Symptoms of a femoral neck fracture

Symptoms of a hip fracture are multiple signs of a serious injury, especially dangerous for the elderly. A hip fracture is one of the main causes of disability in older patients. In people over 65, about 70% of all injuries are fractures of one or another area of the hip joint. The danger of such an injury is that older patients usually have age-related concomitant or underlying diseases.

The injury leads to immobilization of the patient, which aggravates existing pathologies and sometimes leads to death. Most of the victims are women aged 60 to 85 years. The reason for such frequent fractures in older people is age-related changes in bone tissue. In women, such changes are explained by osteoporosis. Bone mineral density decreases, bone tissue becomes thinner and becomes extremely vulnerable, fragile. In addition, muscle tone is significantly reduced in older people, which does not contribute to recovery, but on the contrary can lead to bedsores during treatment. In young patients, hip fractures are extremely rare, and if they happen, they are associated with industrial or sports injuries.

Before identifying the symptoms of a hip fracture, it is necessary to classify fractures in this area. The definition of a hip fracture includes injury to the neck itself, a fracture of the head, and a fracture of the greater trochanter.

Fractures of the cervical femur are divided into medial (intra-articular) and lateral (side). Medial fractures are considered the most dangerous, as they have poor prognosis in terms of fusion and restoration of bone tissue.

In a medial fracture, the plane of injury is slightly above the attachment where the hip capsule passes into the femur. A medial fracture is an intra-articular injury. A lateral injury is a fracture that is below the attachment of the joint capsule. Such fractures are also called lateral or extra-articular.

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What are the symptoms of a hip fracture?

The main symptoms of a hip fracture are persistent, ongoing pain localized in the groin. The pain is rarely strong or sharp, and therefore the victim often tries to endure it, considering the pain signal to be a sign of another, already existing disease. Then, with continued motor activity, the pain begins to intensify, especially if the emphasis is on the heel of the injured leg.

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

The limb that is damaged at the femoral neck is shorter than the undamaged one. 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 a hip fracture are a heel that is called "stuck". The leg retains the ability to straighten and bend, but will slip off a horizontal surface if held suspended.

Unfortunately, fractures of this type are rarely diagnosed initially, the patient tries to move around as before for several days. Therefore, at the slightest alarming signs similar to the symptoms of a hip fracture, it is necessary to call a doctor and begin therapeutic measures. If such a patient is not provided with timely assistance, the fracture may become complicated and become open, displacement of bone fragments and injury to soft tissues and blood vessels are possible.

In clinical practice, femoral neck fractures are classified according to the Garden method and are also divided into categories based on anatomical location and severity of injury - medial (intra-articular) or lateral (extra-articular) fractures, which in turn are also divided into subtypes:

• Medial - fracture of the middle of the femoral neck and fracture under the head of the joint;
• Lateral - a fracture passing through the greater trochanter of the femur and a fracture passing between the trochanters.

Symptoms of a hip fracture vary and directly depend on the type of fracture, but all clinical signs are fairly well and, as a rule, typical:

• Sudden pain in the groin area, which intensifies when putting pressure on the heel of the leg injured in the thigh (the femoral neck is injured).
• Rotational outward rotation of the foot;
• It is possible that the muscles in the fracture area will contract and shorten, pulling the leg towards the pelvis (checked by comparing the length of the legs in a lying position).
• While the flexion and extension functions are preserved, “sticking” of the heel is observed (inability to keep the leg suspended while lying on the bed, the leg slipping).
• A characteristic crunching sound when turning over in a horizontal position.

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

A femoral neck fracture has a fairly characteristic clinical picture, however, with some types of fracture, the injury may be asymptomatic.

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

Subjective symptoms of a hip fracture that patients report are as follows:

• Characteristic pain in the hip joint, which may intensify with movement and when changing the position of the leg;
• The injured leg is turned outward with the foot (external rotation);
• Symptom of “sticking” of the lateral edge of the foot, the patient is unable to raise the leg while lying on his back;
• When palpating the hip area, painful sensations may occur.

Objective symptoms of a hip fracture, determined visually:

• The injured limb is shorter by several centimeters when comparing both legs in a horizontal position;
• Violation of the conventional line from the anterior superior spine to the ischial tuberosity (Roser-Nelaton line);
• Change in the intersection of the Schemaker line in the navel area;
• Intense pulsation of the femoral artery.

Hidden, unmanifested symptoms are typical for an impacted intra-articular fracture, which is dangerous due to its potential development into another type of injury requiring surgical intervention - a non-impacted fracture. This type of femoral neck fracture is diagnosed using a two-projection X-ray.

Impacted fracture of the femoral neck

An impacted fracture of the femoral neck is an intra-articular varus fracture and is dangerous because it has weak clinical manifestations, especially in elderly people who can injure the femur without falling, but by subjecting bone tissue damaged by osteoporosis to intense stress. An undetected impacted fracture of the femoral neck can provoke further displacement of bone fragments and the development of a non-impacted, more serious fracture, since the patient, while maintaining relatively normal motor activity, flexion-extension functions of the leg, continues to load the damaged joint. The only symptom by which an impacted fracture can be suspected may be chronic pain in the hip region, increasing with movement due to 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 projections). An impacted fracture of the femoral neck responds well to treatment, unlike another type of injury - a non-impacted fracture, as a rule, plaster fixation, drug therapy, skeletal traction, and exercise therapy are prescribed.

Symptoms of a displaced femoral neck fracture

The severity of a femoral neck fracture depends on the location of the injury, which can be located inside the joint capsule (bone fracture within the capsule) or outside the capsule. The condition of the bone tissue also determines whether there will be a displaced femoral neck fracture, when bone fragments move away from their normal position. Symptoms of a displaced femoral neck fracture can include eversion of the foot (external rotation), caused by the displacement of fragments of the injured bone, and a typical symptom is a shortening of the limb length. In clinical practice, in diagnostics that determine a displaced femoral neck fracture, the Garden classification is used, which divides injuries into 4 types;

• femoral neck fracture without displacement, incomplete.
• complete fracture without displacement (confirmed by a two-projection X-ray).
• complete 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 for a displaced femoral neck fracture depends on the patient's age and the condition of the bone tissue. It may involve urgent reduction, fixation in young people, and possibly endoprosthetics in older patients.

Medial femoral neck fracture

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

What to do if there are symptoms of a hip fracture?

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

• Call a doctor to your home;
• Put the patient to bed and do not allow him to move;
• Provide immobilization of the injured leg, including the hip and knee joints;
• If it is not possible to apply an immobilizing bandage, support the sides of the leg with rollers or pillows;
• If the pain is severe, give the patient a painkiller.

Symptoms of a hip fracture are quite characteristic and help the doctor to make a quick diagnosis. Unfortunately, the therapeutic process lasts much longer. Due to the anatomical features of the hip joint structure, difficulties arise with its complete immobilization. And the slightest movement can again disrupt the beginning process of fusion. Full recovery, subject to compliance with all the doctor's recommendations, 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 appearance of bedsores. It is also possible to perform surgical treatment of the patient in a hospital setting, when the damaged area is connected using the osteosynthesis method, or replaced with an artificial implant.

Conservative treatment of femoral neck fracture

Currently, surgical treatment is considered the "golden", generally accepted standard, although until recently the only method of helping patients with a hip fracture was joint fixation (immobilization) and traction. Conservative treatment of hip fractures still exists, but it is limited by categorical contraindications to surgery, which are found either in elderly patients or in patients with an underlying somatic disease that occurs in a severe form, such as serious cardiac pathology. Conservative treatment of hip fractures is also possible if the injury is classified as mild according to the Garden classification scale and is defined as an incomplete fracture without displacement, the fracture line should not exceed an angle of 30 degrees.

The conservative method includes fixation of the hip joint, traction as indicated, drug-based restorative therapy, and a set of therapeutic exercises to eliminate the risk of complications.

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Rehabilitation after hip fracture

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

The restoration of general vital forces, correct activation of the functions of the injured joint begins. The beginning of the rehabilitation stage is considered to be the first day of bed rest. Primary rehabilitation after a hip fracture consists of actions that improve general blood supply, the purpose of performing exercises is to minimize congestion both in the vascular system as a whole and soft tissues in particular. To prevent necrotic disorders in the buttocks and sacral region, it is recommended to perform pull-ups using a special belt secured to the bedside crossbar with your hands, exercises and breathing techniques are also effective to reduce congestion in the lungs and eliminate the risk of pneumonia. Special diets containing foods rich in calcium and vitamin D are not necessary, rather a diet that neutralizes the possibility of hypodynamic constipation is indicated. Rehabilitation after a hip fracture should be regular, the doctor's recommendations must be followed throughout the entire period of bone tissue recovery, no matter how long it is.

Fracture of the femoral neck, consequences

The most common complications of hip fractures are necrotic disorders of the trophic tissue of the buttocks and sacral region or bedsores. No less serious is the threat of acute venous congestion, thrombosis of deep vessels - posterior, anterior tibial, femoral and popliteal veins, developing due to prolonged immobility of the patient. A hip fracture also has consequences in the bronchopulmonary system: cases of respiratory failure, congestive pneumonia associated with physical inactivity are common. Such complications are poorly controlled by antibacterial therapy and can lead to cardiovascular pathology and even death. In addition, forced immobility can lead to disruption of digestive functions, psychoemotional disorders. A hip fracture can have the most deplorable consequences if the rules for caring for such a patient are not followed, but the favorable prognosis also depends on other factors - the patient's age, severity (course of the fracture line), the presence of concomitant somatic diseases.

Hip fracture, patient care

In addition to a range of treatment measures – drug therapy, possible surgical intervention, an important condition for recovery after a hip fracture is proper patient care. The need for care is explained not only by the patient’s complete immobility, but also by possible serious complications associated with forced physical inactivity – bedsores, deep vein thrombosis, cardiac pathologies, and a severe psycho-emotional state. In the case of a hip fracture, patient care involves the following actions:

• Turn the patient over regularly, teach him to sit up independently, pulling himself up with the help of a belt specially fixed to the bedside crossbar. All these measures will help to avoid necrotic dystrophy of the tissues of the buttocks and sacral area of the body.
• Massage your limbs regularly (at least twice a day) to stimulate blood flow and prevent circulatory congestion.
• Providing dry bed linen, body moisture can provoke erosive tissue damage. Daily linen change, use of talc, baby powder are recommended.
• A mandatory condition is to follow a diet that includes plant foods rich in fiber to avoid atonic constipation.
• It is necessary to do breathing exercises with the patient daily to eliminate the risk of developing hypodynamic pneumonia.

Recovering from a hip fracture

A hip fracture requires recovery, starting from the first day of bed rest. Massages and exercise routines are necessary to maintain limb mobility, prevent blood flow stagnation, muscle atrophy and bedsores. Recovery after a hip fracture requires regular massage of the lumbar region and buttocks, then massage of the muscles of the uninjured leg, then the sore leg is correctly massaged with an emphasis on kneading the thigh muscles. After that, exercises are performed to activate and relax all the muscles of the body one by one. Regular sit-ups using a special loop attached to the bar are also effective. It is necessary to turn the torso from the back to the stomach every one and a half to two hours. If possible, you should try to massage both feet with kneading movements on your own. Starting from the second week, recovery after a hip fracture consists of flexion-extension movements of the knee joint of both legs under the guidance of a nurse or instructor. All the techniques and exercises recommended by the doctor must be strictly performed throughout the entire period of bone tissue fusion, no matter how long it is; the entire process of recovery depends on how regularly and responsibly the patient performs the complex of therapeutic exercises.

Hip fracture: rehabilitation

A set of rehabilitation measures for a hip fracture is compiled by a doctor taking into account many factors - the patient's age, the severity of his injury, his health condition and the method of treatment - conservative or surgical. Rehabilitation of a hip fracture helps to cure very effectively, since it includes the following procedures:

• A set of specially selected therapeutic exercises that helps to activate blood circulation and neutralize muscle atony, joint rigidity, and prevent the occurrence of bedsores.
• Physiotherapeutic procedures that help speed up the restoration of bone tissue and joint structure.
• A set of breathing techniques aimed at eliminating the risk of developing hypodynamic pneumonia and cardiovascular pathology.

Following a special diet that includes foods rich in calcium and vitamin D, plant fiber. Such a diet helps restore the chondroprotective properties of the joint and eliminates the possibility of atonic constipation.