Receiving disability due to a hip fracture. Fractures of limb bones

Although advances have been made in the treatment and rehabilitation of hip fractures, poor outcomes remain high, so specific gravity disability ranges from 13.5% to 29%.

Better recovery after injury, including physiotherapy, will help reduce this percentage. A good specialist It’s difficult to find; for Mitino residents and for Muscovites in general, I can recommend a massage in Mitino.

Injuries to the hip, among other injuries to the skeletal system and muscular system, are relatively rare. Among closed fractures of all localizations they account for only 1 to 3%, and among fractures tubular bones- about 10%. Traumatic hip dislocations account for about 3% of dislocations in other locations. However, the relative rarity of these injuries does not detract from their significance in the ITU, since hip fractures are among the most severe in their clinical manifestation due to general and local changes.

Among those initially examined in ITU Bureau Sick people with hip fractures rank second among those primarily recognized as disabled after trauma to the musculoskeletal system. At the same time, disabled people, due to the consequences of hip fractures, often remain limited in their ability to work for a number of years or are completely unfit for regular professional activities. Therefore, this circumstance requires ITU to constantly pay attention to the issues of rehabilitation treatment for this group of disabled people.

The expert significance of hip injuries is associated with long treatment periods, a significant number of complications, adverse consequences, not always favorable clinical prognosis (recovery), and labor prognosis.

The article was prepared and edited by: surgeon

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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.

A conclusion on the assignment of disability is issued by a medical commission based on the epicrisis of the patient’s disease and the results of additional studies. 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 medications and devices for free 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. It is considered the most severe by the standards of the patient’s physical condition. 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 care for 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 disorders 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 avascular necrosis femoral head can be either radical or medicinal 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 type 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. Probability of loss of ability to work long time 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 considered in most cases. The assigned group and duration of disability are determined by MSEC based on the general condition of the patient.

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 the patient’s outpatient record. 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 work 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 individual rehabilitation program is drawn up. This certificate is provided to the pension fund at the place of residence and to the authorities social protection. 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.

Femoral neck fracture- an injury in which the integrity of the femur occurs 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 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 obtain an accurate result, X-ray images are taken 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 fewer 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 other 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 anatomical features described above, 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 scope of the 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-bladed 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. Progress of surgery: 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; take x-rays; the three most well-placed knitting needles are left in place, the rest are removed; along the left knitting needles, as if through 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 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. Although modern dentures hip joints 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?

The cost of surgical treatment is 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 often differ greatly.

The average cost of surgical treatment of a femoral neck fracture in Russia is $2000. This figure can vary greatly. There are social support programs 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 a hip fracture, a light massage is performed during the rehabilitation period 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 chest massage is performed;
• 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 of therapeutic exercises:

• preventing complications;
• preventing muscle atrophy, normalization of their tone and movements;
• prevention of osteoporosis;
• restoration of the patient's motor activity.

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– inflammation of the lungs, 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 the load 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:

• means for local anesthesia: 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, depressed state 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 the 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 a urinary catheter is installed;
• 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?

A fracture of the femoral neck is a disease that can lead to serious complications and requires 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 group disability
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 of the 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 to 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, the function of his respiratory system is impaired.
   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 fractures mainly involves preventive measures aimed against osteoporosis:

• Full physical activity, sports and gymnastics at any age.
• Adequate nutrition, 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 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 dressing 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 the 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 for less trauma to the periosteum and a shorter 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 the knee joint and put early weight-bearing 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 for a hip fracture 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 the psycho-emotional state of patients.	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 arms in 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 helps support central nervous system control of the 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 nerve centers 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 the healing of postoperative wounds by improving tissue nutrition, reducing pain, swelling and inflammation.	UHF – has a significant anti-inflammatory effect. Promotes resorption of infiltrate around the 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 exercises occur painful sensations in the knee and hip joint. This is a normal phenomenon that 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, it is necessary psychological help, especially in old age, when a hip fracture can provoke

The general concept of “hip” in medicine refers to the femur, hip joint and the tissues surrounding them. The femur is the strongest and most powerful bone in the human body.

The reason for this is simple - the hip bone bears a colossal load on the entire body. It has been theoretically and practically proven that this bone can withstand a weight load of about 2 tons. The structure of the femur is simple.

It consists of a diaphyseal part (bone body) and two epiphyseal parts (proximal and distal ends). The femur is connected to the pelvis through the hip joint. The structure of the hip joint is as follows:

1. The pelvic bones form the acetabulum, which is cup-shaped;
2. The head of the proximal epiphysis of the bone, which connects to the acetabulum;
3. Articular cartilage covering the acetabulum and head of the femur;
4. The femoral neck is the thinnest part of the bone that connects the head to the body;
5. The greater and lesser trochanters are located on the body of the femur, closer to the proximal epiphysis.

What is the femoral neck? In simple terms, this is the thinnest and most vulnerable part of the femur. Her fractures are not that uncommon. According to worldwide injury statistics, femoral neck fractures account for 6-7% of the total.

Cause of neck fracture

Fractures of the femoral neck in old age are usually pathological in nature and are caused by age-related changes.

Over the years, the level of calcium in the human body, the main building material of bone, giving it strength, decreases. After 40 years, the bone apparatus ceases to renew itself as intensively as at a young age.

The number of developing structural elements of bone (osteons) decreases, and destructive processes accelerate. All this leads to thinning of the bones and increased fragility. The risk of injury increases.

A common cause of injury is falling on one side in old age. Women over 50 years of age are most often affected.

This is due to postmenopause. It's all about the menopause, during which the absorption of calcium by the body slows down.

As a result, calcium metabolism is impaired and osteoporosis develops. Some factors that contribute to fracture:

• The femoral neck extends away from the hip joint at a large angle. And if the angle decreases, then the likelihood of a fracture increases;
• Insufficient bone nutrition. Poor blood supply to the joints is caused by anatomical features. And in old age, the blood supply is even less, which is the reason increased risk fracture;
• The femoral neck is an integral part of the hip joint and, moreover, is not covered by periosteum. As a result, apart from the joint capsule, nothing protects the bone and it is more at risk of fracture.

There are fractures of the proximal end (femoral neck and trochanteric region), femoral diaphysis and distal end hips (supracondylar, transcondylar and condylar fractures). The most common (up to 60%) fractures are the proximal and the least common are the distal (15%) end of the femur.

Fractures of the femoral neck are impacted, often valgus, abduction, and non-impacted - varus, adduction. Impaction of a femoral neck fracture creates the most favorable conditions for healing with any treatment method.

The healing time for fractures is 4-5 months, and restoration of the musculoskeletal function of the limb occurs after 6-8 months. After a period of temporary incapacity for work, persons engaged in mental, light and moderate physical labor begin to work.

Persons working in professions of heavy physical labor, after completion of treatment, on the recommendation of the Internal Affairs Committee of treatment and preventive institutions, should be temporarily transferred to light work.

Non-impacted femoral neck fractures are subject to surgical treatment. The operation of choice is osteosynthesis with a three-bladed rod.

If the operation is effective and there are no complications in the postoperative period, consolidation of the fracture occurs within a period of 6-8 to 10-12 months. The clinical prognosis in such cases is favorable, and patients are considered temporarily disabled during the consolidation period.

Extension of the period of temporary disability beyond 4 months is also indicated for patients who have undergone a second operation 3-4 months after the first due to the identification of such early complications as migration of the rod, secondary displacement of fragments.

When consolidation occurs during a period of temporary incapacity for work, persons engaged in mental work, as well as light and moderate physical labor, are recognized as able to work.

Persons with moderate physical labor require a temporary transfer to light work upon the conclusion of the Inspectorate Commission of medical institutions. Persons with heavy physical labor need rational employment.

If, when transferring to another profession that is not contraindicated for health reasons, a decrease in qualifications occurs, ITU assigns them disability group III.

Complications of a femoral neck fracture include pseudarthrosis and avascular necrosis of the head.

False joints of the femoral neck are usually formed with non-impacted fractures in patients treated conservatively or ineffectively operated on. Treatment of false joints of the femoral neck is surgical.

The fusion of fragments of false joints occurs over a long period of time, and therefore for such patients, during the initial examination at the ITU, it is advisable to determine disability group II.

If, during re-examination, fusion of fragments is established, then the patients’ ability to work is assessed in the same way as with a healed “fresh” fracture.

If the pseudarthrosis is not eliminated and there is a moderate impairment of the SDF (static-dynamic function), the patient is assigned disability group III.

Aseptic necrosis of the femoral head can be a complication with any method of treating a fracture. In case of aseptic necrosis with slow progression, persons with heavy physical labor are assigned disability group III for rational employment.

With rapid progression of aseptic necrosis, leading to complete loss of limb support, surgical intervention is indicated.

In such cases, disability group II is established.

Fractures of the trochanteric region of the femur (pertrochanteric, intertrochanteric) are treated conservatively and surgically. The time frame for consolidation of fractures, regardless of the treatment method, is 3-5 months.

Restoration of working capacity occurs in persons engaged in mental and light physical labor after 5-6 months, and in heavy physical labor after 6-8 months.

When treating such fractures, especially with a conservative method, post-traumatic deformity in the form of riding breeches is sometimes observed. It does not have a significant effect on work ability, but under significant loads it can lead to deforming arthrosis of the hip joint, which, in turn, may be an indication for the establishment of disability group III.

Treatment of femoral shaft fractures is carried out by intraosseous osteosynthesis or skeletal traction. The average time for consolidation of fractures, regardless of the treatment method, is 4-6 months. The working capacity of persons in professions of mental and light physical labor with an uncomplicated course of the fracture is restored after 6-7 months, and for medium and heavy physical labor - after 8-10 months. .

In this regard, during the initial examination at the ITU, patients are shown an extension of the period of temporary disability. Complications of fractures of the femoral diaphysis are delayed consolidation, pseudarthrosis, deformity with shortening of the limb, contracture of the joints (mainly the knee).

Delayed consolidation is detected 4-5 months after the start of treatment and serves as an indication for surgery, most often - bone parietal auto- or homoplasty, sometimes with intraosseous or extraosseous osteosynthesis.

The duration of treatment for such a complication is extended by approximately 1.5 times, but the prognosis is favorable, and therefore, during the initial examination at the ITU, it is advisable to extend the period of temporary disability.

False joints of the femoral shaft require long-term treatment, the prognosis for them is often questionable. Therefore, for patients operated on for pseudarthrosis of the femoral diaphysis, it is advisable to determine disability group II.

The methods of surgical treatment of false joints of the femoral diaphysis are the same as for delayed consolidation. For fibrous pseudarthrosis, extrafocal compression-distraction osteosynthesis is effective.

An unconsolidated pseudarthrosis of the femoral diaphysis with moderate impairment of SDF (stato-dynamic function) serves as an indication for establishing disability group III.

Fractures of the distal end of the femur, periarticular or intraarticular, are most often treated surgically. Consolidation of fractures occurs within 4-5 months.

Restoration of ability to work in persons with mental work occurs after 5-6 months from the moment of injury, in persons with physical work - after 6-8 months.

With the development of deforming arthrosis of the knee joint Stage III arthrodesis or joint replacement may be performed.

Of the traumatic dislocations of the femur, the most common are posterior dislocations.

After reduction of the dislocation, a long-term, at least 4 weeks, immobilization is required and then a long-term, for 2-3 months, unloading of the limb to prevent aseptic necrosis of the femoral head.

The period of temporary disability for patients of all professions is about 4 months. However, after completion of treatment, persons with heavy physical labor must be transferred to work under lighter conditions for a period of 2-3 months, upon the conclusion of the Institutional Inspectorate of medical institutions.

Old hip dislocations can be reduced quickly. It should be borne in mind that the more time has passed since the injury, the more difficult it is to reduce the dislocation.

Surgical reduction 1 month or more after injury is always associated with the risk of developing aseptic necrosis of the femoral head. With unreduced posterior (iliac) dislocation, the dysfunction of the limb is compensated relatively satisfactorily.

The ability to work of patients working in professions of mental, light and moderate physical labor is not impaired.

Retraining is indicated for persons employed in professions of heavy physical labor. For the period of rational employment, he is assigned disability group III.

Fractures of the tibia bones are divided into fractures of the proximal end, which include compression or comminuted fractures of the condyles tibia, diaphyses of the tibia bones and distal metaepiphysis of the tibia bones. Among the latter, comminuted compression fractures of the metaepiphysis of the tibia and ankle fractures are of primary importance. The most common fractures are ankle fractures, followed by fractures of the diaphysis of the tibia, and the least common are fractures of the metaepiphyses of the tibia.

The consequences of fractures of the tibial condyles depend mainly on the degree of restoration of the anatomical relationships of their articular surface.

Treatment time, complications and functional outcomes, as well as assessment of patients' ability to work, are similar to those for fractures of the femoral condyles.

Fractures of the diaphysis of the tibia include isolated fractures of the tibia or fibula and fractures of both bones.

Among the fractures of the bones of the foot, fractures of the talus and calcaneus or severe combined injuries of the foot have independent expert significance. Fractures of the talus and calcaneus without displacement of fragments heal within 3-4 months; full recovery musculoskeletal function of the foot occurs after 4-5 months.

During the period of treatment and rehabilitation, patients are recognized as temporarily disabled. Fractures of the same bones with displacement of fragments often require surgical intervention and an increase in treatment time to approximately 4-5 months.

Such injuries are often complicated by deforming arthrosis of the ankle or subtalar joint, which can limit the ability of patients to work in a number of professions, in particular those associated with physical stress, long walking and standing.

For arthrosis of the subtalar joint, subtalar arthrodesis surgery is highly effective, which completely restores the patient’s ability to work.

The femoral neck is one of the most vulnerable places of the lower extremities. This area is the transition of the hip joint to the diaphysis. This thinning is especially noticeable in women.

Most often, elderly women suffer from such fractures. However, the possibility of injury to young people cannot be ruled out. Pathological prerequisites in this case play a lesser role.

Fractures are mainly caused by various types of trauma:

• falls;
• accidents;
• blows;
• jumping;
• sudden movements;
• sports injuries;
• squeezing the leg, etc.

Symptoms and some consequences of injury appear immediately after injury to a limb.

These include:

• subcutaneous or external hemorrhages;
• swelling;
• strong pain;
• inability to rise, walk;
• the leg is turned with the foot outward;
• inability to lift the leg straightened at the knee;
• increased pulsation of the femoral artery.

A more accurate diagnosis is carried out by a traumatologist. Only after hardware studies can the exact location and severity of the injury be revealed. The sooner clinical picture becomes completely clear, the faster doctors will be able to begin treating the patient. This is important to prevent a number of complications.

During treatment and rehabilitation, various problems may appear.

The following reasons can lead to their appearance:

• severely weakened body;
• heavy loads on the injured leg;
• complex hip fracture, for example, the presence of many fragments;
• repeated or concomitant injuries;
• circulatory disorders;
• infection;
• deterioration of tissue nutrition;
• metabolic disorder;
• deficiency of vitamins and minerals;
• improper care of a patient with a hip fracture at home;
• refusal to undergo hip replacement;
• incorrectly selected rehabilitation procedures;
• failure to exercise;
• age-related changes in the body;
• the presence of certain diseases;
• violations by doctors during treatment.

Very often, the main prerequisite for the development of negative consequences is that the attending physician’s instructions regarding the regimen and implementation of certain procedures are systematically violated. This inevitably leads to problems, so risking your health is strictly not recommended.

The main cause of fractures in older people is osteoporosis. This condition is characterized by demineralization of bone tissue and the formation of voids in it. Due to a sharp decrease in the level of female sex hormones, with the onset of menopause, women become more prone to developing osteoporosis.

For young people, osteoporotic changes are rare. They appear due to hormonal imbalance or prolonged absence of load on the bones (for example, in astronauts in zero gravity conditions).

These factors have virtually no effect on the condition of the bones of young people. A hip fracture in young patients occurs after a serious injury.

The structural features of the hip joint are such that weight distribution and the correct location of the center of gravity play a big role. The joint has the ability for wide-amplitude motor activity. But this shape of the bone increases the risk of injury in the neck area.

This is facilitated by the fact that the neck does not have an outer layer - periosteum and is covered with an articular capsule. In case of injury, the blood supply for bone tissue regeneration is insufficient, and surgical comparison of the fragments is accompanied by difficulties.

For reference. Normally, this part of the bone is supplied with blood through the artery of the head of the femur; in case of a fracture, this route delivers oxygen and nutrients overlaps, which threatens the development of non-infectious necrosis.

Such fractures are characterized by the application of force from above - along the bone. This is achieved by falling on an even foot, jumping or lifting heavy objects. In old age, the neck breaks if a person falls even from a small height.

Classification

Traumatology uses a classification of femoral neck fractures based on the following principles:

1. Bone tissue injury may have the following localization:
   • the junction of the neck and body (farthest from the hip joint).
   • in the middle of the neck.
   • under the head of the femur.

   In the first case, a basicervical fracture is diagnosed. This is the most gentle type of injury for the patient, since it heals the fastest and with minimal risk of consequences.

   Clinically, the most difficult is the last option - a subcapital fracture. In this case, there are many options for displacement of fragments and complications.

2. The offset can be:
   • with a decrease in the angle between the fragments.
   • with its increase.
   • with pressing one fragment into another.

   If after a fracture the fragments are located at a more acute angle, then a varus fracture is implied, and vice versa - a more obtuse angle indicates that this is a valgus fracture.

   If one fragment is wedged into another, then this is a so-called impacted fracture. Such injuries are difficult to diagnose, since changes may not be visible on an x-ray, and the symptoms are often blurred.

3. The axis of the fracture passes:
   • Horizontally. The axis runs perpendicular to the bone. Characteristic of falling on one side.
   • Vertical. The axis runs along the bone. More often appears when lifting heavy objects and landing from jumps.

Varieties

Depending on the pathogenesis, fractures are:

• Physiological change. Damage to healthy bone associated with direct traumatic exposure;
• Pathological fracture. Damage with this type of fracture occurs due to a systemic disease that negatively affects the strength of bone tissue.

Depending on the anatomical location of the fracture:

1. Basiscervical fracture. The injury is located at the base of the neck but distant from the proximal femoral head. This type of fracture is easier to treat;
2. Transcervical fracture. The line of damage stretches through the thickness of the neck;
3. Subcapital fracture. The line of damage is located at the head of the femur. Due to the fact that the head begins to have worse blood supply, the prognosis is less favorable.

According to the violation of tissue integrity, fractures are divided into:

• Closed. Integrity is not compromised;
• Open. The tissues are damaged, bone fragments are visible in the wound.

Fractures of the femoral neck depending on the damage to the joint:

1. If the fracture line runs slightly higher from the point of attachment of the articular capsule to the bone, then such a fracture is called median or medial;
2. If the bone fracture line passes below the attachment point, then the fracture is said to be trochanteric or lateral.

Types of fracture depending on the displacement of fragments:

• Valgus fracture. The head moves upward and outward;
• Varus fracture. The head shifts downward and inward.

Depending on the mechanism of injury:

1. Compression;
2. Hammered;
3. Driven in;
4. Depressed.

Symptoms and signs

Symptoms of a hip fracture in the elderly directly depend on the type of fracture. Types of femoral neck fractures:

• Valgus type (the head is displaced upward and outward);
• Varus type (the head is displaced downward and inward);
• Embedded type (a fragment is inside another).

Valgus type

The consequences of a hip fracture in old age depend on the physiological processes occurring in the patient’s body. Due to insufficient amounts of minerals and associated diseases, bone fusion turns out to be a very difficult process.

In addition, the above injury can provoke an exacerbation various diseases, resulting in the elderly patient requiring bed rest. Often such complications end in death for elderly patients.

The femoral neck can be broken in several places, regardless of the age category of the patients.

The main types of the above damage are the following types of fracture:

• medial, if the hip bone breaks above where the femur attaches to the joint capsule;
• transcervical, if the fracture is localized in the very center of the femoral neck;
• basal, when the damage is located at the base of the neck of the femur.

It is necessary to note that, regardless of the location of the injury, a femoral neck fracture is always intra-articular.

In addition to the appearance of sharp aching pain in the groin area, with a fracture of the femoral neck, the limb looks slightly turned outward. To determine how the limb is inverted, the doctor may look at the patient's foot.

A characteristic feature of damage to the femoral neck is the ability to flex and extend the leg, but the inability to keep it straight. In accordance with the information provided by the instructions, externally the limb appears shortened by several centimeters.

The pain can increase significantly if you tap on the heel of the injured limb.

As many years ago, as now, one of the most serious problems in medicine remains injury to older people.

With age, the amount decreases external factors, which can lead to injury (production, driving, sports, etc.), but the number of internal factors increases significantly.

In older people, the structure of bone tissue changes, it becomes less dense, its fragility increases, and the bones are no longer as strong as at a young age.

And the problem is not only that the bone can break from a much smaller impact force, but also that restoration of its integrity occurs much more slowly.

A hip fracture is one of the most common injuries in older people; this injury is severe for them, requiring long-term treatment and rehabilitation. In 90% of cases, people over 65 years of age are affected.

According to statistics, this injury is more common in women.

This is explained by the fact that after menopause, hormonal changes occur in their body, which, among other things, leads to a decrease in bone density. One of the main risk factors is osteoporosis, which develops in the postmenopausal period.

Why does the fracture occur in this particular place? It's simple: the neck is the thinnest, and therefore fragile, part of the femur, connecting its body to the head, and this part of the bone experiences very serious loads. The cause could be any careless movement, slipping on ice, falling, even just going down stairs.

Symptoms of a hip fracture

The leading symptoms of a hip fracture are pain at the site of injury and dysfunction of the affected limb.

Since a fracture of this location in elderly people is considered pathological, its symptoms may differ slightly from those with a similar injury at a young age.

1. One of the signs of any injury is pain. When the femoral neck is damaged, it is of a specific nature. At the time of injury, pain in the groin area may be mild or absent at all; at rest it subsides, and resumes when moving. Sometimes the pain is very severe, as with any fracture, and pain relief is required. Another characteristic symptom of this injury is the appearance of pain when tapping or pressing on the heel.
2. Impaired limb function. The patient cannot walk or stand without support, since support on the damaged joint is impossible. In addition, at rest in a lying position, the injured leg is turned outward; the patient cannot turn it inward voluntarily. Sometimes shortening of the limb is possible.
3. Subcutaneous hematoma - characteristic feature for bone damage. IN in this case it is localized in the groin area and can become noticeable several days after the injury. In obese people it may be absent, since the hemorrhage during a fracture of the femur in this place is small and the hematoma will be invisible due to the large volume of subcutaneous fat. In thin people it can be quite extensive.

Based on the symptoms, only a preliminary diagnosis can be made, which must be confirmed x-ray.

Treatment

Conservative treatment (without surgery)

Indicated in cases where for some reason, including the patient’s refusal, surgical treatment cannot be performed.

Patients are given skeletal traction for a period from several weeks to 2 months in a hospital setting, and after repositioning the fragments, they are given a special bandage with which the patient is allowed to move with the help of crutches, but cannot lean on the affected leg.

The period of traction and wearing a bandage can last up to 6-8 months, depending on how the damaged bone heals.

Patients are also prescribed drugs that improve metabolism in tissues, strengthen bone and cartilage tissue, vitamins, and are also recommended to eat a diet with a high content of vitamins and minerals necessary for bone tissue regeneration (calcium, magnesium, phosphorus, potassium, vitamin D, etc.).

If possible, physiotherapy, massage and physical therapy are performed, aimed not only at the diseased area, but also at maintaining the body as a whole.

One of the most important problems in the conservative treatment of this serious injury is caring for an elderly person who is forced to remain practically motionless for a long time and cannot care for himself.

In case of a hip fracture, there is no clear time frame for restoring the function of the damaged limb; each patient requires an individual approach. At best, with good treatment return to full life occurs after 6-8 months.

Early mobilization

Sometimes there are cases when it is not possible to carry out surgical treatment, and prolonged immobilization of the patient is fraught with the development severe complications, or the person no longer walked independently before the injury.

In such situations, it is carried out symptomatic treatment, a few weeks after the injury, the patient is allowed to sit and walk on crutches. In the future, it will be impossible to support the injured leg, since bone fusion does not occur.

Movement will only be possible on wheelchair or crutches.

Surgery

Hip replacement significantly improves the quality of life of elderly patients.

In recent decades, osteosynthesis of the femoral neck has literally put tens, if not hundreds of thousands of elderly people on their feet, preserving their health and quality of life.

During the operation, with the help of special metal structures, bone fragments are compared and securely fixed, which creates conditions for their proper fusion.

The duration of wearing the structure is individual; during the treatment period (and after recovery too) it is recommended to take medications for the prevention of osteoporosis, vitamins, nutrition enriched with mineral salts, massage, physiotherapy and physical therapy.

Hip replacement

If a bone is fractured close to its head and there is a high risk of developing avascular necrosis, its fragmentation, or the presence of a large number of fragments, patients are recommended to replace the joint with an endoprosthesis. After installation of the structure, the patient can also move independently within a few weeks.

Consequences of a hip fracture

The consequences and complications of this injury for older people depend on many factors: the patient’s age (65 and 85 years old is a very big difference), the presence of concomitant diseases, his mental state, the chosen treatment tactics, care and rehabilitation.

Unfortunately, even surgical treatment does not provide a 100% guarantee that an elderly patient will be able to walk independently. Even after surgery and long-term conservative treatment, aseptic necrosis of the femoral head is possible, which requires joint replacement, or the formation of a false joint.

A femoral neck fracture (HFF) is a serious injury to the skeletal system, which in many cases leads to disability. Injury is more common in women aged 65-75 years, men are injured less often.

Even minor impact loads on the bone can cause a fracture. Treatment of PSB is a long and complex process that requires complex work of specialists from various fields.

Causes and mechanism of hip fracture in older people

• Body weight that is outside the normal range;
• Low vision;
• Diseases of the cardiovascular system;
• Low activity level;
• Injuries and diseases of the musculoskeletal system that are chronic or have occurred in the past;
• Malnutrition;
• Osteoporosis;
• Oncological processes in bone tissue.

The symptoms for this type of fracture are quite typical. The difference from other fractures is that the motor function of the hip may not be impaired at all or may be slightly limited. the main symptom is pain, which can be alternating in nature and appear only when a person leans on the sore leg.

Signs of a hip fracture in older people are often hidden. The patient may feel discomfort, slight pain and not suspect a fracture. This is characterized by an impacted fracture of the femoral neck. In this case, the mobility of the hip joint is preserved, and pain is felt only during exercise.

After a few days, the fragments disperse, and the person feels all the above symptoms.

Help with a hip fracture

Properly provided first aid for fractures of the femoral neck can significantly shorten the period of subsequent treatment and reduce the likelihood of complications. If you suspect an injury to the thigh and hip joint, the victim should be laid on a flat, hard surface, the leg should be kept immobile (covered with bolsters), and a splint should be applied.

The splint is applied to 2 joints: knee and hip. It is fixed with soft strips of fabric, bandages, and a wide belt. You can additionally fix the leg below the knee. Some care must be taken not to allow the patient's injured limb to move to the side or twist.

In the presence of severe pain, oral (by mouth) administration of non-steroidal anti-inflammatory drugs (ketorol, analgin) is allowed. More complete medical treatment should not be carried out independently.

A prerequisite for first aid is to call an ambulance and transport the victim to a hospital for further examination and treatment.

Further treatment and rehabilitation of the victim depends on a timely diagnosed fracture. But also correctly rendered urgent Care helps to avoid undesirable consequences of injury (for example, secondary mixing of fragments).

A person's complaints of pain in the groin after a fall or accident should suggest a possible fracture. Providing assistance in this condition consists of transport immobilization of the victim and delivery to a medical facility.

It is extremely important in emergency situation provide timely assistance for a hip fracture, but this requires an understanding of certain points. First of all, keep in mind that first aid is often the most important factor in everything that happens next to an injured person.

Diagnostics

In almost all cases, diagnosing a neck fracture is not difficult. To make a correct diagnosis it is necessary:

1. Collect a detailed medical history ( possible diseases nervous or musculoskeletal system, whether there has been trauma);
2. Conduct a detailed examination of the patient and conduct a physical examination (by palpation, determine displacement, pain);
3. Take an x-ray to determine the exact location and nature of the fracture. X-ray helps to accurately see the type of fracture, the number of bone fragments and the nature of the displacement.

In addition to a visual examination, an X-ray examination of the hip joint is performed to confirm the diagnosis of a femoral neck fracture, as well as to determine its type. On the x-ray, the doctor will see the location of the fracture and the axis of displacement of the fragments. Based on this data, he will assign suitable look treatment.

If you or your loved ones have signs of a violation of the integrity of the femur, you should immediately contact a traumatologist. The earlier diagnosis is made and treatment is started, the greater the likelihood of rapid healing without complications.

Treatment

Conservative treatment is used mainly for horizontal impacted fractures, as well as in young patients. Skeletal traction is not applied to young people.

Therapy for a hip fracture involves immobilizing the joint with a cast reaching to the middle of the knee. The period of its use is 3-4 months.

The patient retains mobility, but moves on crutches, avoiding stress on the injured limb.

Surgery femoral neck fractures is the main method of therapy. Indications for surgery are the following factors:

• Old age of the patient;
• Subcapital fractures (the fracture line passes under the head of the bone);
• A large number of fragments;
• Strong displacement of fragments;
• Aseptic necrosis.

Specialists use 2 tactics of surgical treatment: osteosynthesis and joint replacement.

Osteosynthesis is the mechanical fastening of bone fragments using metal screws or a Smith-Petersen nail. In this case, the fixing elements are introduced from the side of the bone body, pass through the fracture line and are screwed into the head.

Osteosynthesis for a hip fracture is suitable for relatively young patients with good condition bone tissue and adequate regenerative potential.

Surgery for a hip fracture in old age: the endoprosthesis replacement method is more often used, when the damaged joint is completely or partially replaced with a mechanical analogue.

There are unipolar (the femoral head and neck are replaced), bipolar (the head, neck and acetabulum are replaced), and total prosthetics.

Today, bipolar type endoprosthetics is considered optimal, since when using this method there is no increased wear of the articular cartilage.

It is known that two types of treatment are used for injuries:

• Conservative (medicines, physiotherapy);
• Surgical.

In case of a fracture of the femoral neck, the use of only conservative therapy is impossible. In this case, surgery cannot be avoided. Moreover, in children the process of treatment and rehabilitation is much faster and easier than in adults and elderly patients.

This is due to the rapid recovery of the child’s body and a special type of fractures in children (the “green twig” type). Of course, only conservative therapy is possible. She is shown in following cases:

1. If the patient is overcome senile dementia or dementia (surgery is contraindicated);
2. If the patient’s condition is serious, surgical treatment is not performed;
3. For impacted fractures with a horizontal fracture line;
4. If the lower part of the femoral neck is damaged.

What methods and methods are used to carry out conservative treatment:

• When treating an impacted fracture, a cast is applied to the area of ​​the hip and knee joints for a period of 3-3.5 months. The patient can move with a walker or crutches;
• If the lower part of the neck is damaged (lateral fracture), the prognosis is quite favorable. For treatment in a hospital setting, a plaster cast is applied for 2.5-3 months. 1.5 months after applying the bandage, weight bearing on the leg is allowed to begin. If the fracture was displaced, skeletal traction is recommended;
• If there is an absolute contraindication to surgical treatment (serious condition, dementia, disability), then a special technique is used, which is called “early immobilization.” With this treatment, the fragments do not heal, but complications are prevented, and the victim’s life remains not in danger.

How is “early immobilization” performed:

1. Numb the area around the hip joint with a local anesthetic (eg, 2% lidocaine or 1% procaine);
2. For 7-10 days, perform skeletal traction;
3. Afterwards, doctors allow you to lie on your side and sit up in bed;
4. After 3-4 weeks, walking on crutches is allowed.

Unfortunately, with this method, further movement on your own is absolutely impossible. In the future, crutches, walkers or a wheelchair are used.

Surgical treatment offers a high chance of successful recovery. It helps to achieve the most positive results with minimal loss of performance. Operations used to treat a femoral neck fracture:

• Osteosynthesis using screws, three-blade nails (for basal fractures) and screws. Ensures effective reposition of fragments and rapid formation of callus;
• Hip replacement. The prosthesis may need to be total (replace the entire joint) or monopolar (replace the head and neck of the bone).

During the treatment of a displaced fracture, the use of a derotation boot is indicated. This is a kind of bandage made of plaster individually for each person. It reduces the likelihood of displacement and stress on the affected limb.

In order to eliminate dangerous consequences, it is extremely important to seek medical help in a timely manner. It is worth considering that certain services have their own price, but in this case it is better not to skimp on your health, so as not to remain disabled for life. It is necessary to ensure the availability of the required medications, proper care, etc.

An important area of ​​treatment is surgical procedures. To eliminate the consequences of the injury and prevent a number of its complications, reposition of fragments and osteosynthesis are performed.

An important nuance is that both young and elderly people are recommended to undergo hip replacement. This will reduce the period of bed rest, and most importantly, prevent the development of dangerous problems, the first of which is aseptic necrosis.

For a chondral fracture of the medial condyle without displacement, a needle is inserted into the knee joint during puncture to aspirate blood and inject 20-40 ml of Novocaine (1% solution). The limb is fixed with a circular plaster bandage.

After 2 days, the patient is recommended to perform exercises to strengthen the 4th femoris muscle. Walking on crutches without loading a large limb is allowed after 8-10 days. The plaster is removed after 1.5 months. The leg is loaded after 4-4.5 months, since early loading leads to impression of the condyle after the fracture.

When bone fragments are displaced in T and V-shaped fractures, skeletal traction and treatment with conservative and surgical methods are performed. A Beler splint is used after the needle is inserted through the heel bone, and a load of 4-4.5 kg is attached. After 4-5 weeks, traction is stopped.

If conservative treatment does not give the expected effect, then open reduction of the fracture and osteosynthesis using metal structures are performed 4-5 days after the injury. The stitches are removed after 12-14 days.

Treatment of a hip fracture is a very long and complex process. And after treatment, the patient expects an even longer period of rehabilitation. There are two methods of treating such a fracture: surgery and non-invasive conservative treatment.

For non-surgical intervention to be effective, it is necessary that the fracture be fresh and uncomplicated. This method may not always be used, only for impacted fractures with horizontal axis.

Attention! Sometimes the patient independently, being of sound mind, refuses surgical intervention, then his pain is relieved and his leg is fixed so that he can walk on crutches. But bone fusion does not occur in this case.

Surgery is also refused if the patient’s general condition is severe or he has diseases that preclude surgical intervention (cardiovascular failure, bleeding disorders, etc.).

Conservative treatment

To treat a femoral neck fracture without surgery, they resort to fixing the joint with plaster. The main goal of this stage is to create the necessary conditions for bone fusion (this necessarily immobilizes the fragments). To prevent movement in the hip joint, a plaster cast simultaneously fixes the knee joint.

Important. The plaster cast must be worn for 3 to 4 months, excluding any strain on the affected leg.

During this time, the fragments grow together and the bone tissue heals. To achieve this, crutches are used. The period of rehabilitation and restoration of motor activity depends on the type of fracture and the degree of displacement.

Young patients are allowed to stay at home during this period. A hip fracture in older people is performed in a hospital setting.

In addition to plaster, skeletal traction (for displaced fractures) and physical therapy are used. The time required for bone healing and restoration of leg function in older people is 2 times longer (you can fully rely on the sore leg only after 7-8 months).

Orthopedic surgery for a hip fracture is more effective than conservative treatment. If the patient has no contraindications to surgery, then it is better to give preference to this method.

Attention. It is better not to delay surgical intervention, but to perform it as soon as possible after hospitalization. This increases the chances of a successful result, as it prevents bone fragments from dying.

The technique of comparing fragments without opening the joint is used for simple fractures and under the control of an X-ray machine. This method is safer, as it eliminates the possibility of infection of the cavity, tissue death due to the intersection of blood vessels and tissues, and significantly reduces the healing time.

After comparing the fragments, they are fastened using special screws made of inert metals or orthopedic nails (osteosynthesis of the femoral neck). Hip replacement surgery is very reliable and popular. In this case, instead of the femoral head and acetabulum, an artificial substitute is inserted into the joint.

Drug treatment

The main danger to the life of a person with a fracture of the hip joint is prolonged bed rest, so therapy requires a maximum reduction in its duration. Surgical treatment provides this opportunity. Thanks to him, it is possible to quickly restore mobility to the patient and significantly reduce the risk of disability.

Disability due to hip fracture

TO internal damage knee joint injuries include damage to the menisci and cruciate ligaments.
If the meniscus is damaged, patients are advised to undergo surgery - meniscectomy. Postoperative treatment lasts about 1.5-2 months, and during this period the function of the knee joint usually returns to normal. The working capacity of patients is restored within 2.5-3 months from the moment of injury, but sometimes due to persistent stiffness in the knee joint, the period of temporary disability is extended. Disability does not occur in patients after a timely and uncomplicated meniscectomy.

2. Passport and its photocopy;

3. A certified photocopy of the work book;

4. Sometimes they may require a certificate of income from the place of work;

5. Outpatient card;

6. Extracts from hospitals and their photocopies;

7. Characteristics from the place of work or study;

8. Application for examination;

9. Report on industrial injury form N – 1 or o occupational disease;

10. IPR (Individual Rehabilitation Program);

11. Certificate of disability.

1. A certificate confirming your disability;

2. Individual Program Rehabilitation.

After that, contact social media. protection of your area - in order to apply for the benefits you are entitled to, and then to the pension fund - to apply for a pension.

I have had a Group II disability for many years, permanent. Now I started to feel really bad. Is it possible to apply for “increased disability”?

Of course, this has always been the case. Of course, with age, a person may develop illnesses and increase restrictions on their ability to live. Consult your doctor.

I heard that soon everyone will have to go for re-examination, since the so-called International Classification of Functioning (ICF) is being introduced, which will determine the degree of impairment not by groups, but in points...

I’ll say right away: the new system does not apply to those who have permanent disabilities. Only to those who apply for examination for the first time, as well as to those who already have a disability for a certain period and will come for re-examination upon its completion.

It is difficult to say when the IFF will be introduced, but there is a possibility that it will be this year. There is no order for its implementation yet.

The draft has just been sent to medical examination specialists for discussion, and we, in turn, are preparing proposals and additions to it. I’ll say right away: the project raises many questions.

For example, it spells out in detail how many points and in what cases a person who has undergone a lung transplant will receive - an operation that is performed in isolated cases in Russia, and there is, for example, nothing about the loss of an eye.

But in one form or another, the ICF system will certainly be introduced. This is provided for in the Declaration of the Rights of Persons with Disabilities.

The ICF system has been successfully operating for ten years in European countries. It allows you to accurately assess the degree of dysfunction of the body. It introduces letter designations and a 100-point scale.

For now, it is assumed that those who come for examination will be assigned both the already familiar groups and these points - in accordance with the IFF. That is, there will be a double assessment. A pilot project to introduce the ICF has already been carried out in Khakassia, Udmurtia and the Tyumen region.

The complexity of the neck fracture has led to the fact that the victim has the right to qualify for a disability group in some cases.

Possible complications

They begin to work on the injured leg while still in bed. To do this, the patient needs to bend and straighten the limb at the hip and knee joint, alternately raise both legs, spread them apart, rotate clockwise and counterclockwise.

The load should increase gradually. Impact forces must be avoided.

The use of simulators is allowed, but their use must be discussed with the attending physician.

Once the patient is allowed to stand, he should actively take advantage of this opportunity. Initially, the patient walks with a walker, then with crutches.

Duration hiking gradually increase from a few meters to a kilometer per day or more.

At the last stage of recovery, you can leave only 1 crutch, and then completely abandon it, returning to the normal method of movement. Next, the muscle strength of the leg is restored. The patient can go to the gym or exercise at home.

Measures indicated for speedy recovery after a consolidated neck fracture:

• Therapeutic exercise helps restore limb function, develop joints and avoid muscle atrophy;
• Massage improves blood flow and strengthens tissue, relieving leg swelling after a fracture;
• Manual therapy speeds up the recovery of damaged areas;
• Physiotherapy (amplipulse, magnetic therapy, ultraviolet irradiation).

1. Knee pain. May appear after prolonged immobilization. Eliminated with medication (painkillers and other drugs), gymnastics and physiotherapy;

2. Bedsores. It is necessary to prevent bedsores (change of position, rubbing with camphor alcohol, maintaining hygiene);

3. False joint on the bone (removed surgically);

4. The child may experience severe shortening of the night (corrected surgically);

5. Re-mixing of fragments. For prevention, the use of a special orthosis and corsets is indicated.

Why do people die after a fracture?

There are many reasons for high mortality:

• Hypostatic pneumonia;
• Thrombosis of large veins and thromboembolism;
• Aseptic necrosis of the femur;
• Infection of the hip joint;
• Development of sepsis upon exposure pathogenic microflora into the bloodstream.

These are the dangerous conditions in which a fracture of the femoral neck is dangerous. To prevent them, you need to stay in the hospital, follow all the doctor’s instructions and take preventive measures.

How recovery will proceed after a hip fracture in the elderly is associated not only with the age-related physiological characteristics of the body, but also with a number of other factors, including:

• accompanying illnesses;
• mental illness;
• the chosen method of treating the fracture;
• appropriate care for a sick person;
• implementation of all recommendations for an effective rehabilitation period.

It should be noted that surgery cannot guarantee the subsequent ability of an elderly patient to walk. Both conservative and surgical methods can lead to the development of aseptic necrosis of the head of the hip bone or the formation of a false (additional) joint.

Given pathological condition requires complete replacement of the joint, since it consists of necrosis of the head of the bone, decomposition and complete disappearance. An additional formed joint can be treated exclusively by surgery.

Depending on the individual characteristics, the specialist can determine the degree of the disorder (the patient is unable to lean on the injured limb or carry out active movements, since any movements provoke a feeling of great discomfort).

It is for this reason that in the first weeks after surgery, it is recommended to exercise after a hip fracture in the elderly.

One of the main complications after a hip injury is the immobilization of the patient for a very long period of time. The predominant number of elderly patients suffering from such damage are characterized by coronary heart disease, arterial hypertension and other pathological conditions of organs and systems in the human body.

Please note that due to the possibility fatal outcome patients due to numerous complications, rehabilitation of an elderly person after a hip fracture is aimed at eliminating them.

In this case we are talking about the following consequences of fractures in the hip joint:

• bedsores localized in the sacrum, buttocks, legs and shoulder blades;
• congestive pneumonia;
• thrombosis of deep veins located in the lower extremities;
• the emergence of a risk of pulmonary embolism;
• formation of joint contractures;
• constipation;
• disorders of psychoemotional origin.

Thus, the main rehabilitation after a hip fracture in older people is to restore motor activity as quickly as possible. Regular exercise can prevent vein thrombosis.

This pathological condition is due to the fact that the patient remains in the same position for a long time. The formation of blood clots and stagnation of blood flow in the human body can lead to serious and even fatal consequences.

Immobilization for a long period of time can undermine a person’s immunity, which predisposes the body to problems in the functioning of the cardiovascular and respiratory systems.

Complications caused by the implemented surgical intervention. Although the cost of the operation is not too high, using screws in the wrong position, at the wrong depth or at the wrong angle can lead to nerves and blood vessels, as well as acetabulum formation.

In rare cases, the effects may be delayed in time. This can be either rejection of the prosthesis or loosening of the metal structure that was implanted inside the hip joint during surgery.

Injuries to the femur, especially its upper part, are dangerous because there is a high probability of developing undesirable consequences both during treatment and some time after completion of rehabilitation. And although a young body is better able to resist negative influences, it is also susceptible to danger.

In order to minimize the negative consequences, and rehabilitation after a displaced hip fracture goes well, it is worth staying in the hospital for a while under the supervision of medical staff. The recovery period can last from 3 to 6 months, and at least a third of this period is recommended to stay in a hospital.

Each patient has different risks of developing negative consequences.

The following complications are possible:

• inflammation;
• sepsis;
• hemarthrosis;
• post-traumatic pneumonia;
• fibrosis;
• cystosis;
• changes in the sensitivity of nerve endings;
• false joint;
• aseptic necrosis;
• lymphostasis and elephantiasis;
• venous thrombosis of the lower extremities;
• fat embolism;
• limitation of a person’s motor ability;
• lameness;
• change in limb length;
• death.

Some complications are very common, but they can be easily eliminated even at home. Others pose a serious threat, so hospitalization is recommended. prerequisite. Unfortunately, even surgical medical intervention does not always have the desired effect.

The most dangerous complications

It is quite possible to reduce the risk of developing any complications after a hip fracture.

1. Emergency assistance to the victim must be provided correctly. Inept actions can only aggravate the severity of the injury and provoke a deterioration in the patient’s condition. Sometimes it is better to limit yourself to calling an ambulance.
2. It is necessary to seek qualified medical help as soon as possible. Even if the fracture does not cause you severe discomfort, still contact a traumatology department. In any case, the consequences are inevitable.
3. Take the medications prescribed by your doctor. This is especially true for antibiotics after surgery.
4. Do not move your leg until the fracture has healed. Displacement of fragments and the occurrence of associated damage must not be allowed.
5. Attend your prescribed appointments at the correct stage of your treatment. Physiotherapy should not be excluded from the treatment program. Massage will also be useful, but only after complete fusion of the bones.
6. Take vitamins. Without supplements, it will be very difficult for the body to cope with the effects of injury. This is especially true for people whose diet is deprived of vitamins and minerals, and whose body is depleted.
7. Do not overload the sore leg in the first year after the injury and its healing. Intense physical activity, prolonged standing - all this can provoke repeated damage to the collum femoris.
8. Regularly undergo the necessary scheduled examinations. In the first time after an injury, it is necessary to monitor the healing process with the help of regular examinations from a doctor and x-ray diagnostics.
9. Attend physical therapy classes. To restore the functions of a sore leg and strengthen weakened tissues, special exercises are recommended, preferably under the supervision of a specialist.

To avoid problems, follow your doctor's recommendations, and at the first suspicion of complications, immediately notify your doctor. To learn more about possible complications of such injuries, their consequences and methods of prevention, watch the video in this article.

After surgery on the hip joint, the patient is allowed to stand up and put light weight on the leg for 3-4 days. At the initial stages, until healing is complete, the patient needs support on crutches.

During the rehabilitation period, it is important to follow all doctor’s instructions and attend treatment procedures that are aimed at improving blood flow in the joint area and supporting the human immune system.

The massage should be done by a specialist. During the mechanical action on soft tissues, the effect of increasing blood flow and lymphatic drainage is achieved, as well as improving the general condition of the patient - removed nervous tension, maintains muscle tissue tone.

Physical therapy exercises are indicated for patients with any type of fractures. Adequate, gradually increasing load on the injured leg helps strengthen the thigh muscles and prevent bone tissue atrophy.

The patient should begin to walk independently gradually: first with the help of stilts, then with two sticks, one stick and, finally, without the help of devices.

The life span of a patient after a hip injury depends on his age and state of health, the presence of chronic diseases, and moral readiness to promote his recovery.

For older people, rehabilitation periods can be over 12 months. As statistics show, few old people survive this period, or rather, almost half die.

A complication of injury in the form of nonunion of a fracture confines a person to bed for the rest of his life. Its duration is influenced by the quality of care, as well as the patient’s willingness to follow the doctor’s instructions.

If emergency care is provided correctly and surgery is performed in a timely manner, the prognosis for the patient improves. A person can live to a ripe old age with minimal discomfort.

How to avoid complications

To avoid fractures of the femoral neck, doctors recommend normalizing your diet - it should be balanced, have sufficient calories, contain all the vitamins and microelements a person needs, vitamins C, D, calcium and phosphorus are especially important.

Every person's daily diet should contain foods containing these substances. It is important to maintain a proper sleep schedule and avoid stressful situations. Chronic stress negatively affects the elemental ratio in bone tissue.

Your bones and muscles should receive regular exercise. For older people, walking is recommended - at least 3 km per day.

Important. Get rid of excess weight, this is not only an excessive load on the musculoskeletal system, but also disorders in all types of metabolism in the body.

Visit your doctor for a purpose preventive examinations and bone health analysis if you are at risk for a hip fracture. It is necessary to treat all diseases of bone tissue and joints in a timely manner: arthritis, tuberculosis, osteomalacia, etc.

Hip fractures occur in people retirement age and younger people. The disease is provoked by accidental falls and blows, but Osteoporosis is always a prerequisite for the disease. Characteristic feature this fracture is severe pain when walking, performing any movement, and even when in a static state of rest.

Questions arise:

1. Can modern medicine help?

2. Is there any government assistance for such patients?

So, do they give disability for a hip fracture and how quickly can it be issued?

According to current legislation, disability cannot be obtained immediately even with such serious disabilities caused by. A time frame has been established during which ALL possible types and forms of treatment for this disease in specialized medical institutions. The state has allocated up to 190 days to diagnose the disease, treat it and subsequent rehabilitation.

Confirmation of the treatment performed is attached in paper form for medical and social examination. And only now, when asked by a representative of the competent medical authorities: do they give disability for a hip fracture?, you can get the answer: “YES.” Registration of financial state assistance for continued treatment is mandatory.