Fractures – first aid

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Extremely dangerous fracture. The older we get, the more often a fall – whether on an icy pavement or while bathing in a bath – can end in a fracture of the neck of the femur. Our knowledge of this injury determines whether it will end in serious complications, disability, and even death.

Any fall in old age carries a risk of serious fracture and health complications. A hip fracture, commonly known as a hip fracture, is a complete or partial fracture in the part that forms the hip joint. It distorts the hip, makes it impossible to walk, causes pain. Bone chippings can damage nearby tissues that are at risk of infection. Such a fracture usually affects the elderly, mostly women, and is the most serious complication of osteoporosis. The most dangerous, however, are the complications resulting from the necessity of prolonged immobilization in the supine position.

An important signal

It is not uncommon that if the fall was not painful, we do not see the need to report it to the doctor. That `s bad! Regardless of the consequences, it may be the first sign of impending health deterioration (there is even the concept of a predicting fall). We cannot ignore such signals, especially if they are repeated. People who have fallen, especially older ones, should always be thoroughly examined.

The characteristic symptoms of a hip fracture include:

1. severe pain in the hip joint area, in most cases making it impossible to walk and stand;
2. swelling, soreness when touching the affected hip and bruising in the area, distortion within a suspected fracture;
3. characteristic position of the diseased limb, which is all twisted outwards;
4. shortening of the diseased limb.

It is worth knowing that a spontaneous fracture may also occur, which may not be noticeable in the presence of a pre-existing serious disease of the hip joint. Spontaneous fracture is most often the result of osteoporosis

First aid

If the fall occurs while we are alone at home, we should contact our doctor and family as soon as possible. We have to crawl to the phone, and when we can’t move – scream our neighbors.

When we witness someone’s fall and the victim complains of hip pain, call an ambulance. Until his arrival, it is forbidden to make any movements or massages within the sore spot. The injured person should not be given fluids and food.

The doctor fixes the fracture himself during transport.

Treatment methods

Treatment of a hip fracture is most often surgical by implanting an endoprosthesis. There is no age limit to which these operations can be performed. It all depends on the patient’s health condition (contraindications may be additional diseases, such as diabetes or hypertension). If it cannot be operated on, treatment with an extract placed on the affected limb or the so-called plaster derotation boot. This requires 6-8 weeks of bed rest and unfortunately carries a high risk of complications.

In people under 80 years of age, hip surgery is performed using a total endoprosthesis (artificial femoral head and artificial acetabulum).

In patients over 80 years of age, hemiplasty is used, i.e. implantation of a prosthesis into the femur while preserving the natural acetabulum of the hip joint.

Necessary rehabilitation

Even a properly healed fracture has a significant impact on the functioning of the hip joint, which deteriorates over the years. Even small changes in the position of the fragments can cause chronic pain. Walking performance may also be impaired or degraded over the years due to muscle weakness. This is due to the fact that the sick joint is generally spared, and chronic pain discourages systematic exercise. That is why it is so important to start rehabilitation after surgery as early as possible so that patients can quickly return to an upright position.

The physiotherapist develops an exercise plan, starting from breathing exercises, through standing upright, to learning to walk with the use of a walking frame or crutches. In this process, it is important that the patient is able to move independently and safely and that he is not dependent on the help of others.

Even the next day after surgery, while the patient is still in bed, general strengthening exercises are performed to reduce the risk of complications – pneumonia or pressure ulcers. Exercise your foot and knee movements, paying particular attention to strengthening your quadriceps. After the operation, you walk with a walking frame or crutches for several weeks or months, so it is necessary to exercise the muscles of the upper limb girdle and the triceps muscles of the arms. Gymnastics can be performed in the supine position or in a sitting position by lifting the torso and buttocks on your hands. Flexing and straightening movements in the hip joint are also recommended. It gradually moves to active (patient) movements in the hip under the supervision of a therapist.

Don’t forget about complications

Even if the operation is successful, the potential complications must not be forgotten. One of the reasons for their occurrence is that hip fractures affect the elderly. Due to their age, they already have a weakened health condition, and it is significantly aggravated by serious surgery and the need for long-term immobilization.

Significant complications after a hip fracture include:

worsening of the patient’s general condition, increased risk of infection, e.g. pneumonia;

postoperative wound infection;

bedsores caused by the need for prolonged bed rest;

thromboembolic complications;

implant infection and / or implant rejection.

In addition, there may be additional tissue damage at the fracture site in the event of a bone chipping fracture.

After hip fracture, a large group of elderly patients require temporary or permanent care. Mortality is the result of complications caused by infections, thrombosis, complications from the cardiovascular system. Most deaths are recorded in the first 6 months. An indicator of increased risk is inability to get up. According to observations, older people who had depression after a fracture were more likely to die from various complications.

Can fractures be prevented?

Osteoporosis causes the bones to become weaker and thinner. It is the neck of the femur, including the wrist and vertebrae that is most at risk. According to the data of the World Health Organization (WHO), the risk of fracture concerns approximately 40% of women and 13% of men. These are mainly people over 60 years of age, suffering from diseases with calcium-phosphate metabolism disorders, chronically ill with cardiovascular diseases, all of whom have osteopenia with a T-score of minus 1 to minus 2,5, and also people with reduced mobility.

The basic principles of the prevention of osteoporosis include providing the body with adequate amounts of calcium (1500 mg per day) balanced with vitamin D. If we do not tolerate dairy products, we cannot drink milk, you can try other products rich in calcium (cheese, green vegetables, nuts, sardines) or take it in the form of ready-made preparations. For example, preparations containing extracts from animal bones or from the shells of crustaceans are helpful.

To choose the right (packaged) foods that contain a lot of calcium, check the ingredients on the label. One more piece of advice: avoid too many foods rich in protein, sodium and salt, such as melted cheese. In large amounts, they can contribute to the body’s loss of calcium. It is worth emphasizing here that the importance of eating habits for healthy bones has been demonstrated in many scientific studies. Extra doses of calcium and calcium-fortified foods increase bone mineral reserves.

Environmental (lifestyle) and genetic factors play a huge role in shaping bone density and strength. It is important to regularly engage in physical exercise such as swimming, water gymnastics, cycling, resistance exercises with weight lifting. Before we decide to choose physical activity, let’s consult a doctor.

Other prophylactic principles include avoiding alcohol and quitting smoking These addictions inhibit calcium absorption and bone formation. You may also consider using hormone replacement therapy (HRT) with your doctor to make up for the hormone deficiency.

Consultation: Robert Świerczyński, MD, PhD, specialist in trauma surgery, orthopedics and sports medicine;