First aid for hip fracture

First aid for a hip fracture should be provided as soon as possible after the victim has characteristic signs of damage. This will avoid serious complications in the future, as well as alleviate the current state of health of the patient until an ambulance arrives at the scene of the incident.

Experts call the presented injury format one of the most serious. At the same time, the medical care that should be provided to the patient before the arrival of doctors here is somewhat different from the standard algorithm for fractured limbs.

The main problem of such a deviation is considered to be a high percentage probability of significant blood loss. Moreover, it does not matter at all whether it will be a closed fracture, or its open alternative. In any scenario, blood loss leads to a stable deterioration in the overall clinical picture.

If you do not help the victim in time, then blood loss can be up to one and a half liters. Such a large volume guarantees the onset of traumatic shock in the first 10-15 minutes after injury.

General classification

To figure out how best to provide first aid, you first need to establish a clear localization of the lesion. During the initial cursory examination, even a person far from medicine will be able to “by eye” determine the severity of the pathology, which in the future will provide more qualified assistance.

According to statistics, about 6% of all fractures occur precisely in the deformity of the femur, which leads to a violation of the integrity of the femoral neck. Doctors call this part of the skeletal system something like a weak link. Especially often its damage is diagnosed in older people who have survived a fall.

During the initial diagnosis on the spot, which allows you to draw up a subsequent program of emergency measures, it is extremely important to pay attention to several characteristic signs of deviation.

If a person has been the victim of a hip fracture, then he will not be able to step on the injured leg, and his knee and foot will be turned towards the healthy limb. Also, the condition will be accompanied by a pronounced pain syndrome, which will intensify every time you try to make even a slight movement.

If no external tears were found, as occurs with an open lesion, then it is worth additionally conducting an auxiliary test. To do this, you will have to gently press on the heel area with a little pressure, or tap on the ankle.

With a fracture, the patient will experience a new surge of discomfort, which will confirm the suspicions that have arisen. Other typical symptoms include:

• soreness not only in the region of the femur, but also in the joints;
• limited movement;
• a visible change in the shape of the thigh, which is often accompanied by its shortening;
• unnatural mobility in the area of ​​the alleged lesion;
• partial or complete loss of sensation in the peripheral parts of the lower extremities.

If at least one of the listed dangerous signs is detected, you should immediately call an ambulance. And before her arrival, others will have to independently try to alleviate the well-being of the victim.

Assistance Instructions

Regardless of the type of fracture and its severity with the amount of affected healthy surrounding tissues, the general scheme for providing pre-medical measures remains identical.

It includes four main steps:

• panic prevention;
• anesthesia;
• immobilization;
• transportation.

The first point is especially important, despite the complexity of its implementation. Only to achieve the desired effect, local sedatives or alcoholic beverages issued “for courage” should not be used. Such scenarios of the development of events will not only aggravate the general condition of the patient, but also turn out to be the foundation for blurring the clinical picture. It will become much more difficult for specialists arriving at the scene to diagnose the extent and severity of the damage received.

Particular attention should be paid to the behavior of the victim. In this case, crying or swearing are the body’s preferred responses rather than indifference. The latter almost always indicates that a person begins to fall into the stage of traumatic shock, which is almost impossible to overcome with improvised means without doctors.

To prevent the spread of pain shock, it is worth turning to methods of anesthesia. It is best to use intramuscular injections of an analgesic spectrum of action. But it is allowed to use them only after prior consultation with the doctor on duty by telephone. It is forbidden to prescribe any medications on your own due to the risks of developing anaphylactic shock or other atypical complications.

The third point of the plan provides for the complete immobilization of the affected part, followed by fixation of the bone structure of the femoral system. This approach is designed to reduce the painful manifestations that make themselves felt even with the slightest movement.

Also, correctly performed immobilization can prevent a number of complications that cause bone fragments. The latter is suitable for an open type of fracture with a wound surface and bleeding. Immobilization will help prevent additional tears:

• large vascular highways;
• nerve roots;
• healthy tissues, involving them in destructive processes.

But trying to set the bones on your own, or pulling out fragments from the wound, foreign bodies is strictly prohibited. Often it is the stuck parts of the bone skeleton and the fragments that have fallen into the gaping wound that play the role of a massive bleeding blocker. It will be more effective to simply apply a splint to fix the skeletal system without the chance of its inadvertent movement.

The final point of the strategy should be carried out by professionals who will take care of the most reliable immobilization without consequences for the patient’s health. As soon as the doctors get to the scene, they should be briefly informed about the circumstances that led to the tragedy, the current state of health of the victim and the measures taken.

Detailed information collected during the provision of a set of pre-medical measures will allow experts to quickly navigate the situation, as well as build a further plan of action.

Features of immobilization

In order to deliver the victim to the nearest hospital in view of the impossibility of the ambulance team to reach their destination, you will have to take care of creating ideal conditions for proper transportation.

The best way to immobilize a victim of a femoral fracture of any format would be a Dieterichs splint, tailored to the anatomical features of a person. But such a version will work only if the appropriate medical instruments are available, therefore only the arrived doctors in the ambulance often work with specialized tires.

And already in the inpatient department of the hospital, the tire is supplemented with plaster rings. They are imposed on three zones:

• shin;
• hip;
• torso.

Moreover, each ring must consist of at least seven layers of bandage along with a plaster solution. In total, five rings are applied to the victim, three of which are fixed on an unhealthy diseased limb, and two are left for installation in the torso.

In field conditions, such assistants are unlikely to be obtained, which is why immobilization with ladder tires comes to the fore in terms of relevance. For first aid, four such tires will fit, each of which should be about 120 cm long. In a pinch, three ladder tools will do.

First, suitable material will have to be wrapped with cotton wool with bandages to make the base softer. If this was not at hand, then even just clean rags or clothes will do.

The first tire is bent strictly according to the office of the three main parts of the body:

• femoral surface;
• feet;
• shins.

Next, you will need to form a recess for the muscle part of the lower leg and heel region. Separately, it is necessary to ensure that arching occurs in the popliteal region, taking into account the obligatory adoption of a slightly bent knee posture. And the lower end is bent in the shape of the letter “G”.

Such a thoughtful approach will allow you to securely fix the foot with a bent ankle joint, which occurs strictly at a right angle for the convenience of the victim. To complete work with the first tire, it is necessary to completely cover the entire foot with its lower end. Approximately two centimeters of material should protrude beyond the tip of the toes.

After it is allowed to start laying the other two tires. They are tied together in length, while the lower end should repeat the bends of the letter “G” at a distance of about 20 cm from the lower border.

An elongated tire must be driven strictly along the outer surface of the body, starting from the armpit and ending with the lower limb up to the foot. To avoid foot drop, you must first install the lower folded edge so that it completely encircles the foot at the top of the rear tire.

If others are lucky to have a fourth professional stair splint at hand, then it is mounted according to the vector of the internal femoral plane. It is worth laying the material from the crotch, leading to the foot. The bottom edge also needs to be folded in the shape of the letter “G” to further secure the foot, preventing its anatomical sagging. The edge wraps behind the foot at the top of the lower folded border of the outer extended splint for added stability. At the final stage, you will need to strengthen everything with gauze bandages.

But sometimes even stair rail elements cannot be found. In such situations, it will be more productive to make a similar design on your own from improvised materials, waiting for the ambulance brigade. The following is used as a basis:

• long stick;
• disinfected metal strip that does not bend;
• building board.

Before starting the manipulation, it is recommended to wrap the found tire substitute with a cloth or cotton with bandages to avoid direct contact of the material with bare skin.

On the outside, the board should be applied, starting from the armpits and right up to the very ankle. On the inner plane, the material is laid first in the inguinal region, and then lead to the end of the lower limb. All parts are methodically wound to the leg and torso itself.

The presented tactics will allow for more or less stable immobilization to the nearest hospital. In addition to the purpose of neutralizing pain, splinting also works as a guarantee that there is no possible displacement of bone structures.

Fracture of the neck of the femur

In addition to the traditional fracture of the femur, often such injuries are accompanied by an affected integrity of the femoral neck. The principle of first aid here remains almost identical. Here, too, it is forbidden to try to set the bones on your own, since this is the prerogative of an experienced orthopedic doctor.

Doctors say that femoral fractures often do more harm with the accompanying traumatic shock than with the rupture of the bone structure itself. In this case, all such fractures can be sorted according to localization into the following types:

• proximal end of the femur;
• diaphysis;
• distal end of the femur.

The first point includes the deformation of not only the neck itself, but also the head or trochanteric region. With the diaphysis, the emphasis is on the destructive effect in the region of the subtrochanteric zone, as well as the upper, middle, lower third of the diaphysis itself.

With a diagnosed distal format, the supracondylar and transcondylar lobes deserve special attention. At the same time, in medical practice, fractures of the proximal end are most often detected.

In professional terminology, there is separately another classification, which provides for the division of fractures into basal, transcervical and subcapital. Doctors also distinguish between adduction and abduction versions of injuries. The latter are often impacted in nature, which makes further treatment difficult.

But it is often the adductive versions of the deformity that are diagnosed in the victims, caused by domestic injuries, such as falls during ice.

After the initial examination was carried out, the data of the anamnesis are taken into circulation. Here it is worth paying attention to how severe the pain is. With impacted injuries, pain can be relatively weak, intensifying only with active actions when changing the position of the joint. In some types of damage, even recoil to the knee joint is possible, but this is not a mandatory characteristic.

From other points, external rotation and shortening of the unhealthy limb by about 3 cm are noted, and with an impacted variation – 1 cm. But if there is an abduction format, then the problematic limb remains almost the same length as the healthy one, sometimes even stretching a few centimeters .

To check the condition of the victim, laid in a horizontal position, they are asked to slightly raise the leg to tear it off the supporting surface. So it will be possible to detect the “stuck heel syndrome”, if it has a place to be. But even if the victim can walk after a hard mechanical impact on the thigh, this does not indicate his normal state of health. Some patients with impacted fractures are also able to be active at first.

Standing apart are pertrochanteric and intertrochanteric fractures, which are localized along the length from the base of the neck up to the rotational line. They occur due to falling on the greater skewer. Against the background of concomitant osteoporosis, which is often diagnosed in older people, the injury becomes more serious.

Such breaks in the integrity of bones, skin, subcutaneous tissue almost never occur without massive blood loss, extensive swelling.

Immobilization in this scenario is carried out using the same Dieterichs tire that is in the ambulance, if you inform the dispatcher about suspicions regarding the type of fracture when calling the doctors.

After the victim is taken to the inpatient department of the hospital, the medical staff will immediately begin treatment according to the principle of stable-functional osteosynthesis. It is believed that the optimal time for surgical intervention with a high probability of a successful outcome is the first day. Otherwise, you can wait until the mechanism of secondary changes and vascular thrombosis is triggered. The latter will block the supply of nutrients to the femoral head.

This is also evidenced by statistics, because only in 22% of all patients with a diagnosed fracture of the femoral neck and subsequent mixing of fragments, the head continues to receive the necessary substances with blood. One third of the victims are cases of ischemia. And the majority, which is over 45%, is struggling with avascularity.

In order to prevent the most serious development of events, it is important to be able to provide assistance to the victim immediately, and guarantee his hospitalization in a short time.