Rehabilitation after a fracture of the femur. Comminuted fracture of the femur: treatment and rehabilitation. Fractures of the upper end of the femur

fracture femur characterized by a loss of integrity. Hip fractures are usually caused by direct impact, hit or fall on the leg. Unfortunately, there are many such situations when a person breaks his leg. Cases become more frequent in winter, when there is ice on the street. Such injuries cause many complications.

Fractures of the femur occur at any level of the fragment. Therefore, fractures are usually classified.

Classification of hip fractures by AO

Fractures of the proximal femur (fractures of the upper third of the thigh). Diaphyseal fractures of the femur (fractures of the middle third of the femur, including a fracture of the femoral shaft). fracture distal femur (damage to the lower third of the bone).

According to the mechanism of injury, there are:

Displaced hip fracture.
Open hip fracture.
Closed fractures of the femur.
Atypical fractures of the femur.
Comminuted hip fracture.
Subcapital fractures of the femur.
Pathological hip fractures.
Hyperprosthetic fractures of the femur.
Periprosthetic hip fractures.
Impression fractures.
compression fractures.
Lateral fractures.

Types of fractures of the femur, depending on the line of fracture, are as follows:

1. Fractures of the proximal femur with a transverse fracture line.
2. Oblique comminuted fractures of the femur.
3. Spiral fractures.

Fractures of the upper end of the femur

Subtrochanteric fracture

The femur with a subvertebral fracture is often injured in young people. Damage occurs due to a strong blow or fall. At the same time, spiral, comminuted fractures are distinguished. Clinical manifestations are characterized by pain and swelling at the site pelvis hip joint. Also, the pain may be in the upper part of the femur.

First aid needs to be provided quickly. It consists in immobilization of the limb using a splint. Also shown is the use of analgesics, ice to relieve pain and reduce swelling. With a subvertebral fracture, it is possible serious complications as a possible venous thrombosis in patients with embolism. Osteomyelitis may also develop after surgery. Sometimes the debris in this section does not grow together, which causes a lot of inconvenience and leads to paralysis of the limb.

Intertrochanteric fracture

This is an extracapsular deformity of the femoral bone. Usually, such injuries occur in people 66-76 years old. Women with pathology face more often.

Intertrochanteric injuries are divided into stable or unstable. The causes of their occurrence are a direct traumatic effect on the axis of the femoral bone. Deformation occurs in combination with trauma to the greater or lesser trochanter.

Symptoms of damage are as follows: the victim has severe pain, swelling. There is also isolated blood loss in the area of the hip joint. It can be visually seen that the limb is slightly shortened with external rotation. It is possible to diagnose a fracture using an x-ray in two projections.

Femoral head injury

Deformations femoral head are divided into capital, which damage the head of the bone itself, and subcapital - in which the fracture is diagnosed under the head. The causes of injury are similar to trochanteric fractures. However, pain in this part of the bone is less pronounced. As a rule, the victim complains of moderate pain, which increases with any movement. If the area of damage is palpated, a dull pain is felt in the depth of the joint.

Hip fracture

When the femoral head is injured, it often occurs. The symptoms and causes of a fracture are similar to trauma to the head of the femoral joint. It can be seen that the leg is turned outward. If there has been a displacement of bone fragments, the injured leg will be shorter than the healthy one.

Diaphyseal fractures

Injuries in this part of the bone are severe, often accompanied by pain shock and severe blood loss.

Causes of damage to the body of the thigh:

Direct hit.
Indirect injury (when twisting or bending the limb).
The fall.

Injury of this nature causes damage to the nerves and large vessels. because of severe blood loss and intolerable pain, the patient experiences pain shock.

It is important to quickly provide first aid to the victim by fixing the limb with a Kramer or Dieterix tire. The use of an anesthetic is also indicated. The patient must be in lying position.

Therapy for damage to the femoral diaphysis includes immobilization of the limb, anesthesia, osteosynthesis and skeletal traction. In complicated situations, surgery is performed. However, if during the provision of assistance the wound was infected, the condition of the victim is severe, surgical intervention is not performed.

Instead, the patient is placed in closed reduction and skeletal traction for six or twelve weeks. Fixation is performed using needles that are passed through the femoral condyles or. During reposition, the patient is placed on a shield, a Beller splint is placed on the leg. After removing the traction, plaster is applied for 4 months.

Injuries of the condyles of the tibia

Condylar deformities - injuries that occur as a result of a fall, direct impact on the site. Usually accompanied by displacement with multiple debris.

Note!

The risk group is people over 65 years of age.

Fracture of the condyles can be single or multiple. The fracture line is intra-articular. Therefore, hemorrhage occurs in the articular sac. As a result, hemarthrosis develops.

Symptoms that are characteristic of damage to the lower fragment of the femur are manifested in the form of severe pain in the knee or at the bottom of the bone. At the same time, mobility is limited, the knee is greatly enlarged, with any movement there is severe pain.

Treatment of a fracture in this part of the femur is carried out conservatively and with the help of surgical intervention. If hemarthrosis is noted, a joint puncture is performed. The terms of wearing a plaster splint for a fracture without displacement are four or eight weeks. If displacement occurs, manual reposition is performed and the duration of the cast is increased.

ICD 10 injury code

Fracture of the femur (S72)

The reasons

A fracture of the femur occurs due to a direct blow to the femoral axis, a blow to the leg with a blunt object, or a fall from a height. Such injuries are typical for older people, as well as for people who are actively involved in heavy sports. Usually falls in sports are normal and common, but the consequences of such injuries are unpleasant and the recovery period is very long. In this case, the site of a fracture of the femoral head or its neck is typical.

Traumatic factors are not the only reasons why femur damage occurs. The pathological side also affects the process of deformation. Patients often face damage due to disease musculoskeletal system(arthritis and osteomyelitis).

Symptoms

A fracture of the femur always causes unbearable pain, which can only be eliminated with the help of medicines. The symptoms of a hip fracture vary.

When the neck of the femur is damaged, the signs of a fracture are pain in the pelvis, as well as in the groin area. As soon as a person tries to make any movement, the pain intensifies. There is also swelling of the tissues at the site of injury. Bruising is not noted. In case of trauma to the vertebral region of the thigh, clinical manifestations characterized severe pain which cannot be tolerated. When trying to palpate the leg, the pain becomes unbearable. Also, this type of damage is characterized by swelling and hemorrhage in the articular sac.

Note!

Extremely dangerous is a pertrochanteric fracture in the upper part of the thigh, which is accompanied unbearable pain, severe swelling and "stuck heel syndrome", since it is impossible to raise the leg.

With damage to the body and lower thigh, displacement is often diagnosed. The treatment of such injuries is long. In this case, you can see that one leg is shorter than the other. Open fractures are accompanied by severe blood loss.

First aid

With a fracture of the femur, it is very important to provide emergency care in a timely and correct manner. The rules for the provision of first aid are as follows:

Call an ambulance and let us know what happened.
Use an anesthetic, pain reliever, to prevent pain shock.
Fix the leg, carry out transport immobilization.

If blood loss occurs, the wound should be treated immediately antiseptic and prevent bleeding. At open fracture the thigh often damages the vessels and arteries, in which case the hemorrhage will be severe, the blood will need to be stopped with a tourniquet or tight wound closure with a sterile bandage or gauze. Approximate blood loss is 1-1.5 liters of blood (1000-1500 ml).

When providing first aid for a hip fracture, sterile materials should be used if it is necessary to treat the wound or stop bleeding. This rule should be followed so as not to infect and provoke inflammation.

Coxite bandage

It is necessary to use a tight bandage on the thigh (coxite bandage) in case of a gunshot before the hip joint, as well as after surgery. But for its fixation, an orthopedic table and special tools are required. Therefore, only specialists can apply such a bandage.

How to splint a hip fracture

Basic rules for applying a splint in case of a fracture. Immobilization for a hip fracture includes fixation of the limb with a splint. If the fracture is open, stop the bleeding and apply a sterile fixative bandage. In closed fractures, the femur must be fixed with a splint. For this, the Dieterichs tire is suitable.

In case of a hip fracture, you can also use improvised materials, for example, a piece of plywood, cardboard, skis, boards, etc. In order for the fixation to be reliable, it is necessary to use two oblong objects that will provide immobilization when transporting the patient to the hospital. Also, a soft lining is placed under the tire so that during transportation, broken bone fragments do not cause even more discomfort to the victim. Tire fixation is performed using belts, ropes that are applied above and below the knee.

What to do with a hip fracture

The application of the Cramer splint for hip fractures is indicated in cases where the Dieterichs splint was not at hand.

What materials are used

Cramer's ladder tire (3–4 pcs.). Sterile dressings. Cotton wool, syringes. Painkillers (Baralgin, Promedol, Fentanyl, Tramal). Stretcher.

Emergency care for a hip fracture should be provided immediately, especially if we are talking about an open fracture arterial bleeding. This condition is life-threatening. On average, the BCC in case of trauma to the femoral bone is 1000-1500 ml.

What needs to be done about it

Immobilize the limb with 3–4 Cramer splints. At the same time, the victim is laid down, an anesthetic is administered. Cotton-gauze pads are applied to the protrusions of the bones with an open fracture. A long tire is used to fix the back of the leg. The other two are splinted on the sides. In this case, all 3 tires must be fixed so that they do not sag.

In this position, the victim is sent to the hospital.

Diagnostics

Hip fractures are very dangerous. The specialist examines and interviews the victim. During the examination, the doctor pays attention to the signs of a fracture. There are absolute (thigh deformity, bone crepitation, leg mobility is impaired, one leg is shorter than the other) and relative ( pain to the fracture site, symptom axial load, hematoma at the site of injury, dysfunction of the leg), based on which the doctor determines the type of diagnosis.

With a fracture of the diaphysis of the femur informative methods diagnostics, which allow to determine the presence of a fracture, are x-rays. The radiograph is performed in two projections. CT and MRI may also be ordered.

Treatment

Fracture of the femur requires emergency care and qualified treatment. Therapy of injury is determined by the severity of injury. Therefore, hip fractures without displacement are treated conservatively. The goal of the hip injury treatment is to match the displaced fragments, as well as their fixation and further rehabilitation.

In case of closed fractures without displacement, the injury site is anesthetized, then a plaster splint (bandage, coxite bandage) is applied. If a displacement occurs, the wound is open, a case blockade is performed. Novocaine solution is used as an anesthetic for a hip fracture.

Treatment of displaced femoral fractures requires reposition of the fragments and, most often, surgery, during which the displaced fragments are compared. How to treat a broken hip in a conservative way often fails due to multiple injuries. The same applies to intra-articular fractures distal femur. In this case, skeletal traction may be prescribed, after which, wearing a cast.

Surgical treatment

If the injury occurred in the lower part of the femoral neck or a fracture of the impacted type, the operation is not performed. Then the treatment goes according to the scheme:

Establishing diagnosis. The first 2 months are carried out skeletal traction in case of a fracture of the femur. Massage during the specified period. After the hood, walking on crutches is shown. After four months, the crutches are removed, and the patient must learn to walk independently. After six months, if the treatment is successful, the patient restores the lost functions of the leg.

But if this did not happen, and the injury requires immediate surgical intervention, an operation is performed with fixation of the debris.

Hip surgery is indicated in the following situations:

There was a fracture of the femur with displacement and damage to blood vessels and tissues. A closed comminuted fracture occurred, which was complicated by isolated bleeding into the area of the articular sac. Conservative treatment of a femoral fracture failed positive result or bone fragments have grown together incorrectly.

Practice shows that fractures of the femoral shaft grow together better and faster along the length, while the fusion of fragments along the width leads to secondary curvature and dysfunction of the leg.

The operation is usually performed under. But if the damage is not severe, local anesthesia can be administered. Next, a comparison is made between the displaced and broken fragments. If necessary, open joint capsule and open surgery.

As a result, when the bone fragments are compared, they are fixed with the help of plates, pins, knitting needles. The Ilizarov apparatus can also be applied. At the end of the operation, the patient is also shown to be on the hood, after which, by traction, the leg is forced to bend.

How much to be treated and wear a cast

A lot of people want to know hips. However, this information is individual, since everyone has their own recovery time. It also depends on age and comorbidities.

It is worth noting that plaster is always applied at a fracture, so the question of how long to wear it is regularly asked by the victims to their doctor. The terms of fracture consolidation are 3.5–4 months. During this time, the patient will need to wear a cast. Once it's removed, it's time for recovery.

How long is it allowed to step on the foot

It is allowed to step on the leg after skeletal traction, if this was carried out, or a week after the operation, if the situation was not difficult. In this case, you can only get up with an emphasis on crutches. It is worth noting that immediately the gait will be disturbed, the patient will have to learn to walk again. Also, an injured leg may limp even after rehabilitation.

Rehabilitation

Rehabilitation after a hip fracture lasts 6-12 months. The rehabilitation program after a fracture of the femur includes:

Breathing exercises.
Physiotherapy.
Massage

In the process of rehabilitation after surgery, it is important to learn how to walk on crutches, distributing the load evenly. Recovery after a hip fracture is very long and requires the patient to be patient and willing to work on himself in order to restore all the functions lost after the fracture.

From the first days after the operation, it is necessary to perform active actions as:

Turns in bed.
Respiratory gymnastics.
Movements in large and small joints shoulders and forearms.
Isometric tension of the muscles of the legs.
Raising the torso with support for the frame or trapezoid.

In order to prevent atrophy of the muscles of the legs, it is indicated to perform:

Muscle tension in the limbs and pelvis gradual increase their intensity. The duration of the exercise is 5–7 s. You can do 8-10 such voltages at a time.
Flexion and extension of the fingers and toes, straightening the legs to appearance of a lung fatigue in the caviar muscles.
Imagination of movement, a mental message about a specific movement. Such exercises are called ideomotor, thanks to them stiffness in the joints will be eliminated.

Initially, after a hip fracture, rehabilitation begins with a slow walk along the hospital corridor under the guidance of a doctor. Walking at first is allowed only on crutches. Further, when the patient gets used to it, it will be possible to go down and up the stairs. If two crutches were previously used, over time, when there is more confidence in the legs, the crutches can be replaced with a cane or badik.

Note!

At first, all rehabilitation measures should be carried out under the supervision of a doctor or instructor. Further, at home, the rehabilitation process must be extended, having previously learned from the doctor about a set of exercises that will be useful for restoring leg functions.

Physiotherapy

Physiotherapy includes not only exercises for a hip fracture. The essence of this method of treatment is to relieve pain, inflammation and swelling of the limb. Thanks to physical therapy, it is possible to improve tissue trophism and metabolism in the area of injury. In addition to exercise therapy after hip fractures, and a gymnastic set of exercises, the following are shown:

Cryotherapy.
Magnetotherapy.
Laser therapy.
Electrophoresis.

The duration of treatment with these procedures is 5-10 times.

Thanks to integrated approach to rehabilitation, it is possible to quickly develop the leg. At the same time, some patients believe that physical therapy does not bring the desired result, and it does not need to be performed. This is not true. Exercise therapy is useful not only for general strengthening health, but also for the full recovery of the affected limb.

Massage

Massage allows you to normalize blood circulation in the affected areas. At the same time, a massage of the back, lower back and symmetrical limb, which was not injured, is prescribed. The duration of the massage is 7-10 procedures.

Complications and consequences

The consequences of a hip fracture are different. Among the most frequently encountered are:

Fat embolism.
Pin out.
Lameness due to shortening of the leg.
Delay in callus formation after a fracture.
Pseudarthrosis, false joints after a hip fracture.
Non-fused fragments, the causes of which have not been identified.
Suppuration.
Oncology.

If the fracture occurred in old age, the rehabilitation process will be very long. Often such people fail to regain 100% leg mobility.

Prevention

A fracture of the left hip, as well as trauma to the right, entails many complications, consequences that often cannot be reversed. However, statistics show that limb injuries can be prevented:

if you regularly visit a doctor and treat diseases;
if ;
if you avoid excessive physical exertion;
if regularly | orthopedic doctor Education: Diploma in the specialty "Medicine" received in 2001 in medical academy them. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty "Traumatology and Orthopedics" in the City clinical hospital No. 29 im. N.E. Bauman.

A displaced fracture of the femur is the most dangerous injury to a person. You should especially protect yourself from injuries to people in old age, since if the femoral neck is damaged, you have to for a long time be in a supine position, because of this, complications may arise from the work of the cardiovascular and respiratory systems.

Types of hip fracture

The thigh bone is the largest tubular bone in the human body. It is divided into the following departments:

upper end section (epiphysis);
lower end section;
central section (diaphysis);

In this regard, hip fracture is divided into three types.

Upper thigh injury

The proximal femur is located in the hip area, that is, at the junction of the bone with its head.

With a proximal injury, the following parts of the bone are damaged:

femoral neck;
femoral head.

Trauma to the femoral neck dangerous view damage and has high percent complications.

The main signs of an injury to the upper third of the thigh are the following symptoms:

Pain in the pelvic region.
The pain is aggravated by tapping on the heel of the injured leg.
Slight shortening of the leg.
There is a "stuck heel syndrome", this is when the victim cannot tear his foot off the surface.
AT horizontal position the victim's leg is turned outward.

The hematoma appears within a couple of days after the injury. In the supine position, the pain is significantly reduced.

Important! With the so-called “impacted fracture”, some victims can easily tear their leg off the surface and even walk, leaning on it.

If this type of injury is not detected in time, then the “fused” parts of the bones will disintegrate, and the injury will be complicated by displacement of the bones, which in turn will make it difficult for the already hard-to-heal fracture to heal.

Treatment

The following types of operations are carried out:

Fixation of bone fragments with the help of various devices, for example, a nail. After the operation, the patient is immobilized for 3 weeks. It is forbidden to load a sore leg for about six months.
Endoprosthetics. After this operation, the patient is recommended to develop the leg in a month.
Rehabilitation after a hip fracture.

Replacing a damaged joint is undoubtedly a significant plus for the elderly.

Mid-thigh injury

The main symptoms of such an injury are the following signs:

Pain at the fracture site.
Atypical bone mobility.
The leg below the fracture is turned outwards.
Shortening of the limb.
Edema.

Often the bone due to this type of injury is displaced due to muscle contraction during the injury.

Treatment

For a fracture of the middle part of the thigh, the following types of treatment are used:

Elongation of a limb.
Operation on the femur. It consists in fixing the bone with a special pin.

Also, the fixation of a broken bone is carried out with special plates.

When treating a fracture by stretching the injured leg, the following actions are performed:

The limb is fixed on a special apparatus at an angle, depending on the type of fracture. Fixation is carried out for 1.5-2 months.
After that, plaster is applied for about 3 months.

You can walk about two months after the end of the extraction, while not putting much strain on the leg, and only with the help of crutches.

A person becomes able-bodied 3-6 months after the injury, this period largely depends on age and physical form the victim.

Lower thigh injury

Distal femur - Bottom part the tubular bone of the thigh, most often the fracture occurs in the area above the knee joint.

The main symptoms of such a fracture are the following signs:

knee pain;
swelling of the knee;
limited mobility of the knee;
the lower leg can be turned inward or outward.

Elderly people are at risk for this type of injury. A displaced hip fracture may also occur.

Treatment

For trauma without displacement, the following treatment is performed:

Blood is pumped out of the injured knee with a special syringe.
Skeletal traction.
Plaster cast for 4-5 weeks.

Treatment can take place as an autopsy knee joint, and without opening. For a displaced fracture, the following treatment is used:

Fragments are fixed with special plates.
If the fracture was fixed well, then the subsequent application of gypsum is not performed.

With an injury to the middle part of the femur, the child has a risk that the leg will be shortened in length, since the growth of the limb in length occurs precisely due to the bones that make up the knee joint. With such a fracture, shortening of the bone occurs in 25% of cases. Therefore, surgery is often used after a hip fracture, and rehabilitation after surgery is also very important.

Important! When providing first aid to the victim, it is necessary to feel the area under the knee in order to make sure there is a pulse in the artery, since the femoral artery is very close to this section.

A person begins physical activity 3-4 months after the injury.

Recovery period

Highly milestone after a hip fracture will be rehabilitation, which lasts up to 6 months. It can also take place at home.

Important! Rapid and complete fusion of a fracture of the femoral neck occurs only in childhood.

How to quickly recover after a fracture? Undoubtedly, the most difficult period of recovery in humans occurs after a hip fracture. In this case, it is important to immediately begin to rehabilitate the injured leg.

exercise therapy

Gymnastics is the foundation of successful leg recovery. It can be started shortly after the operation, without even getting out of bed. You can do the following exercises:

Move your toes.
Rotation of the shoulders from a prone position.
Head rotation.
Exercises with small dumbbells or a hand expander.

Such actions will prevent stagnation of blood in the body, and improve metabolism.
After the patient is allowed to get out of bed, the following exercises will replenish the exercise therapy arsenal:

Flexion and extension of the knee.
Raising straight legs alternately.
Rotation of the feet in a circle.
Bringing the knees together and so on.

The next step will be learning to walk with crutches or a walker, reducing reliance on the arms from the moment the leg muscles are strengthened.

Important! Children should recover under the supervision of a rehabilitologist.

If pain occurs during exercise, it cannot be tolerated, it harms the heart vascular system. Pain medication should be taken.

Massage

Massage can do wonders. The advantages of massage are the following:

Improves blood circulation.
Prevents lung problems.
Normalizes the condition of the muscles.

Massage can be started already on the 2nd day after the operation.

Important! Massage should be done carefully, especially for the elderly, so as not to harm the cardiovascular system of the body.

The duration of the massage should be agreed with the attending physician. Also, do not trust massage to a non-professional.

Food

Nutrition is an important component of the recovery period after surgery, as for better healing bones need a whole complex of vitamins and minerals. The diet of a patient with a broken leg should consist of the following foods:

products with high content calcium;
rich bone broths;
cereals;
vegetables;
vegetable soups and purees.

All these principles of rehabilitation are also suitable for people with a fracture of the femur, in whom the treatment was carried out by a conservative method.

Fractures of the femur - very serious injury. The best prevention hip fracture is maintenance physical activity throughout life, which strengthens the bones and the body as a whole.

A hip fracture is a severe and very dangerous (especially for the elderly) injury that requires long-term treatment followed by rehabilitation. The latter is necessary to minimize possible complications. The injured joint is not adequately supplied with blood, oxygen and nutrients, which can cause aseptic necrosis - very dangerous complication, in which bone tissues gradually begin to die off and at a certain stage, the treatment of such an injury becomes impossible without implanting an artificial joint - an endoprosthesis.

Restorative rehabilitation after a hip fracture is designed to relieve pain and prevent complications by normalizing blood flow in the damaged area, restore joint mobility and bring weakened muscles to normal tone.

Rehabilitation measures with a conservative method of treatment

To relieve primary pain, drugs from the category of analgesics are used - ketanov, analgin and the like, and with regards to the arsenal of restorative measures for a fracture of the femoral head, it is somewhat limited, however, some of the exercises can be done from the first days. With a conservative approach, the following measures are gradually practiced:

Breathing exercises and simple movements;
Exercise therapy exercises with a gradual complication and an increase in their duration. Gradually, there is an increase in loads and more and more muscles are involved;
Therapeutic massage begins to be done already on the 3rd day after the injury. First, the lower back and healthy leg are massaged, then the massage is transferred to injured leg. Efforts limit, without leading to pain;
Starting from the 10th day, physiotherapeutic procedures are used - UHF, electrophoresis, ULF, LF and others;
14 days after injury to the femur, they begin to develop the sore leg with physiotherapy exercises;
Walking the diseased limb with crutches begins after 3 months from the moment of injury;
Walking limbs without crutches.

The terms indicated above are indicative and in each case are determined by the attending physician based on the state of the callus - according to an X-ray examination.

The final rehabilitation after a hip fracture is carried out under the supervision of an orthopedist through a complex of exercise therapy, massage and physiotherapy.

Rehabilitation measures in the surgical method of treatment

Here, the timing and methods of restorative procedures are highly dependent on the type and extent of the intervention. Fractures of the head of the femoral bone are restored by fixing the fragments with plates or screws, and in especially severe situations - fractures with multiple crushing of the bone, complications in the form of necrosis, etc., an operation is performed to replace the femoral joint with an artificial implant. In any case, the approximate order of rehabilitation is as follows:

A day after the operation, passive movements in the knee and hip joints and breathing exercises are done;
After about a week, you can get out of bed and walk on crutches without leaning on your sore leg;
12-14 days after the operation, you can slowly begin to lean on the injured limb, but not with a full weight, insuring yourself with crutches and provided there is no pain;
Depending on the situation, it is possible to fully rely on the injured limb approximately 1 to 4 months after the operation.

From the second - third day they spend full complex restorative activities, including exercise therapy, massage, water and physiotherapy.

Restorative exercise therapy exercises

As already mentioned, physiotherapy exercises are applicable from the first days after injury. It is especially important for older people, whose recovery is more difficult. Below is an exemplary exercise therapy complex.

Exercises for the lying patient:

Alternately, you need to bend and unbend the feet, holding them in a bent and unbent position for 5 seconds. Do the exercise for 5 minutes, while you can not bring to severe pain;
Simultaneously squeeze and unclench your fingers and toes. Compression should be carried out with some tension, but only in the absence of pain;
Without resting on the elbows of the hands, you need to pull up the healthy leg so that the entire plane of the Foot is pressed against the bed, and then lower the leg. Repeat 5 minutes with breaks;
Holding hands on the crossbar, you need to pull yourself up while raising the pelvis;
With a healthy limb, do bicycle-type movements for 5 to 10 minutes with a one-time approach of 1 minute;

Squeeze-unclench the toes - first on one leg, then on both;
Bend-unbend the ankle joints - alternately, and then simultaneously;
Bend-unbend the leg at the knee joint - first alternately, then both at once.

Exercises for the seated patient:

With outside help, lean on a walker;
With support on a walker, partially lean on a sore leg. Hold the support for 1-3 minutes.

Massotherapy

Prolonged immobilization, especially in elderly patients, causes a deterioration in the lymph and blood circulation of the bone, which adversely affects both the healing process of the injury and general condition, therefore, along with exercise therapy exercises, a massage is necessarily prescribed, which relieves pain and significantly reduces negative effect prolonged immobilization. It can be done from the first days after injury, even if the patient is in the stage of skeletal stretching. The procedure is carried out with gentle, light movements on the entire surface of the sore leg.

Application therapeutic massage in the early stages gives quite definite positive effects:

Restores blood circulation of the damaged area;
Reduces hypertonicity of the muscles of the injured limb;
Activates regenerative and trophic processes;
Relieves pain and significantly reduces the risk of complications.

At first, they massage mainly the healthy leg, and give the diseased limb no more than 5 minutes a day. Over time, this time is increased to 10 - 15 minutes. As for massage techniques, almost all known ones can be used, with the exception of intense deep vibration, which is transmitted to the bones of the skeleton and can contribute to the displacement of unfused bone fragments.

If already in early dates to carry out mechanical stimulation of the greater trochanter of the leg with massage elastic balls or a special ball vibrator, then the callus grows faster and recovery occurs sooner. But this is only in case correct use massage, so it is strongly not recommended to engage in self-massage - it can harm.

Diet during rehabilitation

Not last place in the process of restoring the functionality of the limb has proper nutrition. It should be rich in calcium - milk, cottage cheese, as well as proteins and vitamins. Diet must necessarily include fish, preferably sea, eggs, cabbage, preferably cauliflower, sea kale. Decoctions of dried fruits are also very useful.

Folk remedies

Here are 3 examples from numerous traditional medicine recipes:

Comfrey-based compress. Comfrey tincture is mixed with dimexide, diluted 1/1 in boiled water and make a compress for 30 minutes in the area of the femoral joint. After removing the compress, the skin is not washed or wiped. The course of treatment is 10 days for patients under 40 years old and 15 days for the elderly, 1 compress;
Compress based on flax seeds. From the seeds prepare a gruel of thick consistency and apply to the damaged area. The course of treatment is 15 days, 1 time. It is important to consider that such a drug retains its properties for no more than 2 days, so on the 3rd day it needs to be prepared new;
Juniper ointment. Prepared by heating in the oven juniper twigs, shifted with butter, after which it is filtered off and used as an ointment.

Conclusion

A fracture of the neck of the hip joint is a dangerous and intractable (especially in the elderly) injury, however, if you follow all the advice of the attending orthopedist and do not be lazy when doing exercise therapy, rehabilitation for a fracture of the femoral neck usually takes 9-11 months. During this time, the functionality of the joint is fully restored, and the patient begins to lead a normal life.

is a severe injury lower limb. Most patients are forced to stay on bed rest whole weeks or months.

The choice of method of treatment depends on what type of injury was received by the patient and in which part of the femur it occurred.

Causes of hip fracture

Direct impact of force (strike with a heavy object on the thigh);
Fall on the hip.

Signs of a hip fracture

tissue swelling;
Visible bone deformity;
Pain in the area of the fracture;
A person cannot step on his foot;
Violation of flexion in the joints;
Crepitus of fragments;
Bruising on the skin.

Rehabilitation after a hip fracture will be shorter and will be much easier for the patient if he has a positive attitude towards recovery and follows all the doctor's recommendations.

Choice of treatment method

Usually, after receiving an injury, the victim goes to medical institution where he is examined by a traumatologist. After an objective examination of the patient and x-ray examination the doctor makes a diagnosis. It is on the x-ray that you can determine in which place the bone has broken, whether there is a displacement of bone fragments.

A characteristic feature of the treatment of a hip fracture is the fact that preference is given not to the application of a traditional plaster cast, in this case it is best to use skeletal traction. sick under general anesthesia or under spinal anesthesia, an operation is performed during which a trauma doctor inserts a thin metal needle into the femur. After that, the patient's leg is suspended from both ends of the metal needle using various devices in a half-bent position. It is this method surgical treatment helps to ensure that the bone fragments of the femur grow together correctly. But with such treatment, the patient is forced to spend many weeks, and sometimes months, in a horizontal position in a hospital bed.

The main thing is a positive attitude towards recovery.

In this case, the patient should not actively move, change the position of his body abruptly. Naturally, this method of treatment brings the patient not only long-term physical, but also psychological discomfort.

In many patients, after a few days of such treatment, begins to develop depression, they cry, do not want to communicate with relatives and people around them, they believe that they were abandoned in "the most difficult period of their lives."

It seems to some patients that the fracture will never heal and they will remain disabled for the rest of their lives.

In such a situation, the support of relatives and close people, as well as medical personnel, is very important. They should instill hope in the patient for recovery, support him psychologically, and talk with him on various topics.

The patient's treatment process will be easier if he talks to patients from his ward, reads books. Doctors are not forbidden to use various gadgets, phones and laptops in the hospital. Some patients during their stay in the hospital learn a lot of useful information from the Internet, read about their disease, share their experiences and impressions in various forums.

But while being treated in a hospital, one should not forget about rehabilitation, including physiotherapy exercises and therapeutic exercises.

Even when the patient is on traction, even then it is necessary to begin the first classes.

The exercise therapy instructor should tell the patient which are the most simple exercises he can perform independently while in bed.

The simplest solution for expanding the motor mode is a stick suspended above the bed. With the help of it, the patient can independently sit down on the vessel, pull himself up and do various exercises for the hands.

We must not forget about the prevention of bedsores, which can form in patients as a result of a long lying on a hospital bed.

The best solution to this problem is to use various ointments for the prevention of bedsores. Relatives in the pharmacy need to purchase special rubber circles, which can be placed under the sacrum, gluteal region and heels.

Rehabilitation

Exercise therapy in the first period of treatment for hip fracture:

Exercises in which the process of flexion and extension of the foot occurs;
Exercises aimed at flexion, as well as extension of the toes;
The patient performs static tension, and then relaxation of the muscles of the lower extremities;
Periodically strains and after a few seconds relaxes the quadriceps femoris muscle;
The patient produces a cautious easy flexion and extension of the leg in the knee joint.

Exercise therapy in the second period of treatment for hip fracture:

Exercises aimed at abduction and slow adduction of the sore leg;
The patient performs a slow raising and lowering of the sore leg with the help of an exercise therapy instructor;

The patient is lying on his back, his arms are located along the body. He raises his hands up as he inhales, and as he exhales he lowers them down;
The patient is lying on his back and imitates the "boxing" movement with his hands. Every day the movements of the patient should be more intense;
The patient in the supine position tries to reach his chest with his chin and linger at the top for a few seconds, then slowly return his head to the bed. This exercise must be done very carefully, without jerking, gradually stretching the back of the neck;
The patient, on inspiration, strongly compresses his fingers into a fist, and on exhalation, unclenches them;
The patient is in the supine position and at the same time slowly pulls the feet towards himself, then lowers. You can complicate this exercise somewhat if, when raising the feet, spread the toes in a “fan”, then squeeze and lower the foot;
The patient flexes the healthy leg at the knee joint. When performing this exercise, you can not take your heel off the bed;
The patient performs movements with the fingers of a fixed leg;
The patient raises his hands up, then, while inhaling, reaches with his fingers to the headboard, while exhaling, he lowers his arms along the body;
Breathing exercises, which include diaphragmatic, portioned;
The patient performs tension and subsequent relaxation of the gluteal muscles;
The patient performs tension and relaxation of the quadriceps femoris muscle.

In the first period, the patient should perform each exercise 10-12 times. At the same time, he should not experience discomfort and pain.

In this paragraph of the article, we will tell you what exercises can be performed with a hip fracture in the second period of rehabilitation.

The patient is in the supine position, hands behind the head are intertwined. On inspiration, he raises his hands up, and on exhalation, he returns to their previous position;
The patient performs hand movements that resemble stretching of dense rubber;
The patient bends and unbends a healthy leg;
The patient mentally (imagines movements) flexes and unbends the leg at the hip and knee joints, and also flexes and unbends the affected leg at the ankle joint;
The patient holds on to the edges of the bed with both hands and tries to slowly raise the upper body, slightly tearing the pelvis off the bed;
This exercise is performed in the ward with a neighbor. Any object is passed to him with his left hand, and then vice versa with his right;
The patient performs deep diaphragmatic breathing;
The patient bends a healthy leg at the knee joint, but at the same time it is impossible to tear off the heel from the bed. With both hands, you need to grab the edge of the bed and try to lift not only the pelvis, but also the sore leg in the cast. When performing this exercise, the main points of support are the back of the head and the foot of a healthy leg. Some patients are afraid to do this exercise at first, but the exercise therapy instructor should “insure” them;
The patient gently rotates the torso from the back to the stomach. When performing this exercise, the exercise therapy instructor should help the patient and slightly hold the leg, which is in plaster;
Given that the diseased leg is in limbo, a wooden board is applied to the foot and the patient tries to press the board with the foot of the diseased leg.

In the second period of rehabilitation, exercises in water are very effective.(e.g. in a swimming pool) with a comfortable water temperature. The patient can make various swings with the sick leg, bend it and unbend it. Classes for older people with a hip fracture in the pool should be carried out only in the presence and under the guidance of an experienced instructor.

Third period

The patient in the supine position performs circular motions hands;
The patient performs movements that mimic the "boxing" of the pear;
The patient in the supine position slowly raises his hands up while inhaling, slowly lowers them down while exhaling;
The patient bends the healthy leg at the knee joint, and then leans on the back of the head and tries to raise the pelvis and the affected leg. Hands when performing this exercise hold on to the edges of the bed;
The patient puts one hand on the abdomen, and the other on chest. Performs slowly respiratory movements(abdominal type);
The patient from a supine position slowly rolls onto his stomach. If he has certain difficulties in performing this exercise, then the exercise therapy instructor should help him make a turn;
The patient does the plank exercise with straight arms. At the same time, he rests his hands and the toe of a healthy leg on the bed.

What to do if the knee does not bend

Many patients who have been in a cast for more than 2.5 months have the problem of how to develop the knee.

In this case, the issue should be resolved by two doctors - a traumatologist and a rehabilitologist.

If the joint is very swollen, then you can use at home various compresses and rubbing. Some doctors prescribe chondroprotectors to their patients. A good effect to improve blood circulation in the muscles and ligaments of the knee joint is given by physiotherapy and massage.

The patient should understand that the sooner he starts exercise therapy and classes therapeutic gymnastics, the faster the range of motion in the knee joint will be restored.

In some patients during long period the leg is not developed after a hip fracture, the person is lame, the leg quickly gets tired and swells in the evening. In this case, to restore the function of the femur and knee joint, the patient is recommended to take up dancing, swim more in the pool.

Hip fracture is a violation of the integrity of the femur, which occurs as a result of injuries and various pathologies femur. Any bone fracture causes anxiety and anxiety in a person: whether the bone will grow together correctly and how the functions of the lower extremities will be restored. It will take a lot of strength and courage to survive a broken leg and, above all, psychological nature. After all, having remained bedridden for a long time, a person is in a constantly depressed state of mind, he develops depression. One of these complex injuries that require serious treatment and prolonged immobility is a fracture of the femur.

The largest anatomical segment of the lower extremities is the femur, which is a tubular bone. FROM outer side bone is lined with periosteum connective tissue), which causes the development and growth of bones in children, and also contributes to its fusion in fractures and injuries.

The femur has its own specific structure:

two epiphyses (upper and lower);
the body of the bone is the diaphysis;
bridges or areas connecting the diaphysis with the epiphyses;
where muscles attach to bone (apophyses).

The upper epiphysis contains the head, which is located in the articular cavity. Below the head is the neck - the thinnest and most vulnerable part of the hip joint. It is attached to the body of the bone at a certain angle. At the place of their connection there is a small and greater skewer. With a fracture of the femur, the functionality of the entire anatomical structure, that is, the lower limb, is disrupted.

It is especially difficult for the femur to grow together in old age; for young people or children, such a fracture is also dangerous, but the chance of a successful outcome is much higher.

The femur performs one of the most important functions in the body - it connects the upper part of the skeleton with the lower limbs. It also performs a number of other functions:

support function (the main ligaments, muscles and tendons are attached to it, which are responsible for the movements of the lower extremities);
motor function (is a certain point of support during movements);
blood-forming function (in the region of the femur is Bone marrow where stem cells are born that mature into adult blood cells);
participates in phosphorus-calcium metabolism.

Causes of the fracture

In young people, such injuries occur as a result of falls from a height, traffic accidents, a strong direct blow to the thigh. In older people, such injuries are also caused by injuries, but in this case, even the slightest bumps and falls, and sometimes even a simple stumble, damage the integrity of the femur. Such fragility and fragility of bones is explained by degradation bone mass in the elderly (after 65 years).

In children, similar injuries also occur and their causes are the same as a fall from a height, a strong blow or twisting of a limb. If a pathological process is observed in the femur, then exposure to it will lead to damage and injury.

Types of hip fractures

Injuries may include:

hip fracture with displacement;
open hip fracture;
closed hip fracture.

Fracture with displacement

It occurs as a result of the impact of significant force on different parts of the femur. This type of damage is most common in older people with osteopenia and osteoporosis. In this case, the body of the bone or its distal part is most often damaged.

A fracture with a displacement can be of several types:

damage to the proximal part (lateral and medial);
damage to the middle third with displacement (diaphyseal);
damage to the lower third (distal or condylar).

Each type of damage has its own characteristic symptoms.

Proximal injury

Medial - represent damage to the head and neck of the femur. Lateral - damage to the trochanter (large and small).

In case of injury, a slight pain syndrome is felt in the groin area, which is hardly noticeable at rest. However, when you try to move your leg or lean on it, the pain increases and becomes unbearable. With this damage, characteristic manifestation- a symptom of a sticky heel. It is manifested by the inability to raise the leg while lying on the back.

Damage to the middle third with displacement

Characterized by acute pain syndrome, hematoma formation, severe swelling, displacement of bone fragments, an increase in the circumference of the thigh. Fragments of bones damage blood vessels, which always leads to profuse bleeding. There is pathological mobility of the thigh and crepitus of fragments. When probing, you can find the ends of bone fragments, which, when shifted, lead to a shortening of the limb on the damaged side.

Damage to the lower third

The pain is moderate and extends to the knee. There is also swelling and limited mobility. The limb is displaced relative to its axis, and the rupture of the vessels entails a substantial loss of blood.

Open fracture

One of the most dangerous injuries, which has many unpleasant complications. Successful treatment and the recovery of an open fracture depends on how competently the first aid was provided.

Trauma can be identified by the following symptoms:

unbearable pain in the thigh;
formation open wound due to violation of the integrity of the skin;
the development of severe bleeding;
restriction of mobility;
bone fragments are in contact with the external environment.

Since the bone fragments are visible through the wound, it is not at all difficult to diagnose the type of injury. Broken bones can cause severe injury blood vessels, muscles or nerve endings.

If large vessels are damaged, severe bleeding may occur. When providing first aid, first of all, the bleeding should be stopped, otherwise, blood loss can lead to a violation heart rate, traumatic shock, panic attack, loss of consciousness, and sometimes death.

Closed fracture

At strong impact many bone fragments can occur on the femur. Usually such injuries are closed and without displacement of fragments. Recognizing a closed fracture is not easy. The following symptoms usually accompany the injury:

severe pain that spreads from top to bottom down the leg;
inability to lean on the leg and stand on it;
limb edema;
hematoma and bruising in the area of damage;
shortening of the injured leg;
change in the shape of the thigh at the site of injury (breeches effect).

Damage can be identified by visual changes in the hip joint and limb after injury. Another thing is with impacted injuries of the upper part of the hip joint. In this case, a person will be able to stand and even step on his foot, because clinical picture such injuries are less pronounced.

First aid for hip fracture

Depending on the type of fracture, first aid is provided. So, for example, with an open fracture, it is necessary first of all to stop the bleeding. When closed fracture, it is impossible to determine where the injury occurred.

So, first of all, it is necessary to immobilize the injured limb with the help of the Dieterichs bus. However, this design may not be readily available as it is found in specialized ambulances. Therefore, such a tire must be built from improvised means. Skis, boards, pieces of plywood, etc. can act as such means. Two oblong objects made of dense material are used to firmly fix the limb. They are applied from different sides, opposite to each other.

When using a tire, it must be remembered that it is applied taking into account anatomical features this zone. Which joints are subject to fixation in case of hip fracture? It is necessary to fix three joints at once: hip, knee, ankle. The tire should not be adjacent to the wound, that is, in the area of \u200b\u200bprotrusion of bone fragments outward. A soft tissue should be placed at the joints under the splint so as not to compress the vessels and not disrupt blood circulation.

In order to correctly apply the tire, it is necessary to put its long part on the outside so that one end is at the level of the heel, and the other rests against armpit. The other tire must reach inguinal region and located with inside. I use the third tire when transporting the victim. It is superimposed on the posterior region of the lower limb and should capture the foot. If there was no object that can be used as a splint, then immobilization can be ensured by tightly bandaging the injured leg to a healthy one. You can tie one leg to the other with a towel, a piece of cloth, a sheet, a shirt, or other material.

To prevent the development of pain shock, it is necessary to carry out anti-shock measures and analgesic therapy. The ideal pain reliever is injections of promedol or morphine, but the presence of such drugs in an ordinary first-aid kit is unlikely, so you can give the victim tablets of analgin or other painkillers. If they are not at hand, then you can reduce the pain with a few sips of strong alcohol.

It is possible to transport the victim to a medical facility only in the supine position, otherwise there is a risk of displacement of bone fragments and development severe consequences(fat embolism, large blood loss).

What is contraindicated to do in case of injury

If an injury occurs, it is strictly contraindicated:

the victim to move independently;
lean on the affected limb;
fix the splint to the leg too tightly, as blood circulation and its innervation may be disturbed, regularly monitor the color of the leg and its sensitivity;
fixing the sore leg too weakly;
be afraid of sagging of the foot, this happens when it is poorly fixed;
not enough soft tissue under the tire, which can lead to the formation of wounds;
keep calm and composure, because confidence and calmness can be transmitted to the victim.

Treatment

Treatment involves the use of skeletal traction and pins. However, each type of injury has its own principles of treatment.

If the proximal part is damaged, the neck is most often affected. In this case, the treatment is surgical. Used in the treatment of young people conservative therapy, which involves wearing a plaster cast for 2-3 months. Then the movement is carried out on crutches, however, without the load on the injured leg. You can load the limb a year after the injury. Full recovery occurs after eight months. Elderly people undergo skeletal tension for two and a half months.
At lateral injuries use conservative treatment, which has good performance. Elderly people are prescribed skeletal traction, and then cuff traction.
With diaphyseal - use both conservative treatment and surgical. A large hip bandage is applied if the bone fragments have not been displaced. Skeletal traction is prescribed for oblique and spiral injuries.
With distal - superimposed gypsum bandage for two months. If the displacement of the fragments is noted, before applying the bandage, they are repositioned.

As clamps, devices such as splints and pins are used. They are introduced into the bone and head through the saddle. Several fixing screws are also used.

Hip fracture rehabilitation

Rehabilitation must begin as soon as possible. It pursues the following goals:

prevention of muscle atrophy;
early formation of callus;
security motor activity and function of the limb.

As recovery procedures use:

physiotherapy procedures;
massage;
physiotherapy exercises.

Massage and physiotherapy exercises are used from the very first days. As you recover, the volume physical activity increases. This is a prerequisite that prevents the development of muscle atrophy, the formation of contractures and strengthening of the ligaments. During exercise, blood circulation in the damaged area improves, accelerated regeneration soft tissues.

Physiotherapeutic procedures are carried out in order to improve the condition of blood vessels, soft tissues and oxygen enrichment. For this, appoint:

ultraviolet irradiation (UVR);
electrophoresis;
magnetotherapy;
iontophoresis.

Recovery continues at home. A person independently performs physical therapy and massage.