Symptoms of a hip fracture

Symptoms of hip fracture are multiple signs of serious injury, especially dangerous for the elderly. Fracture of the femoral neck is one of the main causes of disability in older patients. In people over 65 years of age, the total number of injuries accounted for about 70% of fractures of this or that zone of the hip joint. The danger of such trauma lies in the fact that elderly patients usually have age-related concomitant or underlying diseases.

Trauma leads the patient to immobility, which exacerbates existing pathologies and sometimes leads to a fatal outcome. Most of the victims are women aged 60 to 85 years. The cause of such frequent fractures in the elderly are the age-related changes in bone tissue. In women, such changes are explained by osteoporosis. The bone mineral density decreases, the bone tissue becomes thinner and becomes extremely vulnerable, fragile. In addition, the elderly people significantly reduced muscle tone, which does not contribute to recovery, but on the contrary can lead to pressure sores during treatment. In young patients, fracture of the femoral neck is extremely rare, and if it happens, it is associated with industrial or sports injuries.

Before determining the symptoms of a hip fracture, it is necessary to classify the fractures of this region. Determining the fracture of the neck of the femur involves trauma to the neck itself, a fracture of the head and fracture of the large trochanter.

Fractures of the cervical region of the femur are divided into medial (intraarticular) and lateral (lateral) fractures. The most dangerous are the medial fractures, since they have poor prognosis in terms of splicing, bone repair.

With a medial fracture, the plane of injury is slightly higher than the attachment, where the capsule of the hip joint passes into the hip. A medial fracture is an intraarticular trauma. A lateral injury is a fracture that is below the place of attachment of the joint capsule. Such fractures are called lateral or extra-articular.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

How are the symptoms of a hip fracture?

The main symptoms of a hip fracture are persistent, continuing pain with localization in the groin. The pain is rarely severe and acute, and therefore the victim often tries to endure it, considering the pain signal as a sign of another, already existing disease. Further, with the continuation of the motor activity, the pain begins to increase, especially if the emphasis is on the heel of the injured leg.

The second symptom is the turning of the broken limb outward - the external rotation of the foot.

The limb that is damaged in the neck of the thigh is shorter than the intact. This change is almost imperceptible, it is no more than 4 centimeters, but the straightened legs are uneven in length. This is explained by the contraction of the muscles of the broken leg, which seem to be pulled up to the hip joint; 

The characteristic clinical symptoms of hip fracture are the heel, which is called "adherent". The leg retains the ability to unbend and bend, but it will slip off the horizontal surface if it is held by weight.

Unfortunately, fractures of this kind are initially rarely diagnosed, the patient tries to move for several days, as before. Therefore, at the slightest alarm signs, similar to the symptoms of a hip fracture, it is necessary to call a doctor and begin therapeutic activities. If you do not provide timely assistance to such a patient, the fracture can become complicated and go to an open form, fragments of bone can be displaced and their soft tissue and vessels can be injured.

Fracture of the femoral neck in clinical practice is classified according to the method of Gardena, and is also divided into categories according to anatomical localization and severity of injury - medial (intraarticular) or lateral (extraarticular) fracture, which in turn are also divided into subspecies: 

• Medial - a fracture of the middle of the neck of the femur and a fracture under the head of the joint; 
• Lateral - a fracture passing through a large trochanter of the thigh and a fracture passing between the skewers.

Symptoms of hip fracture are different, they directly depend on the type of fracture, however, all clinical signs are quite good and, as a rule, typical:

• Sudden pain in the groin, worsening when the heel is injured in the thigh (the hip is damaged). 
• Rotational turn of the foot outward; 
• It is possible to contract the muscles in the fracture zone and shorten, pull the leg to the pelvis (checked by comparing the length of the legs in the prone position). 
• With the preservation of flexion-extensor functions, "sticking" of the heel (impossibility to keep the foot on weight, lying on the bed, slipping the leg) is observed. 
• The characteristic sound of a crunch when turning in a horizontal position.

Specify the type of hip fracture, which depends on many factors - age, bone tissue, the nature of the injury, its location and severity, as well as confirm the diagnosis can be using an X-ray.

Fracture of the femoral neck has a rather characteristic clinical picture, but in some types of fracture, the trauma can be asymptomatic.

Symptoms of hip fracture depend on many factors - the age of the patient, the condition of his bone tissue, the type and severity of the fracture.

The subjective symptoms of a hip fracture, which patients present, are as follows: 

• Characteristic pains in the region of the hip joint, which can be amplified in motion and when the leg position changes; 
• Injured leg is turned outward (external rotation); 
• The symptom of "sticking" of the lateral edge of the foot, the patient is not able to lift the leg, lying on his back; 
• When palpation of the hip area, painful sensations are possible.

Objective symptoms of hip fracture, determined visually: 

• The injured limb is shorter by several centimeters, if you compare both legs in a horizontal position; 
• Disturbance of the conditioned line from the anteroposterior to the sciatic mound (Roser-Neelaton line); 
• Change the intersection of the Shemaker line in the navel area; 
• Intensive pulsation of the thigh artery.

Hidden, unmanifested symptoms are characteristic of a punctured intraarticular fracture, which is dangerous for its potential development into another type of injury, requiring an operative intervention - a non-fractured fracture. This type of fracture of the femoral neck is diagnosed using a two-projection x-ray.

Punctured fracture of the femoral neck

The fractured femoral neck fracture belongs to the intra-articular varus form and is dangerous because it has weak clinical manifestations, especially in the elderly, which can injure the femur without falling, and subjecting the bone tissue damaged by osteoporosis to intensive loading. An unintentionally punctured fracture of the femoral neck can provoke further displacement of the bone fragments and the development of an unbalanced, more serious fracture, since the patient, continuing to maintain relatively normal motor activity, the flexion-extensor functions of the leg, continues to load the damaged joint. The only symptom by which a fractured fracture can be suspected may be chronic pain in the hip region, which increases when moving due to the developing internal hemorrhage into the joint cavity (hemarthrosis), which has no other etiological explanation. The diagnosis is confirmed using a two-projection X-ray (axial and anteroposterior projection). The punctured fracture of the femoral neck is well treatable, as opposed to another type of injury - unbranched fracture, as a rule, gypsum fixation, drug therapy, skeletal traction, exercise therapy are prescribed.

Symptoms of hip fracture with displacement

The degree of severity of the hip fracture depends on the site of the injury, which can be located inside the joint capsule (bone fracture within the capsule), and outside the capsule. From the state of bone tissue, it also depends on whether the fracture of the femoral neck is offset, when the bone fragments depart from their normal position. Symptoms of fracture of the femoral neck with displacement may be a reversal of the foot (external rotation), provoked by the displacement of fragments of the injured bone, also a typical symptom is a shortening of the length of the limb. In clinical practice, in the diagnosis determining the fracture of the neck of misfortune with displacement, the Gardena classification is used, which divides trauma into 4 types; 

• fracture of the femoral neck without displacement, incomplete. 
• full fracture, not having a bias (confirmed by a two-projection x-ray). 
• full fracture, with partial displacement, the line of the fragment does not coincide with the boundaries of the acetabulum. 
• complete fracture, displacement of fragments with orientation parallel to the acetabulum.

Treatment, which involves fracture of the neck of the hip with a shift, depends on the age of the patient and the state of bone tissue. It can consist of urgent correction, fixation in young people, it is possible to have an endoprosthesis in older patients.

Medial fracture of the femoral neck

Fracture of the neck of the thigh is divided into three categories - neck injury, head fracture and trauma of the large trochanter. Medial fracture of the femoral neck or median fracture is a fracture that is localized above the site of attachment of the hip joint to the femur. Median fractures are injuries inside the joint, when the bone fracture line can be located through the neck or near the joint of the neck with the femoral head. Medial fracture of the femoral neck in turn is divided into two types - subcapital (fracture below the head of the joint) and transcervical (fracture in the middle of the neck of the thigh). The prognosis of recovery after a medial fracture is rarely favorable, since by virtue of the necrotic process in the head of the bone an independent fusion is impossible. The only way to help reconstruct the injured zone is surgery (endoprosthetics). This type of fracture is treated quite successfully with the help of prosthetics, even in elderly patients who do not have categorical contraindications.

What if there are symptoms of a hip fracture?

If there are the above symptoms of a hip fracture, especially in an elderly person, the following steps should be taken: 

• Call a doctor at the house; 
• Put the patient in bed and do not let him move; 
• Ensure the immobilization of the damaged leg, grasping the hip and knee joint; 
• If it is not possible to impose an immobilizing bandage, place the leg on the sides with rollers or cushions; 
• With severe pain, give the patient an anesthetic.

Symptoms of a hip fracture are quite typical and help the doctor to quickly diagnose. Unfortunately, the therapeutic process lasts much longer. Because of the anatomical features of the hip joint design, difficulties arise with its complete immobilization. And the slightest movement can again disturb the beginning process of splicing. Complete recovery, provided that all the recommendations of the doctor are followed, can occur no earlier than in six months. During treatment it is necessary to monitor the condition of the muscles of the back, legs, buttocks, to avoid the occurrence of bedsores. It is also possible to perform operative treatment of a patient in hospital conditions, when the damaged site is connected by the method of osteosynthesis, or is replaced by an artificial implant.

Conservative treatment of hip fracture

Currently, the "gold", universally recognized standard is operative treatment, although more recently the only method of helping patients with fracture of the femoral neck was joint fixation (immobilization) and the method of traction. Conservative treatment of the femoral neck fracture still exists, but it is limited to categorical contraindications to surgery, which occur either in elderly patients or in patients with a major somatic disease occurring in severe form, for example, serious cardiopathology. Also conservative treatment of fracture of the femoral neck is possible if the injury according to the Gardena classification scale is light and is defined as an incomplete fracture without displacement, the breakage line in this case should not exceed an angle of 30 degrees.

The conservative method includes fixing the hip joint, stretching according to the indications, medication restorative therapy, performing a complex of therapeutic physical training to avoid the risk of complications.

[10], [11], [12], [13], [14], [15], [16]

Rehabilitation after hip fracture

Rehabilitation in the therapy of hip fracture is of great importance, its task after carrying out all medical measures (and possibly surgery)

Becomes the restoration of the general vitality, the correct activation of the functions of the injured joint. The beginning of the rehabilitation stage is the first day of the appointment of bed rest. Primary rehabilitation after fracture of the femoral neck consists in actions that improve the overall blood supply, the goal of doing the exercises is to minimize stagnant phenomena in the vascular system as a whole and in soft tissues in particular. For the prevention of necrotic disorders in the buttocks and the sacral region, it is recommended to perform pull-ups with the help of a special strap secured to the bedside bar, exercises and techniques of respiratory techniques are also effective to reduce stagnation in the lungs, eliminating the risk of developing pneumonia. Special diets containing foods rich in calcium and vitamin D are not necessary, rather a food ration that neutralizes the possibility of hypodynamic constipation is more likely. Rehabilitation after a fracture of the neck of the hip should be regular, the doctor's recommendations must be followed during the entire period of recovery of bone tissue, no matter how long it may be.

Fracture of the femoral neck, consequences

The most common complications in hip fractures are necrotic disorders of the trophism of the tissues of the buttocks and the sacral region or bedsores. No less serious threat is acute venous congestion, thrombosis of deep vessels - posterior, anteroplethrum, femoral and popliteal veins, which develops due to prolonged immobility of the patient. Fracture of the neck of the thigh has consequences and the areas of the broncho-pulmonary system: cases of respiratory failure, congestive pneumonia associated with hypodynamia are not uncommon. Such complications are poorly supervised by antibacterial therapy and can lead to cardiovascular pathology up to a lethal outcome. In addition, forced immobility can lead to a violation of digestive functions, psychoemotional disorders. Fracture of the neck of the thigh can have the most deplorable consequences if one does not follow the rules for caring for such a patient, but the favorable prognosis depends on other factors - the patient's age, severity (the course of the fracture line), the presence of concomitant somatic diseases.

Fracture of the neck of the thigh, care of the patient

In addition to a complex of medical measures - drug therapy, possible surgical intervention, an important condition for recovery after a fracture of the neck of the hip is the proper care for the patient. The need for care is explained not only by the complete immobility of the patient, but also by possible serious complications associated with induced hypodynamia - pressure ulcers, deep vein thrombosis, cardiac pathologies, and psychoemotional severe condition. With a fracture of the neck of the thigh, caring for the patient involves the following actions: 

• Regularly turn the patient over, teach him to sit down on his own, pulling himself up using a belt fixed on the bedside bar. All these measures will help to avoid necrotic dystrophy of the tissues of the buttocks and the sacral area of the body. 
• Regularly (at least twice a day) massage the limbs to activate blood flow and prevent stagnation of blood circulation. 
• Providing dry bed linen, body moisture can provoke erosive tissue damage. It is recommended daily change of linen, application of talc, baby powder. 
• An obligatory condition is the observance of the diet, including vegetable food, rich in fiber, to avoid atonic constipation. 
• It is necessary to engage daily with patient breathing exercises to avoid the risk of development of hypodynamic pneumonia.

Recovery after hip fracture

Fracture of the neck of the hip involves a recovery that begins with the first day of bed rest. Massages, sets of exercises are necessary in order not to lose mobility of limbs, to prevent stagnation of blood flow, muscle atrophy and the occurrence of pressure sores. Recovery after a fracture of the femoral neck involves regular massaging of the lumbar region and buttocks, then the massage is performed on the muscles of the intact leg, then the leg is painfully massaged with an emphasis on kneading the hamstrings. After the exercises are performed to activate and relax all the muscles of the body alternately. Also, regular lifts to the sitting position with the help of a special loop attached to the bar are effective. Every day it is necessary to perform torso turns from the back to the stomach every 1.5-2 hours. If possible, you should try to independently massage the feet with mopping movements. Starting from the second week, recovery after a fracture of the femoral neck is the flexion-extensor movements of the knee joint of both legs, under the guidance of a nurse or an instructor. All the methods and exercises recommended by the doctor must be strictly observed during the entire period of bone tissue fusion, no matter how long it may be, how the whole process of recovery depends on how regularly and responsibly a patient performs a complex of therapeutic physical training.

Fracture of the femoral neck: rehabilitation

The complex of rehabilitation measures for fracture of the femoral neck is made up by the doctor taking into account many factors - the age of the patient, the severity of his injury, the state of health and the way in which the treatment is performed - conservative or surgical. Fracture of the neck of the hip, rehabilitation helps to cure very effectively, because it includes such procedures: 

• A complex of specially selected physical therapy that helps to activate blood circulation and neutralize muscle atony, stiff joints, and eliminate bedsores. 
• Physiotherapeutic procedures that help the early recovery of bone tissue and joint structure. 
• A complex of respiratory techniques aimed at eliminating the risk of development of hypodynamic pneumonia and cardiovascular pathology. 

Compliance with a special diet, including products rich in calcium and vitamin D, vegetable fiber. Such a diet helps to restore the chondroprotective properties of the joint and excludes the possibility of atonic constipation.