Fractures of the upper end of the femur
Fractures of the upper end of the femur can be:
Intraarticular fractures include:
- fractures of the femoral neck – major (fracture of the femoral head)
- subcapital, with a fracture line passing just below the head of the femur
- transcervical or chrezsheechny – if the fracture line passes through the neck of the femur
- fracture, the line which passes near the base of the cervix, on the border of the body of the bone called bazistservikalny.
Extraarticular fractures – a fracture at the level of skewers – and trochanteric fractures of the intertrochanteric and chrezvertelnye.
Fractures of the upper end of the femur occur most often in the fall on the side surface of the pelvis and hips. Most elderly people suffer, especially women with postmenopausal osteoporosis. The structure of the bones of their sparse and fairly easy to break. When fractures of the medial, which is closer to the upper edge of the bone fracture healing is slow, as in the femoral neck has no periosteum, the power it is difficult.
Fusion is possible with a very dense and proper comparison of the fragments. In addition to the absence of periosteum, fracture in this area is often affected and intraosseous blood vessels, so blood flow to the femoral head is disrupted, making it more difficult union of fractures. Thus, the fused medial fractures are very durable, require prolonged bed rest, and often there are complications.
In transcervical fractures when the fracture line passes through the neck of the femur, the patient depends on the safety of blood supply, which is the greater, the lower is the fracture line.
When fractures of the femur skewers can be considerable bleeding from the area of injury (up to 2 liters) and is accompanied by severe pain.
Patients complain of pain in the injured hip, groin area. Sometimes the pain alone can be a gentle, but greatly enhanced by motion. The damaged leg is turned on its side, the foot rests on the support side surface. In the supine position, patients can not be straightened up in the knee and hip foot. This is called "a symptom of heel stuck."
When fractures skewers found large bruises. If the fracture is impacted, that is introduced into the peripheral otlomok central fragment, patients can move freely, and the fracture is found only in a few days.
Clarify the diagnosis after the radiological examination.
Treatment of fractures of the upper end of the femur. Initially, the fracture is held analgesia by injection of local anesthetic. In extra-articular fractures of the trochanteric or used conservative or operative treatment. Younger patients are more commonly used conservative methods of treatment.
For successful treatment it is necessary to compare the fragments, to eliminate bias and securely immobilize the limb. Used by skeletal traction. Needle is carried out through the tuberosity of the tibia or the femur condyles. Use the load to 10 kg. Terms of skeletal traction for about 8 weeks. Then applied plaster cast or a functional treatment is carried out in which the patient is allowed to walk with crutches and is assigned to physiotherapy. Full load on the injured leg is allowed not earlier than after 3-4 months. Older patients preferred surgical treatment, which makes it possible to reduce time in bed.
For surgical treatment is used osteosynthesis screws, plates, three-blade nail spongioznymi cannulated screws. Patients begin to walk with crutches in a week.
Must be appointed physiotherapy. Full load on the limb will be in 6-10 weeks.
Intraarticular fractures of the medial or require much more effort at treatment. When conservative treatment of patients with early mortality was 20%. That was associated with complications during prolonged bed rest in elderly patients (pneumonia, decubitus ulcers, venous thromboembolism). At present, skeletal traction and casts a long time in elderly patients do not apply.
Surgical treatment is available only if the patient due to underlying medical conditions does not allow the resort to surgery or in the case of impacted fracture, which is firmly held in place. In this case, the patient is laid on the bed with a shield and use the bus Beller. After 3 weeks, make an X-ray, and if there is evidence of bone fusion, after 5-6 weeks, gradually allow the load on the limb.
In other cases, for health reasons is carried out surgery. Performing three-blade nail fixation, cannulated screws, bone autotransplantation. With the development of complications, or false joint asepticheskogonekroza femoral head prosthesis is hip. Usually, surgical treatment gives good results.
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