How dangerous is the fracture of the hip
The structure of the hip joint
Fracture of the hip joint is considered one of the most painful and complex injuries of the limbs. Most often, such a trauma occurs in people in old age, which greatly complicates its treatment. By this time, the articular tissues become weakened and recover much more slowly.
Similar processes occur in bone, muscle tissue, ligaments and tendons. High-quality medical care in the treatment of fracture is very important, but no less important is the properly organized after-injury rehabilitation period. At this time, it is necessary to use not only medications to strengthen bones and joints, but also to develop a damaged limb site.
What happens on the injured site
There is a misconception that with this fracture only the joint suffers. When a person undergoes this type of fracture, trauma disrupts the functioning of not only the articular tissue, but also the blood vessels. Damage is given to the femur. There is a fairly large group of people who are at risk of being among the patients of medical institutions because of such a trauma is more than great. These include people who suffer from osteoporosis.
With this disease, the bones gradually change their density, become brittle, brittle. Destructive processes affect joint and periarticular tissues. This is especially dangerous, since the process of their recovery after trauma is much more difficult than in people who do not have this diagnosis. Injury accompanied by easily recognizable symptoms that will help understand what happened to the limbs.
In a patient with osteoporosis, a fracture often occurs not because of a fall from a high altitude or mechanical damage, it is enough to fall off a bed or from a chair - and the person will already be injured.
Damage to the joint often leads to the disability of the patient
It is necessary to know: a person who has received a fracture can begin with a pain shock. The victim rarely remains conscious. For the state of a person must be observed. If he remains conscious, experts recommend talking to him until medical help arrives. After receiving a fracture, he will not be able to stand on the damaged leg. Sharp pain will feel not only in the thigh. Pain can be concentrated in parallel and in the area of the knee joint. Be sure to pay attention to the position of the foot. A sign of this fracture is the outward turned foot.
What first aid should I provide
? Transportation of a person who has received a fracture of the lower limbs is a special issue. If, due to circumstances, it has to be carried out independently, it is necessary to observe several rules. The main task of those who carry out transportation is such delivery of the victim to the medical institution, during which he will not suffer additional harm. Transport rules:
- The area of the affected articular tissue and bone should not be disturbed.
- After a fracture of the leg before receiving medical care, in no case be returned to its normal position. It is better not to touch the place of injury at all.
- To correct the location of the pelvic bones is strictly prohibited.
- When transporting on stretchers, it is important to fix the person correctly. Fixation is carried out in the belt area.
- On the stretcher must fix the hip joint. In the same way, they do it with the knee joint.
- When transporting after a fracture, you must also fix the ankle. Ideally, the fixation is carried out using a transport bus. Quite often it is not at hand. What to do in this case? For this role a long stick or a board is quite suitable.
- If the fracture is open, you must stop the blood quickly.
- To reduce the pain, the patient needs to urgently give an anesthetic drug.
What is done in case of complications of
There are various classifications of hip fractures. At the heart of one of them - the presence of displacement in trauma. Fracture of the hip bone is considered one of the most difficult. The higher the bone fracture, the greater will be its displacement and, accordingly, the more serious and dangerous consequences of trauma.
The location of the fracture largely determines the type of displacement. If it occurred at the top of the thigh, the chip will move forward to the outside. If the fracture is below the hip joint, the fragment is displaced inside and behind. When the fracture site is in the middle of the hip bone, its movement can occur along the length. If injury to the hip joint with displacement occurred in the lower part of the thigh - this is the worst case scenario. Displacement is dangerous for the condition of the artery, because a fragment can damage it at any time.
Surgical method for the treatment of fracture
Modern medicine in the treatment of hip injury uses one of two ways:
The first is quite effective in cases where there is no bias, doctors are engaged primarily in the joints of the affected limbs. The one that is traumatized, immobilized, a plaster bandage is applied on the leg. This technique of fracture treatment is considered classic. It is often used if the patient is contraindicated because of health. The first step in the fight against the fracture occurred is the introduction of a local analgesic. The nature of limb injuries determines the methods of their further treatment.
In the appointment of an operation, various factors accompanying the trauma are taken into account. If the fracture is intraarticulate, then there is a high probability that surgical intervention will be required.
How to return mobility to legs
However, if a person has a serious concomitant disease, doctors do not prescribe an operative intervention. An important role is played by the age of the victim. The older the person, the more problems he has not only with the joints, but also with the functioning of the internal organs, the tissues of which are worn out and can no longer fully fulfill their tasks.
The patient's old age is usually the main obstacle to surgical intervention. In elderly patients with prolonged bed rest, which is mandatory for the treatment of trauma, complications such as pressure sores, pneumonia, thromboembolism appear.
For the recovery of a person, it is necessary to correctly fix the site of the injury in a stationary state so that bone and articular tissue repair is there. But it is very important that the patient is mobile, because a prolonged bed rest can significantly worsen his condition.
The appointment of procedures for the restoration of joints and damaged bone during a trauma is the right to give only a doctor. No self-medication is permissible, otherwise the consequences will be extremely severe, negatively affect the effectiveness of the performed surgical intervention.
About autoplasty and endoprosthetics
Doctors advise: if the health and age of the victim is allowed, treat the fracture surgically. Bone autoplasty is in some cases considered the best option. Fixation of the damaged limb is carried out by means of a three-bladed nail. Endoprosthetics of the joint doctors do not appoint in all cases. It requires an operation when a false joint begins to form near the bone. The nature of the consequences that trauma brings with it is also taken into account. Endoprosthetics are urgently needed if the patient develops aseptic necrosis on the injured limb.
When the fracture is vertical, a non-surgical skeletal traction method is usually used. Extension usually lasts 2 months. Then on the injured limb, doctors impose a plaster bandage. And a few months will pass before the bones, articular tissues become consolidated and the patient will be allowed to step on the aching leg.
Faster to heal the resulting fracture is only capable of surgery. It increases the possibility of increasing the mobility of the patient, and then the full load on the bones of the affected limbs can be carried out after 1.5-2.5 months. It is necessary to know: after the operation, the treatment of the injury does not stop.
To maintain the length of the leg and the correct position of the bone, the patient is given the extension
How to develop a damaged limb area? This is the issue that physicians and patients need to address further. The knee after hip fracture also needs to be developed. After removing the plaster bandage it is important to restore the former mobility to the joints, for which purpose specially selected complexes of physical exercises are used. There are methods of developing joints in warm water, it has a beneficial effect on faster recovery of bone tissue. Those who need to develop a knee, doctors in some cases will recommend an exercise bike. A good analog of an exercise bike is an ordinary bicycle.
Measures to develop joint mobility must be used in conjunction with the use of multivitamin preparations that help to quickly repair damaged joints and bones and strengthen them.
Fracture of the hip joint and its treatment
The hip joint is the junction of the hip and pelvic bone and has a spherical shape. It has a special mobility and ability to withstand heavy loads. This joint is involved in such stages of the movement as sloping and straightening the body, moving the legs to and fro, turning the legs inside and out. This is achieved due to the peculiarities of the structure of the joint: the head of the femur in the pelvis enters the swivel cavity. The joint capsule is well strengthened with ligaments, which form a circular zone.
Hip joint - schematic photo
Under the hip fractures are understood the trauma of the head, neck of the femur and acetabulum.
The main cause of the fracture of the head and neck of the hip joint in young people in most cases is a traffic accident. Elderly people, especially postmenopausal women with osteoporosis, are at risk because their bone structure is thin and easily broken. Trauma in this category of patients can be caused by a fall on the lateral surface of the thigh and pelvis.
Intra-articular fractures of the femur include:
- major fracture of the femur - this is head trauma;
- subcapital, in which the fracture line passes under the head of the femur;
- transdermal( transcervical) - a violation of the integrity of the bone in the femoral neck area;
- basaltservikalny - when the fracture line lies at the base of the neck, where it borders on the body of the bone.
As for the fracture of the acetabulum, it is a consequence of an increase in the strength of traumatic factors and in most cases is combined with a hip dislocation. All injuries associated with this part of the hip joint are divided into simple and complex.
To simple refer:
- fracture of the posterior column, which is combined with a fracture of the posterior wall;
- fracture of posterior wall and transverse;
- fracture of both columns;
Signs and symptoms
Symptoms of cervical fractures of the hip joint:
- Pain in such injuries is localized in the groin area and is characterized by a mild manifestation at rest, but increases dramatically when trying to move the injured leg.
- The hematoma appears a few days later, so it can not be an early indication of an injury.
- The symptom is external rotation of the foot, when the entire outer edge of the foot lies on a horizontal surface.
- Active internal rotation of the leg is absent: on the side of the injury, the injured person is unable to rotate the leg inside, so the foot remains in the outward position. This is a clear sign of pathological changes.
- A limb shortening of 2-4 cm can be observed.
- Girgolov symptom - the pulsation of the femoral artery increases, the patient can flex and unbend the leg, however, the heel slides along the horizontal surface. At the same time, a person can not raise or hold a straight raised lower limb.
Accurate diagnosis is confirmed by X-ray examination!
The main symptom of an acetabular fracture is severe pain when moving. If the injury is accompanied by a hip dislocation, in which the femoral head penetrated the pelvic cavity, passive and active movements are blocked by a severe pain syndrome. There is also a westernization of the area of the large trochanter and some shortening of the leg.
Radiography allows you to specify the type of fracture, and computed tomography imaging concomitant disorders.
Consequences of hip fractures
What are the consequences of such fractures
Injuries of this type lead to immobilization of the patient, which means that the problem of pressure sores is urgent. Uncritical violations of trophic gland and sacral region are observed. A serious threat to the general condition of the patient is venous congestion and thrombosis of deep vessels located in this part. Hypodinamia leads to stagnation of pneumonia and respiratory failure.
Forced prolonged immobility can lead to disturbance of digestive functions and psychoemotional complications.
Consequences of acetabular injuries are aseptic necrosis of the femoral head, the cavity itself and coxarthrosis.
Treatment of various types of fractures
Methods of treatment
For head, thigh and acetabulum injuries, anesthesia is administered by administering a local anesthetic solution.
Subsequent treatment of the hip joint depends on the nature of the injury and can vary very widely: from the appointment of skeletal traction to surgical intervention.
Successful treatment begins with the elimination of displacements, the comparison of debris and immobilization of the limb. For this purpose, skeletal traction is used. The duration of it is from 4 to 8 weeks. Gradually, the elements of the load are removed, a plaster bandage is applied or a functional treatment is prescribed, when the patient is recommended to walk with crutches, without full load on the limb. Therapeutic exercise is shown.
Full load on the injured leg is not permitted until the 3rd month.
Elderly patients are shown surgery, which reduces the duration of bed rest. This is important, since prolonged immobility in the background of the elderly threatens multiple complications.
Rehabilitation after hip fractures
After the medication or surgery, rehabilitation therapy is of great importance. It is aimed at the general restoration of the vital forces of the patient and the correct activation of the functions of the affected joint. The process of recovery begins from the first day of the appointment of bed rest and consists in actions that are designed to improve blood supply, minimize stagnation in the vascular system and soft tissues.
In order to prevent necrotic disorders of the gluteal and sacral region, it is prescribed to perform pull-ups using a special strap. Decrease the stagnation of the lungs and reduce the threat of developing pneumonia called respiratory techniques. A sensible measure to prevent hypodynamic constipation is a special diet.
Well, at last, we would like to offer you a video about rehabilitation measures in case of hip joint fracture.
That's it. We are waiting for your questions in the comments. Do not be ill.
Leave a comment
Your email address will not be published. Required fields are marked *
You can use the following HTML tags and attributes: & lt; a href = "" title = "" & lt; abbr title = "" & lt; acronym title = ""& gt; & lt; b & gt; & lt; blockquote cite = "" & lt; cite & gt; & lt; code & gt; & lt; deltatetime = "" & lt; em & gt; & lt; i & gt; & lt; q cite = "" & lt;; strike & gt; & lt; strong & gt;
Fracture of the hip joint - Sustavy-Bezboli.ru
Fracture of the hip joint is a trauma that most often happens in old age. In this case, not only the femur suffers, but also the blood vessels, so that the bone fragment formed during the trauma can gradually disappear.
In clinical practice, the fractures that occur in the hip joint are divided into medial, lateral, and overtly-susceptible.
Fracture of the hip joint
A large number of fractures occur around the coxofemoral joint. This is due to the fact that it is affected by various traumatic factors of high-energy and low-energy origin.
In elderly and senile age, vertebral fractures, fractures of the neck of the femur and the bottom of the acetabulum most often occur. However, in clinical practice, fractures of the acetabulum, proximal femur, which can be accompanied by damage to the ligamentous apparatus, and also a fracture of the knee joint can occur at the same time.
To a special group of fractures it is customary to include traumas characterized by irregularity and unpredictability in the anatomical and functional outcome.
Reasons for fracture
In young patients, the cause of a hip fracture is an accident or a fall from a high altitude.
In elderly and old age, the causes of hip fracture may be:
- Decreased bone strength( osteoporosis).
- Reduced physical activity and malnutrition.
- of Oncology.
Symptoms of hip fracture
In the case when an overcross fracture is diagnosed, the victim complains of severe pain in the hip joint area, external rotation of the injured limb is noted, a swelling and hematoma develops in the region of the large trochanter of the femur.
In the event of a medial fracture of the femoral neck, external rotation and pain are less significant. The victim has a symptom of a "stitched heel", i.e.he can not lift his leg on his own, but with outside help raises her practically without pain.
In cases of susceptible and excessive fractures, severe pain in the hip joint is noted, both with passive movements and at rest. External rotation, limb shortening and crepitation of bone fragments are also observed.
Diagnosis of injury
The diagnosis process takes into account the age of the victim, the mechanism of injury, as well as all of the above symptoms. To clarify the diagnosis, X-ray examination is mandatory.
Sometimes, in order to determine the nature of the displacement of fragments, the victim may be assigned a CT scan, MRI or scintigraphy.
Conservative treatment of hip fracture involves the immobilization( immobilization) of the joint and subsequent stretching, which allows you to compare bone fragments. In this case, the limb of the injured person is superimposed with a coaxial gypsum dressing.
It should be noted that at present such a technique is used only when it is impossible to perform an operation for vital signs or in the absence of a competent surgeon and the necessary equipment. To date, the gold standard in the treatment of hip fractures is osteosynthesis, which allows you to quickly fix bone fragments and maximize the functioning of the hip joint.( 4 votes, average: 4.50 of 5) Loading. ..
Fracture of the pelvic bones is one of the most complex and dangerous injuries, often accompanied by massive bleeding, damage to internal organs and leading to a rackloss of capacity for work, and in many cases, disability. In some cases, pelvic injuries cause death, which can result in blood loss, pelvic trauma or pain shock.
According to medical statistics, pelvic injuries are found in 5-7 people out of 100 diagnosed musculoskeletal injuries. In a quarter of cases there are injuries to the pelvic organs, and in 30%, traumatic and painful shock. Lethal outcome for such injuries occurs in 6 cases out of 100. Most often, young and middle-aged people, mostly men, suffer from pelvic fractures, often traumas of this kind are found in adolescents.
Causes of injury
To fractures of the pelvic bones can lead:
- pressure on the pelvis during road accidents, with natural( landslides, avalanches) and man-made disasters( destruction of buildings, wrecks), as a result of industrial injuries;
- sharp, severe blows to the pelvis, caused during fights, training or performances on power sports;
- falls from height - climbers, paratroopers, builders and people who are fond of jumping more often suffer;
- blow against the water when improperly diving from the tower;
- a sharp contraction of muscles with strong tension, more often such situations occur in athletes;
- thinning and brittleness of the pelvic bones, developing with osteoporosis;
- in women during labor can develop pubic symphysis breaks.
In 75% of cases, the cause of injury to the pelvic bones becomes an accident, and pedestrians suffer more often than people who are in the car.
Anatomical features of the pelvis
The pelvis serves as a receptacle and protection for the urogenital system and supports the entire skeleton. It is formed by three twin bones - pubic, ischial, iliac, connected with each other by thin bone seams, immovably connecting with each other and with the sacrum, form a closed circle - the pelvic ring.
All three bones are involved in the formation of the acetabulum, which is part of the hip joint. Any damage to the pelvis affects the condition of the entire body.
Classification of pelvic bone fractures
Traumatologists distinguish several groups of pelvic bone fractures:
- Injuries in which the integrity of the pelvic ring is not damaged, such fractures are called stable. These include the marginal and isolated fractures - the fracture of the sacrum( transverse), the coccyx, the wing and crest of the ilium, the branches of the pubic or ischium bones and the fracture of the bumps of the ischium.
- Unstable fractures, in which the integrity of the ring is broken, the following subgroups of unstable fractures are identified:
- unstable vertical front - one or two-sided lesions of the pubic or ischium bone;
- unstable vertical rear - trauma of the wing of the ilium, fracture of the sacrum in oblique or vertical direction;
- double unstable - simultaneous damage to the anterior and posterior half-rings of the pelvis; this subgroup includes Malenga fractures( vertical) and Niederle( horizontal);
- multiple pelvic fractures.
- Acetal cavity damage - one or two-sided fractures of the edges or bottom, often such a trauma is accompanied by a dislocation of the hip joint.
- The last group includes fractures - a fracture of the pelvic bones accompanied by a dislocation of the lobate or sacroiliac joint.
Damage to the
pelvis fracture The following injuries are attributed to the related injuries:
- Massive bleeding - blood loss with stable fractures can range from 300 to 500 ml of blood, and when unstable, it reaches 3000 ml.
- Damage to the internal organs - rupture of the bladder, urethra, vagina or rectum. In this case, the contents fall into the cavity of the small pelvis and can cause the development of an infectious inflammatory process.
- Damage of large and small nerve trunks of the lumbar plexus, manifested by pronounced neurological changes.
Clinical manifestations of
All clinical manifestations of fracture of pelvic bones are divided into local and general. Separately, one can distinguish the symptomatology of traumatic or painful shock.
Local symptoms of pelvic bone injuries
Symptomatic pathology depends on the location and type of fracture and varies depending on the severity of the lesion. Local manifestations include:
- visually distinguishable bone deformation of the pelvic region;
- pronounced pain syndrome;
- development of hematomas in the pelvic region;
- edema of various localization and sizes;
- violation of motor functions of the lower limbs;
- with open trauma to local symptoms also includes bleeding;
- with unstable fractures, mobility and crunch of fragments can be observed;
- for some types of fractures varies the length of the limb from the side of the lesion.
Local manifestations of selected fractures
|No.||Fracture localization||Clinical manifestations of trauma|
|1||Upper pelvic area and iliac bone||The volume of movements in the hip joints is reduced, the pain localization is the area of the iliac wing. With a fracture of the wing or iliac bone, there is a characteristic symptom, called a symptom of the back stroke - it is easier for the patient to go forward with his back.|
|2||Coccyxum||The intensity of pain increases with pressure on the lower part of the sacrum.|
|3||Pelvic ring||If the integrity of the pelvic ring is not disturbed, the pain is localized in the crotch or pubic region and is enhanced by palpation or attempts to perform movements with one foot. In violation of integrity - pain syndrome is observed in the pelvic and perineal regions, and movements with the legs make it stronger.|
|4||The branches of the pubic bone||A person with such an injury occupies position e, which is called the "frog pose".|
|5||Pubic symphysis||The patient takes a forced position with slightly bent tightly connected legs, the dilution of the limbs causes severe pain.|
|6||Rear semi-ring||Because the pain is localized from the side of the lesion, the patient is forced to lie on the healthy side. Bruising is located mainly in the crotch area in men, they are localized on the scrotum.|
|7||Acupuncture||Trauma is often combined with hip dislocation and is manifested with severe pain, forced position of the injured limb, impaired hip joint functioning.|
General clinical manifestations of pelvic fracture
Such a serious trauma as a fracture of the pelvic bones is usually accompanied by significant blood loss, which can be indicated by the pallor of the skin and a sharp decrease in the values of blood pressure. In addition, traumatic shock and trauma to the urogenital and digestive system often develops.
Manifestations of traumatic shock
- rapid change in the color of the skin( they become pale);
- cold sweat;
- increased heart rate;
- decrease in blood pressure;
- possible loss of consciousness.
Symptoms of pelvic organs
- When the urethra ruptures, urine retention develops, bleeding from the urethra is observed, a hematoma appears in the perineal region. The size of the bladder is increased, and it is difficult or impossible to insert a catheter.
- Damage to the walls of the bladder can be accompanied by the presence of blood in the urine( hematuria), while the contours of the bladder itself with palpation and percussion are not determined.
- Sign of rupture of the vagina or rectum is the development of bleeding from them, these injuries are determined by gynecological examination or finger examination of the rectum.
A common symptom of pelvic organ damage is the marked swelling of the tissues in the lower abdomen.
Consequences and complications of trauma
During the injury and during its treatment, the following complications can occur in the patient:
- a sensitivity disorder resulting from damage to the nerve trunks and compression of the tissues;
- trauma to muscle fibers, blood and lymphatic vessels, tendons;
- damage to the pelvic organs;
- development of an infectious inflammatory process;
- abnormal or delayed fracture fusion;
- development of osteomyelitis;
- tissue malnutrition;
- the formation of contractures that limit the motor activity and functionality of the lower limbs.
Diagnosis of pathology
Pelvic fractures are diagnosed by a traumatologist after examination and radiography. Associated lesions require additional methods of examination, which include:
- laparoscopy is performed with injuries of internal organs;
- when the patient is in serious condition laparocentesis or even laparotomy may be used;
- for suspected bladder damage requires ultrasound;
- trauma to the urethra is diagnosed by urethrography.
Methods for treating pelvic bone fractures
In case of pelvic fractures, it is very important that the injured person be delivered to the hospital as soon as possible. Quickly initiated adequate treatment can save a person's life with a pelvic injury. Therefore, if you suspect this kind of injury, you should immediately call an ambulance. It is very good if first aid is provided to the victim prior to her arrival.
Basics of First Aid for Pelvis Fractures
If there are open fractures, stop bleeding and treat the wound edges with an antiseptic. To relieve the pain, it is necessary to inject analgesics intramuscularly or give them to the affected person in a tablet form.
It is necessary to lay the injured person correctly, for which a tightly folded blanket, clothing or roller is placed under the knees, and the upper part of the trunk is lifted( a hard pillow is placed under it).It is desirable that in this position the knees of the patient do not disperse, if possible, they are fixed in one position.
If there is a symptom of a traumatic shock, you should loosen the straps, collar and buttons, ensure the flow of cool clean air, use ammonia.
It should be remembered that it is strictly forbidden to relocate a person with suspicion of a pelvic fracture. To transport such a patient, special tools are necessary. Therefore, do not try to deliver it to the hospital on your own.
Basic methods for the treatment of pelvic bone fractures
The trauma or surgeon deals with the treatment of pelvic fractures, depending on the severity of the damage, consultation and treatment is sometimes required for specialists of other specialization( resuscitator, urologist, gynecologist, proctologist).First of all, a complex of anti-shock measures is carried out, in which the following components are included:
- Conducting adequate anesthesia - intraocular or intraosseous analgesia can be administered with novocaine or lidocaine, in certain types of fractures and with multiple combined injuries, it is preferable to use general anesthesia. The question of the type of anesthesia is solved individually.
- Reimbursement of the volume of lost blood - with a small blood loss to the patient, transfusion and intravenous injection of replacement solutions for the second day are prescribed. Massive bleeding requires the immediate commencement of recovery of blood loss. When non-stop profuse bleeding is necessary surgical intervention, consisting in the ligation of the arteries, after which blood substitution therapy is prescribed.
- Immobilization of the fracture - the type of immobilization and its duration depend on the localization of the fracture and its appearance. With stable fractures, it is possible to lay the patient on the shield, while a roll is placed under his knees or Beller's tires are used. Unstable fractures are a direct indication for the use of skeletal traction.
In some types of fractures, surgical intervention is prescribed, during which the fragments will be connected by metal plates or spokes( osteosynthesis).After the complete fusion of the bones, a repeated operation is necessary to remove the fixation elements.
The duration of treatment depends on the severity of the fracture and can take quite a long time. After the fusion of the bones, a rehabilitation period is required during which the patient returns to his habitual lifestyle. During this period the person is under medical control and undergoes physiotherapeutic procedures and massage sessions, is engaged in physiotherapy exercises, takes medications that strengthen bone tissues and accelerate their fusion.