Disability after a hip fracture. Is there any disability for a hip fracture?

Femoral neck fracture– trauma in which there is a violation of integrity femur in the neck area - the thinnest part connecting the body of the bone with its head.

Femoral neck fractures account for 6% of all types of fractures. Statistics show that most often it is pathological and occurs as a result of minor trauma in a person with osteoporosis. The pathology is most common among women after menopause. 90% of cases occur in people over 65 years of age.

This type of injury is characterized by the fact that the fusion of fragments always occurs poorly, over a long period of time (the reasons will be discussed below). Often patients tolerate surgical intervention much easier than long-term conservative treatment.

Due to the fact that the injury in most cases occurs against the background of osteoporosis, this does not require a significant traumatic effect. A femoral neck fracture can occur when a person falls from their own height, for example, if a person slips or stumbles while walking.

The most severe complication of this type of fracture is aseptic necrosis(death) of the head of the femur. It resolves and this leads to the need for prosthetics.

Anatomical features of the femoral neck and hip joint. Mechanism of femoral neck fracture.

The hip joint is one of the largest and most powerful in the human body, as it bears the greatest load during standing and walking.

Elements that make up the hip joint:

• glenoid cavity, located on the bones of the pelvis, has a cup-shaped shape;
• articular cartilage located around the glenoid cavity, additionally covers the head of the femur and strengthens the joint;
• femoral head spherical in shape is located in the articular cavity, a thin ligament extends from its top to the center of the cavity;
• femoral neck– the thin part of the femur that connects its head to the body;
• greater trochanter and lesser trochanter– bony protrusions located behind the neck of the femur, muscles and the capsule of the hip joint are attached to them;
• joint capsule The hip joint covers the socket, head and neck of the femur.

Anatomical features that influence the specificity of femoral neck fractures:

• the femoral neck is located inside the articular cavity, covered by the articular capsule and not covered by the periosteum (the outer layer responsible for the growth and nutrition of the bone);
• the neck of the femur comes off from her body at an angle, which normally can be from 115⁰ to 135⁰: the smaller the angle, the greater the load on the femur, increasing the likelihood of a fracture;
• main arteries, supplying blood to the neck and head, penetrate the bone along the lower edge of the articular capsule and in the recess between the trochanters;
• to the head of the femur Only one artery is suitable, located in the ligament connecting it to the center of the glenoid cavity: in older people it becomes overgrown.

In most older people, the blood supply to the head and neck of the femur is from below, from the neck and trochanters. If the fracture occurs close to the head, then it practically stops receiving blood. Necrosis and resorption occurs.

Typically, a femoral neck fracture occurs when a traumatic force is applied along the axis of the leg. For example, when a person falls on a straightened leg. When a traumatic force is applied perpendicularly (a blow to the hip joint area from the side, a fall on the hip joint area), a fracture of the pelvic bones most often occurs, but the femur may also be damaged.

Causes of hip fractures

The causes of hip fractures differ between young and old people.

Causes of hip fracture in older people

In people over 40–50 years of age, the main cause of injury is increased bone fragility due to osteoporosis. To cause a fracture, a minimal traumatic force is required, for example, when falling from your own height while walking.

Factors predisposing to pathological fractures of the femoral neck in older age:

• oncological diseases;
• visual impairment;
• sedentary lifestyle;
• malnutrition, starvation;
• menopause in women;
• diseases of the nervous system accompanied by movement disorders;
• atherosclerosis, obliterating endarteritis and other vascular pathologies.

Causes of hip fractures in young people

In young people whose bones have normal strength, a strong, high-energy traumatic impact is required to cause this type of fracture.

Most common reasons femoral neck fractures at a young age:

• traffic accidents;
• work injuries;
• falling from high altitude;
• combat wounds in places of military conflicts.

Types of femoral neck fractures

The location of the fracture line on the femoral neck is of great importance for further forecast. The closer to the head the bone is broken, the greater the risk that necrosis will occur.

Types of fractures by level of location:
The fracture line can run horizontally or vertically. The more vertical it is, the higher the risk of displacement and complications.

The prognosis is influenced by the degree and direction of displacement of fragments.

Types of displacements in femoral neck fractures:

• varus fracture– the head of the bone moves downwards and inwards, the angle between the neck and the body decreases;
• valgus fracture– the head moves upward and outward, and the angle between the neck and the body of the bone increases;
• impacted fracture- one fragment is driven into another, most often such a fracture is simultaneously valgus.

Symptoms of a hip fracture

Symptom	Description
Leg dysfunction	After a fracture, the patient most often cannot stand or walk. Movement in the hip joint is almost impossible. This occurs due to a violation of the configuration and function of the joint.
Pain in the groin area	Usually the pain is not very pronounced, because the fracture is pathological and is not associated with severe trauma. Sometimes the patient does not even notice the moment of the fracture and does not experience the acute pain characteristic of injuries. At rest, the pain completely subsides, and when the patient tries to move the leg, it occurs again.
Rotate the leg outward	When the patient lies relaxed, the leg on the affected side is turned outward. This is revealed by the position of the foot and knee. This symptom due to the peculiarities of muscle attachment to the greater and lesser trochanter of the femur.
Inability to turn the leg inward	The patient is unable to turn the leg on the affected side inward. This symptom, like the previous one, is due to the peculiarities of muscle attachment to the greater and lesser trochanter of the femur. Turning the leg outward can be physiological when there is no injury. But if it is impossible to turn inward at the same time, then this always indicates pathological changes.
Pain on axial load	If you press on the patient's heel or tap it with the leg straightened, pain will occur.
Leg shortening	Occurs when varus fractures when the angle between the neck and the body of the femur decreases. It is expressed insignificantly and most often is not noticeable externally.
Subcutaneous hematoma (bruise under the skin)	Occurs in the groin area a few days after the injury. First, vascular damage and hemorrhage occurs in the joint area, deep in the tissues. It then becomes noticeable under the skin.

Peculiarities of symptoms in impacted femoral neck fractures

If the fracture is impacted, then all the symptoms described above may be absent. The function of the limb is practically not impaired. The patient can walk. The only symptom is pain in the groin area, which is not given much importance due to its low intensity.

A few days later, the fracture “breaks apart.” The impacted fragment comes out of the second one, they become separated. All the symptoms described in the table above occur.

X-ray for femoral neck fractures

X-ray is a study after which a final diagnosis of a femoral neck fracture can be established. To get an accurate result X-ray images performed in anterolateral and lateral projections. Sometimes the doctor prescribes additional images in other projections, when the hip is maximally brought to the midline or abducted.

What does a patient with a hip fracture look like? Photo:

Treatment of femoral neck fractures

Is it possible to treat a hip fracture without surgery?

Indications for which conservative treatment of femoral neck fractures may be prescribed:

• impacted fractures;
• fractures in the lower part of the neck, the line of which passes through the greater and lesser trochanters;
• patient's serious condition, which is a contraindication to surgical treatment.

Conservative treatment of impacted femoral neck fractures

An impacted fracture can be treated without surgery only if its line is horizontal. With vertical fractures there is a high risk of “splitting”, so their conservative treatment is undesirable.

Treatment of impacted femoral neck fracture in patients young.

A plaster splint is applied to the hip joint area, extending to the knee joint. Wearing period is 3 – 4 months. Patients are allowed to walk on crutches without relying on the injured leg.

Treatment regimen for hip fracture in elderly patients:

• conservative treatment is carried out in a hospital setting, in a traumatology and orthopedics clinic;
• skeletal traction is applied for 1.5 - 2 months, usually with a load weighing 2 - 3 kg;
• from the first days of treatment, the specialist engages in physical therapy with the patient;
• after removing skeletal traction, the patient is allowed to walk on crutches without leaning on the sore leg;
• after 3–4 months, small, strictly dosed loads are allowed under the supervision of a specialist;
• after 6 months it is allowed to lean on the injured leg while walking;
• After 6–8 months, the patient’s ability to work is completely restored.

Conservative treatment of lateral femoral neck fractures

Lateral fractures capture the lower part of the neck of the femur, their line runs along the greater and lesser trochanters. Strictly speaking, these are not fractures of the femoral neck, but of the body. There are the least problems with their treatment because they grow together relatively well and quickly.

Conservative treatment of a non-displaced fracture:

• a bandage is applied to the hip joint area for a period of 2.5 - 3.5 months, until complete fusion occurs;


• After 1.5 - 2 months from the start of treatment, dosed loads on the injured leg are allowed.

Conservative treatment of a displaced fracture:

• application of skeletal traction to the leg, usually weighing 6–8 kg, treatment in a hospital setting;


• after removing skeletal traction, wear a plaster cast.

Conservative treatment for contraindications to surgery

A technique known as early immobilization is used. Its goal is to save the patient's life. In this case, fusion of the fragments does not occur.

Indications for early immobilization:

• general serious condition of the patient, general contraindications to surgical interventions (exhaustion, increased bleeding, etc.);


• senile insanity and others mental disorders;


• if the patient could not walk independently before the fracture.

Treatment regimen for early immobilization:

• local anesthesia joint areas (injection with novocaine, lidocaine);
• skeletal traction within 5 – 10 days;
• after removing traction the patient is allowed to turn on his side, hang his legs off the bed, and sit down;
• walking on crutches start from the 3rd week from the start of treatment;
• further the patient cannot walk independently; he moves only with the help of crutches.

Surgical treatment for hip fracture

When is surgery indicated for a broken neck?

Due to the above anatomical features, healing of femoral neck fractures usually occurs poorly and takes a long time, within 6 to 8 months. About 20% of older patients die from complications. Therefore, surgical treatment should be carried out in all cases where it is possible.

If there are no indications for conservative treatment described above, surgical intervention is always performed.

It is advisable to perform the operation as quickly as possible. When the patient is admitted to the hospital, it is carried out urgently. If the operation is not performed immediately, then skeletal traction is first applied.

General principles of surgical treatment of femoral neck fractures

• the operation can be performed under local anesthesia or general anesthesia, depending on the patient’s condition and the volume of intervention;
• before fixing the fragments, they are performed reposition– correct comparison;
• if the fracture is simple enough and it is possible to intervene under X-ray control, then reposition is performed in a closed way– the capsule of the hip joint is not opened;
• V difficult cases when X-ray control is not possible, perform open reduction with opening of the capsule.

Types of surgical interventions for femoral neck fractures

Type of intervention	Description
Osteosynthesis– connection of fragments using metal fixing structures
Osteosynthesis using three-blade Smith-Petersen nails	The Smith-Petersen nail is thick and has a three-bladed cross-section. It securely holds the femur fragments. It is driven into the femoral neck using a special hammer from the side of the trochanters of the femur.
Osteosynthesis using three screws	More reliable way compared to using a nail. It is used mainly in young patients. Move surgical intervention : the doctor makes an incision and accesses the joint; from the side of the trochanters, several thin knitting needles are twisted into the femoral neck using a drill; do x-rays; the three most well-placed knitting needles are left in place, the rest are removed; along the left knitting needles, as if along conductors, screws are tightened, which look like a hollow tube and are threaded on the outside.
Osteosynthesis using a dynamic hip screw - Dynamic Hip Screw (DHS)	The DHS is a metal structure with several screws that are screwed into the femur. It is quite bulky and its installation is difficult. Therefore, many orthopedic traumatologists prefer to use several separate screws instead.
Hip replacement– replacement of the femoral head and acetabulum with prostheses. Carried out when high risk development of complications. Indications: the patient is old and the fracture line passes directly under the head of the femur; significant displacement of fragments; compound fractures; the presence of several fragments, fragmentation of the head and neck of the femur; already developed aseptic necrosis of the femoral head.
Endoprosthesis replacement with total hip joint prostheses.	Total prosthesis replaces the head and neck of the femur, the acetabulum of the pelvis. Methods of fixation of total hip joint prostheses: Cementless. Suitable for young patients with normal condition bone tissue. Between the surface of the prosthesis and the bone there is a spongy layer. Over time, the bone tissue grows into it, and reliable fixation is achieved. Cement. Typically used in older patients with osteoporosis. Prosthetic leg fixed in the bone using special cement. Despite the fact that modern hip replacements are durable, over time, as a rule, there is still a need to replace them.
Monopolar femoral head prosthesis.	Only the head and neck of the femur are replaced. The prosthesis is not installed on the acetabulum. Such prostheses have one big drawback: as a result of constant friction of the artificial head against the acetabulum, its articular cartilage wears out more quickly.
Bipolar femoral head prosthesis	The head of the prosthesis is placed in a special capsule, which is in contact with the acetabulum. The main friction occurs not between the prosthesis and the socket, but within the prosthesis itself. This reduces wear on the joint.

What is the approximate cost of surgery for a hip fracture?

Price surgical treatment determined by the following factors:

• type, complexity and duration of surgical treatment;
• type and cost of the metal structure and prosthesis used;
• the clinic where the treatment is carried out, the doctor who cares for the patient;
• prices in Russian and foreign clinics most often vary greatly.

The average cost of surgical treatment of a femoral neck fracture in Russia is $2000. This figure can vary greatly. There are programs social support, in which the operation can be free for the patient.

How is rehabilitation carried out for patients operated on for a femoral neck fracture?

The system of rehabilitation measures for a femoral neck fracture is aimed at accelerating the healing of fragments and restoring the patient’s activity. The timing of each event is determined individually by the attending physician.

Massage

After suffering a femoral neck fracture in rehabilitation period held light massage different groups muscles.

Purposes of massage:

• improving blood circulation and lymph outflow;
• prevention of trophic disorders, bedsores;
• prevention of congestive pneumonia(inflammation of the lungs, which develops as a result of prolonged immobility) - for this purpose a massage is performed chest;
• normalization of muscle tone, preventing their atrophy and preventing osteoporosis;
• improving the function of the respiratory and cardiovascular systems.

In elderly patients, massage is performed very carefully, in short sessions, to avoid increased stress on the cardiovascular system.

Physiotherapy

Purpose therapeutic exercises :

• preventing complications;
• preventing muscle atrophy, normalization of their tone and movements;
• prevention of osteoporosis;
• recovery motor activity patient.

Approximate sets of exercises for patients with a hip fracture (selected individually in each case):

Exercises of the first period	Ideomotor exercises. The patient does not perform the movements, but only imagines them. This greatly facilitates the restoration of motor activity in the future. . The patient alternately strains the muscles of the back, buttocks, abdominals, arms and legs. This helps prevent muscle tissue atrophy and improve blood flow. The time of tension for each muscle is 20 seconds. The exercise is performed 2 – 3 times a day. Starting position: lying on your back. Movements in different parts body: turns and tilts of the head, flexion and extension in the elbow, shoulder, wrist joints, movements of the healthy leg. You can use small dumbbells and expanders (at the discretion of the doctor). The set of exercises is performed first once a day, then 2 times a day; Breathing exercises. Aimed at prevention congestive pneumonia– pneumonia, which occurs as a result of prolonged immobility of the patient.
Second period exercises	This set of exercises is performed after the patient's plaster is removed. The starting position in all cases is lying on your back: flexion and extension at the ankle joints; rotation of the feet clockwise and in the opposite direction; flexion and extension in the hip joints; spreading to the sides and bringing together the legs, which are bent at the knee joints; spreading to the sides and bringing straight legs back together; alternately raising straightened legs; lowering the legs bent at the knee joints onto the bed to the right and left; breathing exercises.
Third period exercises	This set of exercises is associated with the restoration of motor activity, when the patient is allowed to gradually stand up. Walking with stilts: gradually reduce the load on the arms and increase on the legs; Walking with two sticks; Walking with one stick; Independent walking.

The patient begins to engage in therapeutic exercises in the hospital. For this purpose, a specialist visits him daily. In the future, it is recommended to call a specialist at home to continue treatment.

Drug therapy*

Medications used for hip fractures:

• local anesthetic agents: Novocaine, Lidocaine, etc.: the doctor performs local injections that help cope with pain;
• painkillers: Analgin, Baralgin, Ketorol, etc.
• sedatives and hypnotics: Phenazepam, Motherwort infusion, Valerian infusion, Novopassit, etc.
• agents that improve blood flow in small vessels: Picamilon, Vinpocetine, Nicotinic acid, Cinnarizine, etc.;
• anticoagulants (Clexane, Warfarin, Fragmin, Xarelto, Arixtra)– drugs that reduce blood clotting and prevent the formation of blood clots in blood vessels.

*All medications are taken strictly as prescribed by the doctor.

Psychotherapy

Patients with a hip fracture are often depressed due to prolonged immobility. For most patients, sessions with a psychotherapist are recommended.

How to care for a patient with a hip fracture before surgery?

Bedridden patients with a hip fracture require constant care.

Care measures:

• frequent change of underwear and bed linen;
• it is necessary to ensure that there are no folds on the bed, crumbs and dirt do not accumulate;
• if the patient is in skeletal traction, then his leg should be placed in correct position using sandbags;
• regularly wash the patient with a damp cloth and special products;
• regular supply of the vessel if necessary, careful compliance intimate hygiene;
• the patient is assisted in daily washing and brushing of teeth;
• if after the operation there is urinary retention or incontinence (in most cases this is a temporary phenomenon), then it is established urinary catheter;
• When caring for a patient in serious condition, the caregiver's responsibilities include feeding the patient.

Nutrition for patients with hip fracture

Most often, a patient with a fracture of the femoral neck experiences a decrease in appetite. Food should be tasty, have enough calories, improve digestion and contain a sufficient amount of calcium.
General nutritional recommendations for a patient with a hip fracture:

Product group	Products	Meaning
Fiber-rich foods	fruits (apples, bananas, oranges, grapefruits, plantains, etc.); vegetables (beets, cabbage, potatoes, carrots, etc.); cereals (wholemeal bread, whole grain pasta, oats); nuts (almonds, cashews, peanuts, pistachios, walnuts); beans (beans, peas, soybeans).	Fiber ensures normal intestinal motility (motor function) and ensures the maintenance of normal microflora.
Milk and dairy products	milk; cottage cheese; kefir; Ryazhenka	Milk and fermented milk products are a source of calcium, which is necessary to ensure the normal condition of bone tissue and the rapid healing of fragments.
Drink plenty of fluids	fruit drinks milk	The liquid helps flush out harmful metabolic products from the body. Need to limit drinking regime in people suffering from heart disease, kidney disease, prone to edema.
Limiting meat food		The presence of excess meat in the patient’s diet, especially fatty meat, negatively affects intestinal function and the condition of blood vessels.

What are the traditional methods of treating a hip fracture?

Femoral neck fracture is a disease that can lead to severe complications and requiring treatment under the guidance of a specialist (orthopedic traumatologist). Folk remedies can be used during the rehabilitation period to reduce pain and accelerate the fusion of fragments. Before using any methods, you should definitely consult with your doctor.

Ring magnets

Magnets with an induction of no more than 100 mT, which are usually used in water filters and loudspeakers, are suitable for treatment. For treatment, a magnet is applied to the skin in the area of ​​the damaged hip joint and moved clockwise for 10 minutes. Then the magnet is turned over and the other side is done the same.

Mumiyo

Take a certain amount of mummy and mix with vegetable or rose oil until a homogeneous mass is obtained, resembling an ointment in consistency. Rub into the skin over the affected joint 1 – 2 times a day.

Potato

Raw potatoes are used to relieve pain from hip fractures. Take one medium-sized potato and grate it on a fine grater. The resulting pasty mass is applied to the joint area.

Geranium leaves

Pour 1 - 2 teaspoons of dried geranium leaves with a liter of water. Boil, strain. The resulting decoction can be used as a bath or compress on the hip joint area.

Are patients with a hip fracture entitled to disability?

Reduced qualifications when transferring to another place of work, the need for which is caused by a fracture of the femoral neck.	III disability group
Initial examination of patients whose fracture is complicated false joint(see below).	II disability group
Unfused false joint with moderate impairment of support on the injured leg and movements.	III disability group
Complication in the form aseptic necrosis femoral head(see below)	II disability group
Complication in the form arthrosis of the hip joint(see below).	III disability group

Complications and consequences of a hip fracture

1. Aseptic necrosis of the femoral head. Its necrosis and resorption occurs as a result of circulatory disorders. If there is a high risk this complication, then in order to prevent it, preference is given to joint replacement before osteosynthesis.


2. Pseudarthrosis formation. Occurs when fragments fail to union - a movable joint is formed between them. In this case, dysfunction of the leg can be expressed in varying degrees. Often they are minor and the patient can move freely. Treatment is surgical.


3. Vein thrombosis. When lying in bed for a long time, venous blood stagnates, which results in the formation of blood clots. In order to prevent thrombosis, they try to restore the patient’s motor activity as early as possible.


4. Congestive pneumonia. When the patient is weakened and bedridden, his function respiratory system broken.
   Mucus stagnates in the lungs. Pneumonia develops. Often it is very severe and leads to the death of the patient. Prevention is carried out using breathing exercises.


5. Early complications after surgery: insertion of screws at the wrong angle, insufficient or too deep insertion of screws into the bone, damage to the acetabulum, vessel or nerve.


6. Late complications after surgery: loosening of the metal structure, failure of the prosthesis.


7. Joint infection after surgery, development of arthritis.


8. Arthrosis– degenerative disease of the hip joint. Leads to disruption of its function. Requires long-term conservative treatment.

How to prevent hip fracture?

Prevention of this type of fracture mainly involves preventive measures, directed against osteoporosis:

• Full physical activity, sports and gymnastics at any age.
• Nutritious food, the presence in the diet of a sufficient amount of foods high in calcium.
• The use of multivitamin complexes and dietary supplements with calcium is especially important in old age, during menopause in women, and during illness.
• Fighting excess body weight.
• Timely treatment of diseases of bones, joints, endocrine organs.

How to provide first aid for a hip fracture?

Competent first aid for a hip fracture is extremely important. It determines how effective the treatment will be and how quickly the patient can get back on his feet. In the first minutes after an injury, the main task of the victim and those around him is to prevent displacement bone fragments, since a displaced fracture is less treatable and in 80% leads to aseptic necrosis of the femoral head.

How to recognize that a victim has a femoral neck fracture:

• moderate or slight pain in the groin;
• turning the foot outward;
• inability to lift the heel of an extended leg from the surface;
• shortening or lengthening of the injured limb;
• the victim cannot get up on his own. The exception is for victims with impacted fractures.

How to help with a hip fracture

What does the ambulance crew do?

• Painkillers are injected - 30-50 ml of 1% novocaine solution into the fracture site.
• Antishock drugs are administered if necessary.
• The leg is fixed with a transport splint: pneumatic or Dieterichs splint.
• Apply a sterile bandage and administer blood substitutes for open fractures and significant blood loss.

What is the connection between hip fracture and osteoporosis?

Hip fracture and osteoporosis are closely related. According to statistics, 80% of people with such a fracture suffer from osteoporosis. Why is this happening?

Osteoporosis makes bones brittle. On the one hand, old bone tissue is quickly destroyed (resorption is actively occurring), and on the other hand, new bone tissue is formed very slowly. This leads to the fact that the bone acquires a spongy structure, becomes less dense and prone to fractures.

Due to the fragility of bones in osteoporosis, 70% of femoral neck fractures are comminuted or multi-comminuted. This complicates treatment, requiring the surgeon to use special techniques. For example, bone plate with angular stability, which is secured with screws, holding the bone fragments in the required position. These patients are more likely than others to have a joint prosthesis installed.

Patients with osteoporosis have a difficult time recovering from a fracture. Their callus formation is worse, and bone fusion occurs more slowly. Stavropol State medical academy were studied rules for the treatment of patients with osteoporosis who have suffered a hip fracture:

• Operation in all cases, except for those patients who have serious contraindications.
• Low-traumatic operations: The operation is performed through 2 small incisions – a bridge osteosynthesis technique. This allows less trauma to the periosteum and reduces postoperative period.
• Application of Angular Stable Inserts for fixation of bone fragments.
• Exclusion of external fixation after surgery. Doctors recommend avoiding plaster and other rigid dressings.
• Early activation after surgery. The patient begins active movements earlier, which improves bone nutrition and avoids contracture (decreased mobility) of the joints. Patients are recommended to move in knee joint and early loading on the operated leg.
• Drug treatment of osteoporosis promotes bone fusion.

Based on this study, recommendations for the treatment of patients with osteoporosis who have suffered a hip fracture have been developed. Thus, in addition to generally accepted measures (traction, surgery, splinting for immobilization), patients with osteoporosis are prescribed drugs to strengthen bone tissue.

Group of drugs	Mechanism of action	Medicines	Mode of application
Bone tissue resorption inhibitors – biophosphants.	Substances that reduce the activity and lifespan of osteoclasts. These cells are responsible for the dissolution of bone tissue and the destruction of collagen. Thanks to the intake of biophosphants, the rate of bone destruction decreases and their mineral density increases. At the same time, they take vitamin D and calcium.	Prolia	Subcutaneous injection 60 mg every 6 months.
		Bonviva	1 tablet (150 mg) 1 time per month. Swallow the tablet whole while standing or sitting to avoid irritation of the upper digestive tract.
Drugs that regulate phosphorus-calcium metabolism	Drugs in this group stimulate osteoblasts and inhibit osteoclasts. This means that the destruction of bone tissue is slowed down and its synthesis is simultaneously stimulated.	Osteogenon	2-4 tablets each. 2 times a day. The duration of treatment is determined individually.
Vitamin and mineral complexes	Replenish mineral deficiency (calcium, magnesium, phosphorus, vitamin D3) and accelerate bone tissue recovery.	Osteomag	2 tablets per day after meals.
		Calcium D3-nycomed	1 tablet 2 times a day, regardless of meals.
		Aquadetrim, Vigantol	2-5 drops of the drug are dissolved in a tablespoon of water. Take 1 time per day.
Hormonal agents	Regulates the exchange of calcium and phosphates. Reduces calcium loss from bone tissue.	Calcitonin	Administered subcutaneously or intramuscularly at 5-10 IU/kg per day. The dose is divided into 1-2 doses. There is a spray for intranasal use. The course can last 2-4 weeks. Then the dose is reduced and treatment is continued for another 4-6 weeks.

How to develop a leg after a hip fracture?

Proper rehabilitation in case of a hip fracture, it is extremely important. Timely and standardized physical activity helps to avoid problems with knee joints, muscle atrophy and further destruction of bone tissue and disability. Rehabilitation doctors have developed step-by-step programs how to develop a leg after a hip fracture.

Early initiation of rehabilitation allows one to maintain the viability of the blood vessels supplying the femoral head and thereby avoid the development of avascular necrosis. Taking these factors into account, development begins from the first day of treatment.

Recovery without surgery

Deadlines		Execution method
From day 1	Breathing exercises Improves lung ventilation, preventing the development of pneumonia. Improves psycho emotional condition sick.	Inflating a balloon or rubber glove. Blowing air through cocktail straw into a glass of water. Full breath. Inhale: slightly inflate your belly, then fill the middle and upper sections of your lungs with air. Exhale: release the air freely and slightly draw in the stomach. If dizziness occurs, you need to temporarily stop exercising and continue after a few minutes. Repeat each exercise 5-10 times. Perform the complex 2-3 times a day.
From day 2	Physiotherapy(physical therapy). Exercises for the upper half of the body. Gymnastics improves blood circulation, avoids the formation of blood clots and bedsores. Improves lung function to prevent pneumonia.	Exercises are performed after breathing exercises. Turns the head to the right and left shoulder. Pressing your chin to your chest and moving your head back (as far as the pillow allows). Flexion and extension of fingers. Circular movements with the brushes clockwise and in the opposite direction. Flexion and extension of the arms at the elbow joints. Clasp your hands and try to spread your arms to the sides. Squeezing the ball at chest level. Retraction of straight arms to the sides. Abdominal muscle tension. All exercises are performed 5-10 times at a slow pace. The complex takes 10 minutes, repeat 2-3 times a day.
	Leg exercises. Aimed at maintaining muscle tone and improving blood circulation in the joints.	Perform all possible movements with the healthy leg. Wiggling fingers. Rotation at the ankle joint. Bend the leg at the knee joint, sliding the heel along the bed. Raising a bent or straight leg. With a sore leg, exercises are performed mentally. This allows you to support the management of the central nervous system leg muscles. In the future, such preparation will allow you to quickly restore its functions.
From day 3	Massotherapy. Improves blood circulation and tissue nutrition. Prevents the formation of blood clots, swelling and muscle atrophy.	Before removing the cast, massage the lower back and healthy limb. Blood circulation in a broken leg under a cast will improve reflexively due to irritation of the nerve centers of the spinal cord. The massage is carried out from the bottom up, along the blood vessels, to improve blood outflow. It is advisable to have the massage performed by a specialist.
From the 10th day	Physiotherapeutic treatment. Physiotherapy improves tissue nutrition, promotes the formation of new blood vessels, which leads to accelerated bone tissue regeneration. Physiotherapy also has an analgesic and anti-inflammatory effect.	Physiotherapeutic procedures are carried out in a hospital setting. Electrical stimulation – simulates muscle contraction without putting stress on the joint. Procedures are done daily or every other day. The current strength is adjusted individually, based on the patient’s sensations. 7-14 procedures per course. Magnetotherapy – has an anti-inflammatory and anti-edematous effect, and has an analgesic effect. The procedures are carried out daily for 15 minutes, in the amount of 15-20 sessions per course.
From the 14th day or after removal of the cast	Therapeutic exercise for a sore leg.	The exercises should be preceded by a massage. Alternate contraction of different muscle groups of the legs. Clenching and unclenching of toes. Circular movements of the foot in a clockwise direction. Pulling your socks away from you and towards you. Flexion and extension of the legs at the knee joint. Bringing and spreading legs bent at the knees. The exercises are done alternately with the sore and healthy legs. If pain occurs at the site of injury, it is advisable to reduce the range of motion.
20-30 days after injury	Stand up with crutches without supporting your injured leg.	Crutches are adjusted to the height of the patient. This allows him to move around the apartment without putting any strain on his sore leg.
In 5-6 months	Stand up, leaning on your injured leg.	In the first stages, the patient walks with two crutches to reduce the load on the damaged joint. After you gain stability in your leg, you can walk with one crutch on the side of the affected leg. It is allowed to replace the crutch with a cane when the leg is stronger and the formation of a bone callus is visible on the x-ray.

Recovery after surgery

Deadlines	Types of procedures and activities. Their goal	Execution method
From day 1	Breathing exercises. Improves the supply of oxygen to the body, stimulates the functioning of the lungs and their natural cleansing, and improves the emotional state of the patient.	Diaphragmatic breathing: when inhaling, the stomach is slightly inflated, and when exhaling, it is deflated. Forced exhalation: free inhalation through the nose, forced exhalation with the sound “ha” through the mouth, accompanied by contraction of the abdominal muscles. Raise your shoulders while inhaling and lower them while exhaling. The hands lie symmetrically on the lower ribs. Inhale - the ribs diverge and rise. The exhalation is accompanied by the sound “ssss”, the hands compress the ribs. Inflating a balloon.
From day 2	Physiotherapeutic procedures. Accelerate healing postoperative wounds by improving tissue nutrition, they reduce pain, swelling and inflammation.	UHF – has a significant anti-inflammatory effect. Promotes resorption of infiltrate around surgical wound. When heat appears, it is necessary to reduce the intensity. There are 10-15 procedures for 10 minutes per course. Magnetic therapy – pain relief, reduction of swelling and inflammation. The procedure lasts 15-20 minutes, 10-20 sessions are required. Ultrasound therapy improves blood circulation and tissue trophism. The duration of the procedure is 12-15 minutes, 6-12 sessions are prescribed per course. Pulse currents - to increase muscle tone in the first days after surgery. 20 procedures, 7-10 minutes each.
From day 3	Massage. Massage improves blood circulation and prevents the formation of blood clots. Improves the general condition of the patient and promotes rapid tissue regeneration.	The massage is performed with light, stroking and rubbing movements, stimulating the flow of blood and lymph from the fingers to the torso. For the first two weeks, avoid exposure around the operated joint.
From day 4	Therapeutic gymnastics exercise therapy Maintaining muscle tone in a healthy leg.	At this stage, the patient is able to perform exercises with the healthy leg: Movement of the foot up and down. Rotation of the foot at the ankle joint. Knee bending - pulling the heel towards the buttocks along the bed. Abduction of the leg bent at the knee joint to the side. Tension of the quadriceps muscle located on the front surface - straighten the knee, pressing the leg to the bed. Contraction of the gluteal muscles. Tighten for 10-20 seconds, then relax. Leg spread. Abduct your healthy leg as much as possible, sliding your heel along the bed. Each exercise is performed 4-8 times. The complex is repeated 2-3 times a day.
From 5-7 days	Stand up with crutches without supporting your sore leg.	For the first 3-5 days you are allowed to move around the apartment. Gradually the loads are increased.
In 7-10 days	Lean lightly on the affected leg when walking on crutches or a walker.	Avoid sharp pain while moving. Avoid sudden movements, especially when moving to a sitting position.
After removing the plaster (deadlines vary individually)	Passive gymnastics for a sore leg. Improves muscle condition and prevents muscle atrophy. Improves blood circulation in the joint and reduces pathological effusion inside the joint capsule.	Passive gymnastics is carried out in a supine position, it should be preceded by a massage, which helps to relax the muscles of the injured leg. The exercise therapy instructor asks the patient to relax the muscles and bends the limbs at the joints. With its help, the patient performs a set of exercises. Circular movements of the foot. Toe adduction and abduction. Flexion and extension of the leg at the knee joint. Bending the leg at the hip joint. Hip abduction to the side. Rotation of the hip inwards and outwards. Each movement is repeated 3-4 times at a slow pace. Over time, the number of repetitions is increased to 15-20.
2-4 weeks after plaster removal	A set of therapeutic exercises for an injured leg.	The exercises are described in the main part of the article. The first lessons must be carried out with an instructor, since excessive loads can disrupt bone healing. And insufficiently hard training leads to the fact that the recovery period is delayed. During exercise, pain occurs in the knee and hip joints. This normal phenomenon which goes away over time. However, this must be reported to the instructor. Some patients are recommended to take painkillers before exercising.
In 4-8 weeks	The patient should be encouraged to move, using a walker or crutches. Only active movement will help a person return to society. Otherwise, he faces death from complications.

The given time frames and recovery program are approximate. Each point must be agreed upon with your doctor. Specific recommendations depend on the patient’s health status and the rate of callus formation.

In order to develop a leg after a hip fracture, the patient’s positive attitude and his belief in recovery are very important. Therefore, if a person is depressed or depressed, psychological help is necessary, especially in old age, when a hip fracture can provoke

Clinical expert characteristics. Fractures of the limbs are a common type of injury, which leads to loss of ability to work, both temporary and permanent. Fractures can damage surrounding tissues, blood vessels and nerves. Fractures can be transverse, oblique, comminuted, impacted, screw, etc. In addition, closed fractures are distinguished, in which the integrity is not compromised skin, and open when the integrity of the tissues surrounding the bone is compromised. Based on location, fractures of the diaphysis, metaphysis and intra-articular are distinguished; the latter often cause complications from the joint, which worsens the prognosis for recovery.

The basic principles of treatment are to compare the fragments and hold them until a callus appears. To achieve the above, a conservative or surgical treatment method is used, which is selected by the surgeon according to indications.

Detection methods morphological changes and functional disorders. Traumatic fractures of the bones of the extremities have clear clinical symptoms: pain, dysfunction, swelling, etc. However, for a final diagnosis it is necessary to X-ray examination. In most cases, diagnosing limb fractures does not cause difficulties in clinical settings. During the treatment, X-rays are also taken to determine the condition of the callus. In some cases, tomography is performed, which helps clinicians make a final conclusion about the condition of the callus.

Clinical and labor prognosis, indicated and contraindicated conditions and types of work. For fractures of the humerus in the upper third, which clinicians divide conditionally into intra-articular, extra-articular and fractures surgical cervix, treatment is carried out under the conditions of a trauma hospital, both conservative and surgical methods. The average period of temporary disability for uncomplicated fractures is from 2.5 to 3 months. If complications arise during treatment or after its completion, then the issue of the patient’s ability to work may not be resolved during the 4-month period of being on sick leave, and such a patient is sent to VTEK. With an improperly healed fracture, arthrosis shoulder joint with availability pain syndrome, plexitis and other complications in VTEC, disability is established Group III only to persons whose work involved physical stress. Sick leave for more than 4 months is extended provided that the patient, after treatment, is discharged to his previous job, perhaps with restrictions under the VKK of the medical institution.

For diaphyseal fractures of the humerus, the period of temporary disability after uncomplicated treatment can be from 2.5 to 3.5 months. In case of complications, the examination of work capacity is carried out in the same way as for fractures of the shoulder in the upper third.

Fractures of the lower end of the humerus in traumatology are divided into intra-articular and extra-articular. The first include: fractures of both condyles of the shoulder, transcondylar, external or internal condyle, supracondylar, distal end humerus.

Extra-articular fractures include supracondylar fractures, which, when bone fragments are displaced, can cause tension in the peripheral nerve trunks, as well as blood vessels. Supracondylar fractures are divided into extension fractures, when the peripheral end of the bone is displaced posteriorly, and flexion fractures, when the distal fragment is displaced anteriorly. After reduction of the fragments, a posterior plaster splint is applied from the upper third of the shoulder to the heads of the metacarpal bones for a period of 10 to 14 days, and subsequently prescribed physical therapy and physiotherapeutic procedures, as restoration of function in elbow joint will be the main criterion for resolving the issue of the victim’s ability to work.

Intra-articular fractures of the humerus, such as transcondylar fractures, are more common in young men, and their treatment does not differ from the supracondylar fractures that have been mentioned.

Severe intra-articular fractures are fractures of the condyles of the humerus. The most common fracture of the lateral condyle occurs when a fall occurs on a bent forearm. A special group consists of fractures of the humerus with a T- or Y-shaped fracture plane and divergence of the condyles in different directions. Such fractures are usually treated in an inpatient setting using traction, and are often surgical treatment. The period of temporary disability, taking into account subsequent physiotherapy and physical therapy, reaches up to 4 months.

However, intra-articular fractures are often complicated by deforming arthrosis, osteomyelitis, and subsequently there are restrictions on movement in the elbow joint, etc. These complications do not always serve as a basis for establishing disability, especially in patients who, before the injury, performed work without physical stress. Persons' ability to work intellectual work may not suffer. Persons whose work involves physical stress are recognized as group III disabled for a period of 1-2 years, until they acquire an equivalent profession.

Group II disability for patients with fractures of the humerus is established in exceptional cases, in case of complications or the need to wear a plaster splint long time(after repeated operations), which excludes the possibility of working in production conditions for 6-10 months or more.

Fractures of the bones of the forearm among all injuries of the musculoskeletal system account for 25.2%.

The outcome of treatment of patients with fractures of the forearm bones largely depends on the nature, type, location of the fracture and method of treatment.

Complex anatomical and functional structure bones of the forearm and adjacent joints (elbow and wrist) causes a variety of fractures of the forearm bones. Any fracture of the bones of the forearm, especially if treated incorrectly, threatens the development of complications, which can lead patients to long-term or permanent disability.

Fractures of the forearm bones are also usually divided depending on their location. In the upper third, fractures of the olecranon and coronoid process most often occur, the first of which is injured when falling on the elbow, and the second, as a rule, accompanies a posterior dislocation of the forearm. The treatment here is conservative, and only where there is a comminuted fracture, one of the fragments is promptly removed to restore the function of the joint. In both the first and second cases, working capacity is restored after 2-2.5 months.

A fall on an outstretched hand usually results in a fracture of the head and neck radius; these types of fractures account for 1.3% of other fractures. Treatment for closed fractures without displacement is reduced to fixing the forearm at a right angle with a plaster splint for 2 weeks. Working capacity is restored after 5-6 weeks in the absence of complications during the treatment period. Our observations have shown that a significant number of people still turn to VTEK with improperly healed fractures, pseudarthrosis, deforming arthrosis or ankylosis of the elbow joint. Making an expert opinion in such patients causes great difficulties. The main criteria for assessing their ability to work will be limited function in the elbow joint. During development
ankylosis or contracture in the expert joint. The approach is covered in the sections Ankylosis, Contractures. A number of patients, even with moderate limitation of movements in the elbow joint, can be referred to the VTEK to determine disability group III. These include patients who work as drivers or perform work related to tank maintenance or significant physical stress.

Disability can only be established if the subject cannot return to work, according to experts, even after extending the sick leave for up to 6 months.

Diaphyseal fractures of the forearm, including fractures of both bones, isolated fractures of the ulna or radius, occupy a significant place among all bone fractures upper limb. The mechanism of injury, compared to other fractures, can be either direct force or a fall on the outstretched hand. With severe trauma to the upper third of the diaphysis, a so-called fracture may occur. Monteggia ulna with dislocation of the radial head. With a severe (usually combined) injury in the lower third of the forearm, a Galiazzi fracture occurs - the radius with dislocation of the head of the ulna.

Treatment is conservative if there is no large displacement of the fragments. All fractures with significant displacement of fragments are subject to surgical treatment. Treatment ends with a long course of physical therapy and physiotherapy. According to N. Novachenko, the working capacity of such patients is restored after 3-4 months.

Diaphyseal fractures of the forearm with displacement of bone fragments present significant difficulties in treatment, and their consequences can often serve as the basis for persistent limitation ability to work. In some cases, treatment may be complicated by the formation of a false joint of either one bone of the forearm or both together. The false joint of the radius and ulna is an anatomical defect in which the disability group is established without a re-examination period, regardless of profession.

Fractures of the distal end of the radius in a typical location occur more often in older women when they fall on an outstretched (or extended) arm. Here it is often possible to observe a “bayonet-shaped” deformation, and in most cases, separation of the styloid process. Treatment of these fractures is usually conservative after reduction. The ability to work of such patients as a result of treatment followed by physical therapy and physiotherapy is restored on average after 1.5-2 months. Such patients, as a rule, do not go to VTEK. However, with combined fractures, complications can be very severe and sometimes lead to disability. Thus, complications after fractures of the forearm bones (which should include pseudarthrosis of the forearm bones, delayed consolidation, limitation of movements, deforming arthrosis of the elbow and wrist joints, improperly healed fractures, etc.) are often the basis for establishing disability, especially in patients who work which is associated with physical stress.

Fractures of the hand bones are divided into injuries to the wrist, metacarpus and fingers. Fractures of the wrist bones include a fracture of the scaphoid bone, which is quite common compared to other bones of the wrist. Typically, such fractures occur when falling on an outstretched arm. Treatment is reduced to immobilization with a plaster splint for 3-4 months, and with delayed consolidation - up to 6 months. This is explained by insufficient blood supply to bone fragments due to damage to the supplying vessels. After removing the plaster splint great place- devoted to physical therapy and physiotherapy. In this case, the ability to work for manual workers may be limited to 6 months. Such fractures are often complicated by pseudarthrosis, in which case surgical treatment is necessary. Fractures of the triquetral, pisiform, greater and lesser polygonal, capitate, and hamate bones are extremely rare. Their treatment comes down to immobilization with a plaster splint, and their ability to work is restored after 3-4 weeks. Such patients, as a rule, are not referred to medical expert commissions.

Fractures of the metacarpal bones occur under the influence of direct trauma and, depending on the nature of the applied force, can be comminuted, transverse, helical, etc. Great importance has a fracture of the first metacarpal bone with a marginal separation of the proximal and intra-articular end, the so-called Bennett fracture. Its significance is explained by the fact that the function of the first finger may be impaired due to improper treatment this damage, which leads to a significant decrease in working capacity, especially in people who work physically. Fractures of other metacarpal bones are also treated with a plaster splint, and patients’ ability to work is restored after 8 weeks.

Fractures of the phalanges of the fingers are quite common and deserve great attention due to the fact that they have important in determining the function of the fingers. In most cases, fractures are open, since the mechanism of injury is direct: falling heavy objects, blows from a tool, or getting fingers caught in a machine. For such injuries, after initial treatment of the fingers, a plaster splint is applied. Working capacity is restored after 4-6 weeks, if the postoperative period proceeds without complications.

Very often, these injuries lead to traumatic amputations of the phalanges of the fingers, in some cases multiple, which subsequently sharply reduces the ability of the victims to work. In case of fractures of the bones of the hand, one of the leading and main criteria for disability is impairment of the function of grasping and holding objects, which prevents the performance of work associated with precise movements and the need to use hand tools.

Amputation defects of the fingers, in which disability is established regardless of profession, are an anatomical defect and are indicated in the appropriate section (see Amputation stump). Limitation of movements in the fingers, especially right hand, serves as the basis for establishing disability for patients whose work involves servicing machines, automatic lines, as well as for those working as drivers. Typically, group III disability is established for a period of 1-2 years before acquiring an equivalent profession.

Hip fractures are severe injuries of the musculoskeletal system, which often lead to disability. In older people, fractures of the femoral neck are observed due to a fall, often on the side. Fractures are divided into medial and lateral; The first include fractures whose border is at the base of the head and transcervical, the second, i.e. lateral, include fractures of the base of the neck and transtrochanteric. Medial fractures heal very poorly because the vessels supplying the femoral head are damaged.

Treatment of such patients is carried out conservatively, and if indicated, surgically. Types of operations using various nails for osteosynthesis are described in special manuals. Patients are on sick leave for a long time; even with uncomplicated fractures, these periods range from 4.5 to 6 months. Such patients are referred to VTEK, where, if favorable clinical prognosis sick leave may be extended to 6-7 months, followed by discharge to work or transfer to disability group III and a recommendation to perform work that does not involve significant physical stress and prolonged standing.

In case of complications (slow consolidation) during treatment, patients are assigned group II disability for a period of one year.

Diaphyseal femoral fractures occur quite often in people of young working age. With these fractures, the displacement of bone fragments can be at an angle, rotation, etc. Treatment is carried out both conservative and surgical, depending on the indications. The duration of temporary disability is from 4 to 6 months. Patients who performed work with physical stress before treatment, after follow-up treatment, which can be extended up to 6 months, are sometimes recognized as group III disabled for a period of 1-2 years, since even after this period they cannot return to their previous work. In case of complicated fractures, as well as delayed consolidation, group II disability may be established for a period of 1 year.

Fractures of the femur in the lower third are less common than fractures in the middle third; among them, condylar fractures, which are classified as intra-articular fractures, occupy a special place. Treatment of these fractures is carried out by traction, and in some cases, with large displacement of fragments, surgical intervention is performed.

The period of temporary disability here also ranges from 4.5 to 6 months. When examined by the VTEK after a 4-month period of sick leave for non-physical workers, the sick leave can be extended to 6-7 months, and sometimes more, with subsequent discharge to their previous job.

Persons whose work is associated with physical stress, long periods of standing, as well as the need to climb to heights due to work conditions, or work in unfavorable meteorological conditions (deep climbers, pipe layers, installers, miners, etc.) do not return to their previous work, even if the fracture has healed. This is explained, as our observations have shown, by the presence of swelling, pain, and partial dysfunction that can occur in such patients. Therefore, when examined at the VTEK, as a rule, after further treatment, they are assigned group III disability for a period of 1-2 years, until they receive an equivalent profession or complete recovery.

Fractures with delayed consolidation, as well as those leading to a sharp impairment of function, persistent pain, development of osteomyelitis, etc., can be the basis for establishing group II disability for a period of 1 year, even for persons whose work before the injury was not associated with physical stress.

Fractures of the lower leg bones, according to various statistics, occupy first or second place in their frequency, second in some cases only to fractures of the forearm. According to location, tibia fractures can be diaphyseal, which are most common. Fractures of the ankles are in second place in frequency, fractures of the tibial condyles are in third place. In some cases, with severe injuries, there are mixed fractures. Fractures of the tibial condyles are a severe intra-articular injury; the lateral condyle is most often affected. Treatment is carried out conservatively with traction and surgically according to indications. According to N.P. Novachenko, full load on the limb is allowed only after 4-6 months, since this takes into account the slow consolidation of the intra-articular fracture, as well as the possibility of subsidence of the condyle. Therefore, in the VTEC, such patients are assigned group II disability for a period of 1 year. In some cases, with a satisfactory course and development of callus, group III disability is established, since the walking function in these fractures, even with pronounced callus, is significantly affected.

Clinicians divide diaphyseal fractures of the tibia bones into isolated fractures of the tibia or fibula, as well as fractures of both bones. The displacement of bone fragments can be transverse, at an angle, along the length, screw, etc. Treatment is conservative if it is possible to compare the bone fragments; According to indications, they resort to surgical treatment. For uncomplicated fractures, the period of temporary disability can be from 3.5 to 4 months.

Physical workers after a tibial fracture, even with successful treatment, cannot return to work before 4-6 months. In case of fractures of both bones of the leg, the period of temporary disability can also be extended to the specified period. If complications develop (slow consolidation, impaired movement function, etc.), patients can be recognized as group II disabled for a period of 1 year. In case of a false joint of two bones of the leg, disability of group III is determined based on the anatomical defect.

Ankle fractures are the most common location of tibia fractures, and they are conventionally divided into typical and atypical. The first include fractures of one of the ankles, two ankles, as well as a fracture of the inner malleolus with a supramalleolar fracture of the fibula and a fracture of the ankles with marginal fracture tibia. The remaining fractures in various combinations are classified as atypical. Usually the choice of treatment is made individually. After treatment, which can be conservative or surgical, physical therapy and physiotherapy are prescribed very early.

The period of temporary disability for ankle fractures is 2-3 months; if there was a combined fracture, the time period is increased to 4-6 months. In case of complicated fractures, patients who before treatment performed work with heavy physical stress and long walking, after 6 months of being on sick leave, can be sent again to the VTEC to determine their disability group III. If complications develop during the treatment period (slow consolidation, severe limitation of movements with severe pain, etc.), group II disability may be established for 1 year.

Among the fractures of the bones of the foot there are fractures of the talus, calcaneus, navicular, cuboid and wedge-shaped, metatarsal, as well as phalanges of the fingers. For fractures of the talus without displacement, treatment is carried out conservatively; If it is impossible to compare the fragments, an operation is performed. Working capacity is restored on average after 2-3 months, for people with manual labor after 4-6 months.

For fractures of the calcaneus without displacement, conservative treatment is carried out with a plaster splint for up to 6 weeks; for fractures with displacement, traction or surgical treatment is performed. Working capacity is restored after 4.5-6 months, and in some cases people who work manually are unable to work for up to 1 year. Therefore, in very rare cases, VTEC establishes group II disability (in the presence of delayed consolidation, severe pain). Such patients must wear an instep support for a long time.

For fractures of small bones of the foot, as a rule, patients are discharged to work after being on sick leave for 2 to 3 months and do not contact VTEK. Only in rare exceptions, when there are complications after treatment, can a patient be diagnosed with group III disability in order to acquire an equivalent profession.

Despite a sufficient number of modern effective treatment methods, hip fractures often lead to complete or partial disability. The main cause of disability is complications after poorly prescribed therapy or medical staff errors during operations.

Is there any disability for a hip fracture?

Disability in the event of a hip fracture provides patients with the opportunity to replace their main activity with light labor and continue working in more suitable conditions. If the victim’s health condition does not allow him to perform even the simplest work, disability gives the right to refuse it. Temporary disability is often prescribed after a hip fracture. In this case, the disability group is removed after a certain period.

The conclusion on the assignment of disability is issued by a medical commission based on the epicrisis of the patient’s disease and the results additional research. It is necessary to visit such a commission annually. In case of complete restoration of motor activity and the ability to resume normal daily life, the group is removed. According to the decision of the medical commission, disability can be lifelong.

The group is most often assigned to elderly people. Disability provides the right to receive supplements to your pension, enjoy various social benefits and receive some benefits for free. medicines and devices to ensure a normal life.

The victim has the right to be assigned a group based on the decision of the medical commission, even if after the operation he is not bedridden, but has the ability to move. The patient still lost his ability to work and cannot be considered a full-fledged worker.

Establishing a disability group for a fracture

Based on the degree of disability, experts distinguish 3 main groups of disability:

1. First group. Considered the heaviest by standards physical condition patient. It is prescribed in cases where the normal functioning of the victim is significantly limited and he cannot care for himself.
2. Second group. Given with less significant disabilities. Such patients can take care of themselves and do not require constant supervision. Disabled people in this group have the opportunity to continue working under special working conditions. They are given additional breaks, the length of the working day is reduced, the production rate is reduced, etc.
3. Third group. The basis for its appointment is moderate functional impairment and loss of ability to work. Such patients move freely without outside help and can take care of themselves.

The cause of disability is most often the development of complications. For a hip fracture, the group is assigned based on the specifics of the injury and the resulting consequences. The most common scenarios:

1. The cause of aseptic necrosis of the femoral head can be either radical or drug treatment. If the pathology develops slowly, the third group is assigned. Increased physical activity is contraindicated for patients, so working conditions require significant changes.
2. With the rapid development of necrosis, when the injured limb completely loses the ability to perform musculoskeletal functions, the patient is given the second group.
3. In non-impacted fractures, false joints are formed. They can form in patients who refuse surgery, or in cases of unsuccessful surgery. Even in youth, fragments of the false articulation take quite a long time to heal. The likelihood of long-term disability is quite high, and older people often completely lose the opportunity to return to their normal lives. With such a fracture of the femur, disability of the second group is assigned. Over time, the victim's condition may improve. In this case, the group is changed to a third or removed.
4. The first disability group is assigned to a non-united fracture of the femoral neck, when the patient remains bedridden for the rest of his life.

In the event of complications arising from a hip fracture, disability is due in most cases. The assigned group and duration of disability is determined by MSEC based on general condition sick.

Disability registration procedure

The process of registering disability is quite lengthy. The law prohibits starting to collect documents for a medical commission immediately after receiving an injury. From the moment of injury, the patient must undergo a course of treatment and the necessary rehabilitation, try everything possible methods restoration of musculoskeletal functions of the limb.

Registration of disability begins no earlier than six months after the fracture and only if the prescribed therapy does not bring the expected results.

All treatment methods used are recorded by the doctor in outpatient card patient. Upon completion of therapy and rehabilitation, the patient is issued a certificate, which is provided to the MSEC members for review.

In addition, the victim will need to collect the following package of documents:

• referral of the attending physician to undergo an ITU commission;
• statement of the results of final examinations after the end of treatment and the recovery period;
• patient's outpatient card;
• copy of the passport;
• working people must provide a notarized copy of their work record book;
• patient's application for consideration of the case by the commission.

The collected documents are transferred to MSEC members. The patient may be asked additional questions if representatives of the medical commission doubt the advisability of assigning a disability. In this case, the patient needs to describe his condition as accurately as possible in order to prove to members of the meeting that the injury has significantly affected the change in quality of life.

If the disability registration process is successful, the patient is issued a corresponding certificate and an additional document is drawn up. individual program rehabilitation. This certificate is provided in Pension Fund at the place of residence and to social protection authorities. Based on the documents provided, the above authorities will assign a pension and benefits.

Actions of the patient if the commission refuses

If, by decision of the MSEC, registration of disability is denied, the patient has the right to write an application for re-examination. A meeting of the commission is convened no later than one month after the application is submitted. The victim can conduct an additional independent examination from doctors who are not directly related to MSEC.

If in this case the registration of disability is refused, the patient has the right to file a claim. The decision of this authority cannot be challenged.

The assigned disability group for a hip fracture depends on the specifics and severity of the injury. The patient will have to undergo an annual examination at MSEC. If his health improves and his performance is restored, the group may be changed or removed altogether.

Recognized as a fairly severe injury, recovery occurs in no less than 6 months, and some patients, especially people retirement age, remain confined to a walker or have limited movements for several more years. In this case, people after a fracture are recommended to apply for disability.

From the time of immobilization until the period of complete recovery, the victim is considered incapacitated, and the employing organization must pay so-called sick leave. Only after complete cure the patient is already able to work and is ready to begin his usual activities. If we consider the case of heavy physical work, the employee after a fracture should be reassigned to light work.

Establishing a disability group for a fracture

As a result of the fracture, a false joint may form. With this diagnosis it is recommended additional operation, accordingly, the downtime will be longer. Such groups of victims in the ITU should be defined as people with disability group 2. Also, patients with an initial diagnosis of pseudarthrosis are assigned to group 2.

Disability for a hip fracture is also assigned to victims whose treatment did not require surgery. For a fracture of the trochanteric region of the femur, patients are assigned group 3, and start physical work allowed no sooner than after 8 months from the date of injury. Over time, ITU may consider removing the disability status if full recovery is possible.