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Hip joint. Hip neck fractures
The hip joint is one of the largest joints in a human body. It is formed by an acetabular hollow of a haunch bone and a head of a femur. On the edge of an acetabular hollow there is a hryashcheobrazny fabric, and the joint is covered by the capsule strengthening sheaves. Muscles cover a joint from all directions.
The femur neck fracture most often occurs at the people who reached advanced age. Approximately in 90% of cases such injury happens at people of old age, and, women in days of a postmenopause most often suffer from it. Conducts hip neck fractures at elderly people to the fact that the patient receives medical treatment for several months, it is very long forced to observe a bed rest. Besides, after such injury at the patient serious complications which approximately in a third of cases come to the end with a lethal outcome in the first year after a change develop.
How there is a hip neck fracture?
As a rule, the fracture of a neck of a hip occurs at the person owing to the injury got at the time of falling sideways. At the same time it is most strongly injured on area of a hip joint. However effects of such falling are not always expressed by such change. Such injury is caused also by existence of other reasons as this joint nevertheless is expected high loadings.
At the same time at sports activities it is difficult to break a hip neck. Therefore, such injury at young people is observed only seldom or never if it is about accidents, serious falling, etc.
Fracture of a neck of a hip of the person most often occurs at the people having osteoporosis. This illness conducts to the fact that at the patient are gradually washed away from a calcium salt organism which are responsible for durability of bones. Development of osteoporosis in the person happens owing to several reasons. It, first of all, too low intake of calcium in an organism or very high expenditure of this element. Besides, osteoporosis — the frequent companion of women whose age approaches the postmenopause period. During this period of life owing to a hormonal imbalance process of washing away of calcium of tissue of bones amplifies. According to medical statistics, osteoporosis is diagnosed for a half of women who were 50 years old.
After a fracture of a neck of a hip of people first of all feels pain in a groin. Such symptoms, as a rule, become more pronounced when the injured person begins to move. Sometimes such pain is weak therefore initially the person will be able just not to pay attention to it. As a result, the person can refuse the help of physicians, apart from an injury of serious.
Externally symptoms of such change are shown by the fact that rotation outside of that leg where there was a hip neck fracture is noticeable. It easily is determined by unnatural turn of foot. Besides, the affected leg becomes several centimeters shorter (as a rule, on 2-3 cm). This phenomenon — a consequence of reduction of muscles, the events after an injury. Therefore at establishment of the diagnosis the doctor examines the patient in a prone position and notes that the leg becomes shorter.
There is one more symptom which it is accepted to call "a symptom of the stuck heel". The matter is that the patient who had a hip neck fracture is not capable to tear off a heel from a surface on which lies. If to knock on a heel on the affected leg, then pain amplifies.
First aid at a hip neck fracture
The success of treatment depends not only on that, operation to the victim, but also from first aid given at suspicion on such change was how correctly performed. Besides, rehabilitation after a hip neck fracture which is carried out by doctors after operation, and the correct care of such patient is important.
But right after an injury before arrival of doctors first aid to the patient is given by those who stay near it. Initially the person needs to be laid in situation on a back, it is reliable to record the tire that leg which suffered. After that it is necessary to call doctors or to bring the victim to medical institution. It is impossible to return a leg in the correct situation without specialists at all.
Types of fractures of neck of a hip
In modern medicine the diagnosis "the hip neck fracture" is made in three cases. Rather easy option — a change in the field of a big spit which limits a femur and a neck of a hip. Heavier change — in directly neck which connects a femur and a head of a hip. But the most hard case the change in the field of a femur head is considered.
Besides the closer there is a change to a bone head, the it is less than chances that the bone will grow together correctly. The matter is that the head of a hip is located in rather closed space. Therefore at a change very often there is a necrosis.
Besides, classification of fractures of neck of a hip by the place of emergence is defined: they are subdivided on medial and lateral. The medial change occurs in the area where the capsule of a joint is attached to a hip, and a lateral change — in the field of a head of a femur is close to the joint.
The hip neck fracture at advanced age very often provokes emergence of the most various complications at the patient. The most frequent complication is decubituses which are shown on a body in the field of a sacrum and buttocks. The matter is that the patient after operation stays very long period in a condition of a bed rest. As a result, soft tissues are squeezed, and there is a disturbance of a blood-groove. Are formed later a necrosis of fabrics which is called decubitus.
In view of the long period of an immovability of the patient one more serious complication — a deep vein thrombosis of legs can appear.
Elderly people after a hip neck fracture often get sick with congestive hypodynamic pneumonia. This form of pneumonia very badly gives in to therapy by antibiotics, and can result in respiratory and cardiovascular insufficiency as a result. The lethal outcome can turn out to be consequence of such serious diseases.
Except the described complications the long immovability of a body can lead to disturbance of normal motor functions of intestines of the person. Chronic locks turn out to be consequence of it. In turn, long locks conduct to serious intoxication of an organism.
One more category of complications — psychoemotional disturbances. Such patients are, as a rule, whining, irritable, and sometimes they show a depression.
How to carry out treatment of a fracture of neck of a hip, the specialist orthopedist defines, considering specific features of an injury, health of the patient, presence of other diseases.
It is necessary to consider that in the presence at a sick vnutrikapsuklny change wound of a joint fragments of bones (the so-called driven change) is possible. Such situation — a way to development of an aseptic necrosis therefore it is necessary to carry out surely operational treatment for the purpose of endoprosthesis replacement of a hip joint. After such operation the patient is recovered rather quickly, and in several days to him appoint occupations physiotherapy exercises. Endoprosthesis replacement has some other pluses. So, practically right after operation of people can move the injured leg. After several days it already goes with a support.
Carrying out as total prosthetics (replacement of all joint is made), and one-band is possible (replacement of a head of a joint is made). In a case carrying out endoprosthesis replacement of complication are observed very seldom — in 5-15% of cases. As a rule, the essence of such complications consists in need of correction of incorrectly picked up prosthesis. Seams after operation are removed in 7-10 days.
During rehabilitation (for about 3 months) it is necessary to adhere to recommendations of the doctor accurately. It is important to go in for physiotherapy exercises, to limit loads of a leg, it is correct to put a leg in a prone position, sitting.
If the extra capsular change is diagnosed for the patient, then in this case surgical treatment consists in carrying out an osteosynthesis. An essence of such operation — fixing of the place of a change with use of a metal pin. Such intervention gives the chance to considerably reduce the period of a bed rest, and, therefore, and complications develop less often. At an oseosinteza the recovery period proceeds about 4-5 months. This method nevertheless is not completely reliable as there is always a risk that bones will not grow together. Therefore, the osteosynthesis is not carried out to patients who already were 60 years old.
Also conservative methods of treatment of such changes practice. It is reasonable to apply them if the elderly patient has a number of associated diseases. Considering age of the patient, doctors can doubt success of such operation therefore make the decision on carrying out conservative therapy. Such treatment consists in providing a condition of an immovability or in carrying out skeletal traction of the injured extremity. At such treatment the change can grow together not earlier, than in 6-8 months after treatment was begun.
During this period very important that the person very strictly adhered to a bed rest. Therefore, careful care of such patient is necessary. Always it is necessary to remember negative effects of the long period of an immovability which are expressed by formation of decubituses and other complications. It is necessary to consider also the fact that at the elderly person such change grows together much longer, than at the young patient.
To reduce probability of fractures of neck of a hip, it is necessary to adhere to recommendations for prevention of osteoporosis. Besides, this disease is important to treat if it already managed to develop, and to try to prevent falling.
To reduce probability of development of osteoporosis, it is necessary to lead active lifestyle and to regularly give to an organism weight loadings. It is useful to run, dance, to go much. In a daily diet there have to be many products, calciferous and vitamin D. Smoking therefore it is desirable to throw this habit, and also to reduce the use of alcoholic beverages to a minimum provokes calcium loss.
Not to allow falling, especially if it is about the elderly person, it is important to clean inconvenient rugs and furniture which can meet on his way. It is regularly worth watching visual acuity of the elderly person and to control his general state of health. It is especially important to control movements of the elderly person in the period of ice. Its footwear has to be the most convenient and not slippery.
Section: Orthopedics and traumatology