dry plant, pour 250 ml of boiling water, insist under a lid for 15-25 minutes. The infusion is filtered and taken three times a day one-third cup.
• A mixture of ground valerian root, St. John's wort and chamomile color not only soothes, but also prevents the development of inflammation in the area of injury. Take 1 tbsp. Equal mixture of plants, pour 250 ml of boiling water, kept under a lid for twenty minutes. Then filtered and drink in the morning, before lunch and before dinner 100 ml.

In addition, you can put lotions based on herbal mixtures:

• comfrey rhizome boiled for twenty minutes, cooled and grinded;
• The rhizome of the viviparous plant is boiled in 500 ml of water until thick.

If you add lard to the above decoctions, you can use the means as an ointment, rubbing the affected place twice a day.

Homeopathy

Not all patients and doctors trust homeopathy, but these remedies are considered safer and no less effective than traditional medicines. Homeopathic remedies can be used for injuries in children and the elderly, they reduce the need to take excessive doses of analgesics, reduce the healing period of bone fracture, have no side effects.

Homeopathy experts advise to pay attention to such remedies:

• Symphytum (comfrey) - heals cracks and fractures, prevents problems with bone fusion, gets rid of the drilling painful sensation.
• Arnica - eliminates pain, significantly shortens the healing and recovery period.
• Eupatorium - acts as a homeopathic analog of Arnica, eliminates pain and bone "brokenness".
• Calcium phosphoricum - prescribed in low potency (3d or 6d), allows calcium absorption, directing it to strengthen bone tissue. Accelerates the fracture fusion process of the femoral neck.
• Ruta - suitable as a first aid treatment for hip injuries and for treating poorly healing painful fissures.

There are not only the above, but also other drugs that can alleviate the condition of the victim and accelerate healing. To choose the most optimal remedy, it is necessary to take into account all the signs of pathology, to assess the reaction of a particular organism to the injury. Nevertheless, the above homeopathic remedies will be effective for most patients who have received a femoral neck fracture.

Surgical treatment

The need for surgical intervention is determined after careful diagnosis, using radiography, CT or MRI. [11]

In some cases, a femoral neck fracture does not require surgery, but in some cases, it is necessary, for example, with deep damage to the bone, with a high risk of complications (necrosis, etc.).

Depending on the type of fracture, specific structures are inserted into the bone - such as spokes, pins or rods. If indicated, replacement of the joint with a prosthesis may also be recommended, either partially or completely. [12]

In femoral neck fractures, the most common intervention is radiologically monitored: the joint capsule is not opened. Endoprosthesis is only recommended if there is an increased risk of complications.

Recovering from a femoral neck fracture

After all necessary therapeutic measures have been carried out, the patient with a femoral neck fracture is referred to a rehabilitation center, where he will be offered such methods of recovery:

• Analgesic treatments - a combination of analgesics with physiotherapy and manual therapy. If necessary, it is recommended to wear a fixation orthosis - a device to reduce the degree of pain.
• Combating hypodynamia - various prophylactic methods are practiced to prevent trophic disorders, cardiovascular pathologies, respiratory and digestive disorders. Massage and hygienic procedures play a special role.
• Special physical training - this rehabilitation method becomes relevant when the patient begins to feel improvement. Loads are selected individually, with a gradual increase in the frequency and duration of exercise. In the initial stages, exercises are performed with the use of bandage support.
• Psychotherapy - this method involves restoring an adequate emotional state of the patient, which is especially important in relation to elderly patients.
• Dietary changes involve saturating the diet with minerals and vitamins - for example, calcium, silicon, which is necessary to accelerate healing and strengthen bone tissue.

All these measures contribute to a significantly reduced recovery period, which passes faster, and the patient has every chance to return to a normal rhythm of life.

Prevention

You can prevent the occurrence of a femoral neck fracture by heeding these recommendations:

• watch your diet, eat good quality and healthy foods;
• competently organize work and rest regime;
• avoid hypodynamia and overexertion;
• avoid lifting objects that are too heavy;
• no smoking, no alcohol;
• to fight the weight;
• adhere to safety procedures, both at work and at home;
• after 40 years of age, additionally take calcium-containing drugs, chondroprotectors;
• Choose clothes and shoes that are comfortable and safe to wear when traveling.

In old age, it is very important to minimize the risk of injury. It is desirable that the house should be free of high thresholds, roll-up carpets and floor mats, which a person can get caught on and trip over. A non-slip rubber mat should be placed on the bathroom floor, and handrails should be attached to the wall so that the elderly person can hold on when getting up from the toilet or bathtub.

Forecast

The femoral neck does not have a layer of periosteum. The blood supply to this bony region is incomplete, so injuries here do not heal well. Insufficient nutrition often leads to incomplete fusion of the bone. After a while, the fracture site is fixed by a dense scar of connective tissue: this is called fibrous fusion. [13] The prognosis depends on many factors: on the patient's age and state of health, on the location of the injury line, on its depth and length. [14] In some unfavorable cases, the fracture may cause disability.