What are the main causes of a broken femur bone? How is a broken femur treated? What is the recovery process for a femur fracture? Get detailed answers to these questions and more in this comprehensive article.

Anatomy of the Femoral Shaft

The femur, or thigh bone, is the largest and strongest bone in the human body. The middle portion of the femur is called the femoral shaft, and it is approximately an inch and a half thick. The femoral shaft is hollow, similar to a pipe, and is completely surrounded by the major muscle groups of the thigh, including the quadriceps, hamstrings, gluteal muscles, and adductors. This anatomical structure makes it rare for a broken femur to pierce through the skin.

Common Causes of Femur Fractures

Femur fractures typically occur due to high-energy traumas, such as car accidents, motorcycle crashes, falls from heights, or injuries sustained during high-speed activities like skiing or biking. These significant impacts can cause the femoral shaft to break. Individuals with femur fractures often have other associated injuries, including fractures in other bones, internal injuries to the chest, abdomen, or pelvis, and/or head or neck injuries. In some cases, these other injuries can be severe or even life-threatening.

Initial Treatment and Evaluation

Femur fractures are extremely painful, and the affected leg will typically appear “floppy” or deformed. Since the individual cannot walk with a broken femur, they are typically transported to the hospital by ambulance. Paramedics or first responders may temporarily stabilize the injured leg using a metal brace, straps, or pillows to reduce pain and prevent further damage. Once at the hospital, emergency room doctors will thoroughly examine the patient’s entire body to identify any other injuries. Multiple x-rays and, in some cases, a CT scan will be performed to better understand the nature and extent of the femur fracture.

Surgical Treatment Options

Femur fractures almost always require surgical intervention to stabilize the broken bone and promote proper healing. If the surgery cannot be performed immediately, doctors may temporarily place a “traction pin” into the leg bone above or below the knee and connect it to weights. This helps align the broken ends of the bone and can provide some pain relief before the definitive surgery.

The most common surgical treatment for a femur fracture is the placement of an intramedullary nail (IM nail), a metal rod inserted into the hollow center of the femur. The IM nail is typically inserted from the top of the femur (near the hip) or the bottom (near the knee), and one or more screws are placed through the nail above and below the fracture site to stabilize the bone. This procedure is often performed through small incisions using x-ray guidance.

In some cases, such as when there is existing hardware in the femur (e.g., from a hip or knee replacement), doctors may choose to stabilize the fracture with a metal plate and screws on the side of the bone instead of an IM nail.

External Fixation

If the femur fracture cannot be adequately stabilized with an IM nail or plate and screws, doctors may use an external fixator. This temporary device involves placing metal pins through the skin and into the bone above and below the fracture site. The pins are then connected to a metal frame outside the leg, which helps stabilize the broken bone.

Recovery and Rehabilitation

After the surgical treatment of a femur fracture, the patient’s recovery and rehabilitation process will depend on the specific nature of the injury, any associated injuries, and the stabilization method used. In many cases, patients are allowed to gradually put weight on the injured leg shortly after surgery, as directed by their orthopedic surgeon. Physical therapy is typically an essential component of the recovery process, helping to regain strength, range of motion, and the ability to walk independently.

The recovery timeline can vary significantly, but most patients with a surgically treated femur fracture can expect to resume normal daily activities and return to work within 3-6 months, depending on the severity of the injury and the individual’s response to treatment.

Potential Complications

As with any major orthopedic injury, femur fractures can be accompanied by various complications, such as infection, delayed or nonunion of the bone, malunion (improper healing), avascular necrosis (bone death), and the development of post-traumatic arthritis. Patients should closely follow their surgeon’s instructions and attend all scheduled follow-up appointments to minimize the risk of these complications and optimize their recovery.

In summary, femur fractures are serious injuries that typically require surgical treatment and a prolonged rehabilitation process. Understanding the anatomy of the femur, the common causes of these injuries, the various treatment options, and the potential complications can help patients navigate the recovery journey and achieve the best possible outcomes.

Femoral Shaft (Thigh Bone) Fracture

Basic Anatomy

The femur (thigh bone) is the largest bone in your body. The femur is the only bone in the upper portion of your leg, and it is completely covered by your thigh muscles. These include the quadriceps (quads) in the front of your thigh, hamstrings in the back, gluteal muscles, and groin muscles (adductors). Because of this, it’s rare for a broken femur to poke through the skin. The long, middle portion of your femur bone is called the femoral shaft. This section of your bone is about an inch and a half thick. It is also hollow like a piece of pipe. The upper part of your femur is connected to your pelvis through the hip joint, which is shaped like a ball and socket. The lower portion of your femur bone also widens out and connects to your tibia (shin bone) and patella (kneecap) at the knee joint.

Figure 1: Skeleton and x-rays showing the femur, and how it makes up the ball part of your hip joint and the upper part of your knee joint.

Injury and Epidemiology

A significant amount of energy is required to cause a femur fracture, most commonly after a car accident, motorcycle accident, fall from a height, or injury from a high-speed activity such as skiing or biking. It’s also common for people with femur fractures to have other injuries. These may include other fractures, internal injuries to the chest, abdomen, or pelvis, and/or injuries to the head or neck. Sometimes these other injuries can be severe or even life-threatening.

Initial Treatment

Femur fractures hurt a lot, and if you break your femur, your leg usually looks “floppy” or deformed. You can’t walk if your femur is broken, so you would typically be brought to the hospital by ambulance. Sometimes paramedics or first responders will place a temporary metal brace, straps, or pillows around your injured leg to stabilize it and make it hurt less. Once you arrive at the hospital, emergency room doctors will carefully examine your whole body to look for other injuries. Several x-rays will be taken, and many times, your doctors will need to get a CT scan of other body parts. This is to look for other injuries and/or to understand your injuries better.

Figure 2: Front x-rays (left and center) and side x-ray (right) of a right femur showing a fracture of the femoral shaft.

Femur fractures almost always require surgery, but sometimes surgery can’t be done right away. If this is the case, doctors may put something called a “traction pin” into your leg bone above or below your knee and connect this pin to a rope with weights. This is done at the bedside under local numbing medicine. The weights can help to temporarily line up the broken ends of the bone, which can help your leg feel better before surgery.

Figure 3: Front x-ray (left) and side x-ray (right) of a traction pin placed just below the knee. The pin can be connected to a rope with weights.

General Treatment

Femur fractures almost always require surgery. The most common way to stabilize or “fix” your broken femur is to place a metal rod, called an “intramedullary nail” (“IM nail” for short) inside the hollow center tube of your femur. Based on factors including other injuries you may have, doctors may choose to put the rod into your femur from the top of the bone (near your hip) or from the bottom of the bone (near your knee). Typically, one or more screws will be placed through holes in the rod above and below the fracture. Because the rod and screws are placed using x-ray guidance, doctors can usually perform the surgery through several small incisions (cuts) in your skin. The rod and screws will stabilize your broken femur, and often you will be allowed to put weight on your injured leg right after surgery. This decision will be made by your surgeon.

Figure 4: Front x-ray (left) and side x-ray (right) of a left femur taken about 3 months after fixation with an intramedullary nail (rod), which was placed from the lower end of the femur (near the knee). The “fluffy” bone at the fracture site shows that the femur is healing.

If your femur fracture can’t be fixed with a rod, doctors may stabilize the femur with a metal plate and screws placed on the side of the bone. The most common reason for this is the presence of hardware in your femur, such as a hip replacement or knee replacement.

Figure 5: X-rays of a right femur fracture below a partial hip replacement. Because of the existing hardware, the femur fracture was stabilized with a plate and screws instead of a rod.

Sometimes, doctors may need to temporarily stabilize your femur fracture with something called an external fixator. This procedure will be performed in the operating room, and involves placing metal pins through the skin and into the bone above and below the fracture. The ends of the pins remain outside your body, and they are connected with bars and clamps, which stabilize the fracture. At some point the external fixator can be removed and your femur may be fixed with a rod or plate and screws.

Postoperative Care

After your femur fracture is fixed, you will probably need to stay in the hospital for a few days. During this time, nurses and therapists will help you begin walking again. Depending on your fracture pattern and how it was fixed, your doctors may place some restrictions on weightbearing. In either case, you will probably need to use crutches or a walker for a while, and you may need to go to a rehabilitation facility or skilled nursing facility. It’s also important to work on bending and straightening your hip and knee joints to avoid stiffness. Other exercises can be done to keep your hip and thigh muscles strong during the recovery process.

You will need to return to your surgeon’s office several times over the weeks and months following surgery. After a few weeks, the stitches or staples used to close the surgical incisions will be removed. X-rays will be taken at different time points to make sure the fracture heals. You may need to do additional physical therapy to build up your strength and balance.

Long Term

Femur fractures fixed surgically usually heal. Your doctors may see signs of healing on x-rays about 6 weeks after surgery, but it normally takes 3 months or more for the femur to fully heal. If your femur doesn’t heal, you may need another surgery to help the bone heal. This surgery would usually include placing additional hardware and may require bone grafting.

Figure 6: X-rays of a left femur fracture 9 months after fixation with an intramedullary nail (rod). The fracture did not heal (which is called a “non-union”), and one of the screws broke. This patient required additional surgery to get the femur to heal.

Most of the time, once your femur fracture heals, you will be able to return to all of the activities you were able to do before your injury. Long term issues may include stiffness of the knee or hip, soreness at the fracture site, or the feeling that your injured leg isn’t quite as strong as the other side. If your fracture was fixed with a rod, it will probably not need to be removed. Some patients say that their leg feels funny if it gets really cold or if the weather changes quickly. Usually over time they get used to it. If your femur was fixed with a plate, you might have some irritation where the tendons rub over the plate. If these symptoms are bad enough, the plate and screws may need to be removed.

More Information

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Paul S. Whiting, MD
Edited by the OTA Patient Education Committee and Justin Haller, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Whiting and Christopher Domes, MD

Fixing Hip Fractures

There are three broad categories of hip fractures based on the location of the fracture: femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures.

Femoral Neck Fractures
The femoral neck is the most common location for a hip fracture, accounting for 45% to 53% of hip fractures.  Per 100,000 person years, approximately 27.7 femoral neck fractures occur in men and 63. 3 occur in women.  The femoral neck is the region of the femur bounded by the femoral head proximally and the greater and lesser trochanters distally (shown below).  A femoral neck fracture is intracapsular, that is within the hip joint and beneath the fibrous joint capsule.

Although other, more detailed classification systems exist, in general fractures are classified as stable and unstable. Each category has different operative management options.

Treatment of Stable Fractures
Stable fractures are nondisplaced, exhibiting no deformity, or impacted in a valgus positions.  Stable fractures may not be detectable on plain radiographs, and MRI scanning may be required.

Because nonoperative management results in a secondary displacement rate of 40%, stable femoral neck fractures are generally best treated with surgical stabilization and immediate mobilization. Treatment is by operative pinning with three parallel cannulated screws placed adjacent to the femoral neck cortex.  

Treatment of Unstable Fractures
Unstable femoral neck fractures are displaced and can be seen on plain radiographs. 

On physical examination, the leg of the affected side is externally rotated and shortened; the degree of rotation and shortening varies with the degree of displacement. Displaced fractures in young patients are usually treated with pinning. Pining is chosen because the risks of arthroplasty, including prosthetic wear and loosening, are high for young patients, and their rate of healing is high due to the absence of osteoporosis. As age and osteoporosis increase, the rate of failure (nonunion, secondary displacement, avascular necrosis) increases.

Hemi- or total joint arthroplasty is associated with a lower rate of repeat surgery than internal fixation and is often the better option for older patients. Younger patients may opt for screw fixation and hip salvage. In hemiarthroplasty, the acetabular cartilage is left intact and the implant articulates with the acetabulum.

Hemiarthroplasty requires less surgery than a total joint replacement because the acetabulum is not resurfaced. There is a smaller risk of dislocation with hemiarthoplasty because it uses a much bigger head size than total hip arthroplasty. In more active patients, hemiarthroplasty also has a risk of acetabular cartilage wear and revision to total hip arthroplasty.

Femoral implants can be cemented or cementless, and there are many designs of each type. Implant fixation can be achieved by the injection of bone cement around the prosthesis or by bony ingrowth into the prosthesis. A bipolar implant has two heads so that motion can occur between one head and the acetabular cartilage and between the two heads.

In theory, this arrangement helps to reduce acetabular wear and provide increased motion. A unipolar implant has only one large head that articulates with the acetabular cartilage.

There appears to be no clinical difference between the outcomes of patients with bipolar or unipolar implants in terms of acetabular wear and hip motion. Compared with unipolar implants, bipolar implants are more expensive and have an additional interface for prosthetic wear. Thus, there appears to be no compelling reason to recommend the more expensive bipolar implant over the unipolar for the elderly patient with a hip fracture. If the stem is not well fixed in the proximal femur, either type will fail quickly.

Total joint replacement typically is performed on an active patient or one with preexisting arthritis. During a total joint replacement, the acetabulum is resurfaced and a metal cup with a polyethylene liner is fixed inside. Articulation at the hip takes place between the implant’s head and the polyethylene liner.

The decision to treat femoral neck fractures with pinning or with arthroplasty is controversial. The advantages of pinning include less invasive surgery, less blood loss, and less postoperative morbidity. However, treatment by pinning carries a higher risk of more surgery in the future. As implied, arthroplasty results in more acute postoperative morbidity, but it offers fewer reoperations for nonunion, hardware failure, and osteonecrosis.

My protocol divides patients into three categories: patients with nondisplaced fractures, “low” activity patients with displaced fractures, and “high” activity patients with displaced fractures. Nondisplaced fractures are treated with pinning. Displaced fractures in inactive patients are treated with unipolar hemiarthroplasty. Displaced fractures in highly active patients are treated with total hip replacement.

Treatment Failures
The failures of screw treatment are nonunion and late avascular necrosis. Nonunion results primarily from a failure to achieve adequate mechanical stabilization of the fracture. If the bone does not heal, the screws will slide and backout as the fracture collapses.

Nonunion typically presents with worsening groin or buttock pain. Late avascular necrosis results from insult to the blood vessels that supply the femoral neck and head. Radiographic monitoring up to 3 years should detect most cases of avascular necrosis. The treatment for avascular necrosis or nonunion is hip replacement.

Failure of a hemiarthroplasty results in pain and acetabular erosion. Other complications include dislocation, fracture, and infection. The treatment for a failed hemiarthroplasty is conversion to a total hip replacement.

The failures of a total hip replacement are similar to those of a hemiarthroplasty: loosening, implant wear, infection, fracture, and dislocation. Treatment for a failed total hip replacement is a revision arthroplasty.

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Intertrochanteric Fractures
Intertrochanteric fractures are breaks of the femur between the greater and the lesser trochanters.  They are extracapsular fractures that is, outside the hip joint’s fibrous capsule.

The epidemiology of intertrochanteric fractures is similar to that of femoral neck fractures.  Per 100,000 person years, intertrochanteric breaks occur in 34 men and 63 women.  Intertrochanteric fractures account for approximately 38% to 50% of all hip fractures.

Many systems of classification, such as the Evans system, have been used to describe intertrochanteric hip fractures. However, most systems lack reliability and, in general, intertrochanteric fractures can be divided into two categories: stable and unstable. Stable fractures are those in which the femur is broken into two or three parts. Unstable fractures are those in which the femur is broken into four parts or the fracture is of the reverse oblique pattern. Reverse oblique fractures are unstable because of the femur’s tendency to displace medially. This classification method aids in determining what method will be used for fixation.

Two-part fractures have one fracture line through the intertrochanteric area.

While assessing the stability of a fracture, the most important points to consider are the bone of the lateral buttress and greater trochanter and the bone on the medial side of the proximal femur called the calcar.

Treatment of Stable Fractures
If the fracture is stable, treatment is with a sliding hip screw coupled to a side plate that is screwed onto the femoral shaft. (shown below)  The screw provides proximal fragment fixation.  It is set inside a telescoping barrel that allows impaction of the bone, which promotes fracture union.  The lateral buttress must be intact so that the screw will not stop sliding.

A four-part fracture has several fracture lines. The fractured bone pieces include: 1) the femoral head, 2) the lesser trochanter, 3) the greater trochanter, and 4) the remaining femur. Fractures with multiple pieces and fracture lines are termed ”comminuted”. The more pieces, the less stable is the fracture pattern. Comminution may make fixation with a sliding hip screw and side plate more likely to fail.

Treatment of Unstable Fractures
Approximately 5% of fractures are extremely unstable, and the direction of the fracture is parallel to the femoral neck. This fracture type is called the reverse oblique pattern. A high rate of failure occurs if the fracture is treated with a sliding hip screw and a side plate. Because of the angle of the fracture, there is no bone laterally to stop the screw from sliding.

For unstable intertrochanteric fractures, including those of the reverse oblique pattern and those with subtrochanteric extension, an intramedullary hip screw is indicated. This device combines a sliding hip screw with an intramedullary nail. There are many proprietary varieties, including the Gamma Nail (Stryker, Mahwah, NJ), the Trigen Trochanteric Entry Nail, (TAN nail, Smith and Nephew, Memphis TN) , and the Proximal Femoral Nail (Synthes, West Chester, PA). Intramedullary hip screws can be placed through small incisions, and blood loss may be less than with a hip screw and side plate. The nail acts as a metal buttress to prevent sliding and provides better fixation in unstable fracture patterns. No differences have been found between the two devices in stable fractures.

With a short intramedullary hip screw, the nail does not extend down the full shaft of the femur. Cross-locking of the nail is through a jig, which prevents rotation of the nail within the femur. Short intramedullary hip screws can create a stress riser in the bone at the distal screw.

With a long intramedullary hip screw, cross locking cannot be done with a jig and must be done freehand under fluoroscopy.  Therefore, cross-locking is more difficult. The nail extends throughout the shaft, protecting the rest of the bone from future fracture.

The hip screw should be placed centrally within the femoral head in the strong subcortical bone. Evaluation of hip screw placement is made by determining the tip-apex distance under fluoroscopy. The tip-apex distance is the sum of the distances from the tip of the hip screw to the apex of the femoral head as measured on AP and lateral radiographs

Baumgaertner et al. showed that no fracture had loss of fixation secondary to screw cut-out when the tip-apex distance was less than 24 mm.  When the tip-apex distance was greater than 45 mm, the screw cut-out rate increased to 60%.

Failure mechanisms of a hip screw include nonunion, screw cut-out, nail breakage, malunion, and limp.   Although sliding of the hip screw allows for bone compression and hopeful healing, it makes the limb shorten and causes abduction weakness.  Most complications are treated with total hip arthroplasty.

Subtrochanteric Fractures
Subtrochanteric fractures are located between the lesser trochanter and the femoral isthmus that is, in the proximal part of the femoral shaft.

They are less common than femoral neck and intertrochanteric fractures, accounting for approximately 5% to 15 % of hip fractures.  Subtrochanteric fractures are less stable than the other two types of hip fractures and, consequently, more difficult to fix.
 

When Your Child Has a Femur Fracture

Your child has a break (fracture) in his or her thighbone (femur). The femur is a strong bone and is very hard to break. So a femur fracture is often the result of great force during severe trauma (such as a car accident, bad fall, or serious sports injury). Your child may have already been seen in an emergency room for initial treatment for the fracture. But further treatment is needed to help the leg heal. A child with a femur fracture is likely to be referred to an orthopedic surgeon (a surgeon specializing in bone and joint problems).

Note for parents of young children

Healthcare providers are trained to recognize a femur fracture as a sign of possible child abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.

Types of fractures

A bone can break in many ways. Here are some fracture types you may hear about:

• Displaced fracture. The broken bone ends don’t line up).

• Nondisplaced fracture. The broken ends are lined up.

• Open fracture. The bone shows through the skin. These used to be called compound fractures. 

• Closed fracture. There is no break in the skin.

• Comminuted fracture.  The bone is broken into more than 2 pieces.

What are the signs and symptoms of a femur fracture?

How is a femur fracture diagnosed?

A femur fracture is often diagnosed when the doctor examines the child. An X-ray (test that creates images of bones) will confirm the fracture. Because it takes great force to break the femur, more X-rays may be done to rule out fractures in nearby bones or to bones in other parts of the body.

How is a femur fracture treated?

The goal of treatment for a fracture is to hold bones together so they can heal. The best course of treatment for your child depends on your child’s age, the location of the fracture, and the type and severity of the fracture. Your child’s healthcare provider will explain the options to you and make recommendations. It generally takes  4 to 12 months for a femur fracture to heal completely.

Spica casting

A spica cast covers the child from waist to ankle. It keeps the thighbone and hip area completely still. This helps the bone heal correctly.

• A spica cast is left on until the bone is healed, in about  8 to 12 weeks. The child may not be able to walk while the cast is in place.

• After the cast comes off, the child may need to use crutches for  3 to 4 weeks while the leg regains strength if he or she is old enough (around age 6). Younger children may need to ride in a stroller or wagon or be carried until they are stronger..

• This type of cast is mainly used in younger children.

Surgery to place fixation devices

Surgery can be done to place devices that hold the bones together while they heal. These are called fixation devices. This option lets children get back to school and other aspects of their life (with crutches or a walker) sooner than with casting. During surgery:

Traction, then spica casting

In rare cases, traction may be needed before casting is done. Traction uses a system of ropes, pulleys, and weights attached to metal pins placed into the leg bone. The system gently pulls on the leg bones to help them line up straight.

• Traction is done in the hospital. It is in place continuously for up to  2 weeks. The child must remain in bed during this time.

• When traction is complete, the child is put into a spica cast to hold the realigned bone in place while it heals completely.

What are the long-term concerns?

• After a fracture heals, don’t worry about getting your child to walk right away. Your child will start walking on the leg again when he or she is ready. Walking too soon can cause further damage to the leg.

• When the child starts walking again, he or she may limp or walk awkwardly. This may last for up to a year. But it almost always goes away.

• After the bone has healed, physical therapy may be recommended to help strengthen the leg. Your child’s healthcare provider can tell you more.

• Just after the fracture heals, the leg may not look straight. But the bone is still going through a process called remodeling. During remodeling, the repaired bone slowly reshapes itself. Most angles or bends in the bone straighten out during this stage. This process takes 1 to 3 years.

• In some cases, the fractured thighbone may grow faster than the uninjured thighbone in the other leg. This results in a slightly longer leg on the injured side (called a leg-length discrepancy). If this is the case with your child, the provider can discuss it with you.

Guide | Physical Therapy Guide to Femur Fracture

The doctor in charge of your care will determine when the time is right for you to see a physical therapist to assist you with further recovery. Your physical therapist will design a specific treatment program to restore function and help you return to activities of daily living.

Physical therapists support your recovery by helping you:

• Reduce pain.
• Improve the movement in your leg, hip, and back.
• Strengthen your muscles.
• Improve your standing balance and ability to walk.
• Return to the level of activity that you enjoyed before the break. This may include a return to sports like tennis, golf, or bike riding for people who were living a physically active lifestyle.

Your treatment program, based on your unique condition and goals, will be designed to help you return to your regular activities and may include:

Use of an assistive device. At first, your physical therapist may prescribe the use of an assistive device, such as a walker or crutches, and teach you how to use it. Many femur fractures require patients to avoid putting any weight on the broken leg to allow time for the bone to heal. Some people may be allowed to put a small amount of weight on the leg. Each person’s recovery is different. Older adults and people with other health conditions may need to first use a wheelchair.

Manual therapy. Your physical therapist will provide manual (hands-on) therapy to gently help you start to regain motion. They may perform gentle exercises (such as leg movements) that you can’t perform yourself at first.

Strengthening exercises. Your physical therapist will design an exercise program to help you regain movement and strength. You will learn and perform your exercises during your physical therapy sessions and continue them at home when appropriate. Your physical therapist will adjust your exercise program as you improve.

The First 24-48 Hours

Following injury or surgery, your physical therapist will help you:

• Get up out of bed to stand and walk. Early movement can help prevent blood clots and other complications.
• Learn to safely use a walker or crutches as ordered by the surgeon or physician.
• Learn safe movements and exercises to keep the muscles in your entire lower leg moving.

After the First 48 Hours

Your doctor will determine when a more intense physical therapy program is right for you. Whether in the hospital, an inpatient rehabilitation facility, an outpatient clinic, or at home, a physical therapy treatment program will be designed to help you:

Reduce pain. Your physical therapist may use different types of treatments to control and reduce your pain. These may include:

• Ice and heat.
• Gentle electrical stimulation.
• Taping.
• Exercises.
• Skilled manual therapy techniques.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in your leg and hip. These might start with passive motions that your physical therapist applies to your leg and hip joint. They will help you progress to active exercises and stretches that you perform yourself.

Improve strength. Certain exercises will benefit your healing at each stage of recovery; your physical therapist will design a personalized treatment program just for you. They will choose and teach you the proper exercises that will restore your strength, power, and agility. These may include using weights, elastic bands, weighted pulleys, cardio machines, and weight machines.

Return to activities. Your physical therapist will collaborate with you to decide on your recovery goals, including a return to work and sport. They will design your treatment program to help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will use equipment, manual techniques, exercises, and work retraining activities. If a return to sport is desired, your physical therapist will work with you on sport-specific techniques and drills to help you achieve your goals.

Prevent future reinjury. Your physical therapist will recommend a home-exercise program to help you strengthen and stretch the muscles around your hip, upper leg, and core to help prevent future problems. These may include strength and flexibility exercises. These exercises will aid the return of balance and are essential to reduce the risk of falls, especially in older adults.

Hip Fracture | Michigan Medicine

Topic Overview

What is a hip fracture?

A hip fracture is more than a broken bone. If you are older, breaking your hip can mean a major change in your life. You will probably need surgery, and it can take as long as a year to recover. But activity and physical therapy can help you get your strength and mobility back.

Most people break their hip near the upper part of the thighbone (femur). It usually happens near where the thighbone fits into the hip joint.

What causes hip fractures?

Most hip fractures happen to people who are 65 or older, and they are usually caused by falls. As you get older, your bones naturally lose some strength and are more likely to break, even from a minor fall. Children and young adults are more likely to break a hip because of a bike or car accident or a sports injury.

Other things that increase your risk of breaking your hip include:

• Being female.
• Your family history—being thin or tall or having family members who had fractures later in life.
• Not getting enough calcium and vitamin D, which you need for strong bones.
• Not being active. Weight-bearing exercise, such as walking, helps keep bones strong.
• Smoking.
• Medical conditions that cause dizziness or problems with balance, or conditions such as arthritis that can interfere with steady and safe movement.
• Taking certain medicines, such as long-term steroid medicines used to treat asthma or COPD.

What are the symptoms?

If your hip is broken, you will most likely:

• Have severe pain in your hip or lower groin area.
• Not be able to walk or put any weight on your leg.

These symptoms are most common after a fall. But if you have very thin bones from osteoporosis or another problem, you could break your hip without falling.

In rare cases, people have only thigh or knee pain. They may be able to walk.

How is a hip fracture diagnosed?

Doctors use X-rays to diagnose a broken hip. You may need another test if your doctor thinks that you have a fracture but can’t see it on an X-ray. You might have a test such as:

• An MRI, which gives better images of bones and soft tissues.
• A CT scan, another way of getting more detailed images.
• A bone scan, which involves injecting a dye, then taking images. It can show hairline fractures, where the bone is cracked but the pieces are still in place.

How is it treated?

You will most likely need surgery to fix your hip. Surgery usually works well, but your hip will probably take a long time to get better.

Surgery is done as soon as possible after a hip fracture is diagnosed, often within 24 hours. Having surgery right away may help shorten your stay in the hospital and reduce pain and complications. Sometimes surgery is delayed for 1 to 2 days so other medical problems can be treated first.

The type of surgery you have will depend on where the break is and how bad it is.

• Hip repair surgery is called internal fixation or “hip pinning.” The doctor uses metal screws, rods, or plates to hold the bone together while it heals. This surgery is usually chosen if the bones can be lined up properly.
• Hip replacement surgery involves replacing part or all of the joint with artificial parts. In a partial hip replacement, the doctor replaces the broken upper part of the thighbone. In a total hip replacement, both the hip socket and the top of the thigh bone are replaced. Total hip replacement is often done when the fractured bones can’t be properly lined up.

After surgery, your doctor will want you to start moving as soon as you can. This will help prevent problems such as pneumonia, blood clots, and bed sores. These things may happen because you have to stay in bed so long. You may also need to take a blood-thinning medicine to reduce the risk of blood clots.

After your surgery, it will be hard to do things like cooking and getting dressed by yourself. So for a while you may need to stay in a rehabilitation (rehab) center.

Your doctor will encourage you to take part in a rehab program that includes physical therapy and occupational therapy. This will teach you:

• Exercises to help you regain your strength and ability to move around.
• New ways to do simple daily activities.
• Safe ways to stay active.

Taking part in a rehab program is very important because it will speed up your recovery and help you to get back to your normal activities sooner.

After a hip fracture, some people aren’t ever able to get around as well as they could before. They may need to use a walker or cane. They may need help with daily activities such as dressing and bathing. And many can no longer live on their own. Work hard to get your strength and mobility back so you can be as independent as possible.

How can you prevent a hip fracture?

There are many things you can do to prevent a hip fracture. One of the most important is to prevent osteoporosis. Bone thinning can happen to men or women. But it is more common in women.

To keep your bones strong:

• Get plenty of calcium and vitamin D. Dairy foods like milk, cheese, and yogurt have lots of calcium. It’s also in some vegetables like broccoli and kale. Vitamin D is in foods such as salmon, tuna, and fortified milk and cereals. If you want to take supplements, ask your doctor how much you need.
• Limit alcohol to no more than 1 drink a day for women and no more than 2 drinks a day for men.
• Do weight-bearing exercise that puts pressure on bones and muscles. Walking is a good choice.
• If your doctor prescribes medicine to slow osteoporosis, take it as directed.
• Don’t smoke.

You also need to be extra careful to prevent falls. Here are a few ways to make your home safer:

• Keep walkways clear of electrical cords and clutter.
• Be sure you have good lighting where you are walking.
• Put grab bars and nonslip mats in showers and tubs.

It can also help to:

• Get your eyes checked on a regular basis.
• Exercise to help keep your strength and balance.
• Take medicines as directed. And from time to time, ask your primary care doctor to review your medicines. Some medicines, such as sleeping pills or pain relievers, can increase your risk of falling.

Diaphyseal Femur Fracture – StatPearls

Continuing Education Activity

Diaphyseal femur fractures are commonly encountered in association with other high-energy injuries. These injuries can lead to life-threatening sequelae. Prompt intervention and thoughtful management lead to the best patient outcomes. This activity reviews the etiology, presentation, evaluation, and management of diaphyseal femur fractures and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

Objectives:

• Describe the mechanisms of injury that can lead to a diaphyseal femur fracture.

• Review the approach for evaluation and assessment of a patient presenting with a potential diaphyseal femur fracture, including any indicated imaging studies.

• Outline the treatment options for diaphyseal femur fractures, depending on patient population and fracture severity and location.

• Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in prompt diagnosis of diaphyseal femur fracture and improving outcomes in patients diagnosed with the condition.

Access free multiple choice questions on this topic.

Introduction

Diaphyseal femur fractures are commonly encountered in association with other high-energy injuries. These injuries can lead to life-threatening sequelae. Prompt intervention and thoughtful management lead to the best patient outcomes. Unlike in the past when these fractures were managed with only splints, today intramedullary (IM) nailing is the mainstay of treatment. Pediatric patients are managed with flexible rods to allow for bone growth.

Etiology

The femur is divided into the following regions: head, neck, intertrochanteric, subtrochanteric, shaft, supracondylar, and condylar areas.

Younger patients are generally involved in high-energy mechanisms, most commonly motor vehicle collisions. Elderly patients can sustain osteoporotic femur fractures from ground-level falls.[1] Another common etiology is from gunshot injuries sustained to the lower extremity.

Stress fractures can occur in individuals with excess physical activity. Finally, some low energy femur fractures may be associated with osteoporosis or prolonged use of bisphosphonates.

Epidemiology

There are an estimated 9 to 22 femur fractures per 1000 people worldwide that present every year. These injuries present in a bimodal distribution. Studies show that diaphyseal fractures are often seen older patients, those with decreased bone density, low body mass index, and extensive anterior and lateral bowing.

Pathophysiology

The femur is the largest bone in the human body. It has an anterior bow with a radius of curvature of 120 cm.[2] Along the posterior middle third of the diaphysis, there is a raised crest known at the linea aspira, which serves as the attachment site for muscles and fascia and a strut to compensate for the anterior bow.

The characteristic deformity following a femur fracture is caused by the strong lower extremity muscles which are attached to the femur. The proximal fragment is held in flexion and abduction. The iliopsoas, which attaches at the lesser trochanter, provides a strong flexion vector. The gluteus medius and minimus, which attach at the greater trochanter, provide a strong abduction force. The distal fragment is held in varus and extension. The adductors attach at the medial femoral condyle and provide a varus force. The gastrocnemius attaches at the posterior distal femur, pulling the fragment posteriorly and inferiorly and creating an extension deformity at the fracture.

History and Physical

As there may be concurrent life-threatening injuries, it is important to assess the patient’s entire status. Upon presentation to the trauma bay, adherence to the advanced trauma life support (ATLS) principles is paramount. If the patient is unstable or if intra-abdominal pathology is suspected, the patient may be transported to the operating room urgently for exploratory laparotomy. It is important to remember that the patient’s life precedes limb.

If the patient is stable, it is important to perform a thorough physical exam. An obvious thigh deformity may be noted. It is important to perform a thorough neurovascular exam including pulses and assess for an open fracture.

Bilateral femur fractures have been associated with a greater risk of pulmonary complications and increased mortality.

Evaluation

Imaging

Imaging starts with plain radiographs. Orthogonal radiographs of the femur should be obtained. In addition, orthogonal images should be obtained of the hip and knee joints.

It is important to assess for ipsilateral femoral neck injuries.  A 1-9% incidence has been noted in the literature. Many level one trauma centers have adopted protocols to include computed tomography (CT) scans which include both femurs to the level of the lesser trochanter. Before the widespread adoption of these protocols, associated ipsilateral femoral neck injuries were missed approximately 20-50% of the time.[3]

Imaging may also play a part in management decision-making. The start site for IM nailing may be compromised in diaphyseal fractures with an associated proximal femur fracture. In these cases, a CT of the proximal femur is helpful to assess the integrity of the greater trochanter or piriformis fossa.

Classification

Open femur fractures can be categorized by the Gustillo-Anderson classification system. Epidemiologic studies documented 43% grade I, 31% grade II and 26% grade III open fractures. Aggressive management is necessary due to the mechanism of injury and the amount of soft tissue that must be violated for a femur fracture to become open.

Two common classification systems are used to describe diaphyseal femur fractures.

The Orthopaedic Trauma Association Classification

 32A – Simple

• A1 – Spiral

• A2 – Oblique, an angle less than 30 degrees

• A3 – Oblique, an angle less than 30 degrees

32B – Wedge

• B1 – Spiral wedge

• B2 – Bending Wedge

• B3 – Fragmented Wedge

32C – Complex

• C1 – Spiral

• C2 – Segmental

• C3 – Irregular

Winquist and Hansen Classification[4]

• Type 0 No comminution

• Type I Insignificant comminution

• Type II greater than 50% cortical contact

• Type III less than 50% cortical contact

• Type IV Segmental, with no contact between proximal and distal fragment

Blood work is always done to assess levels of hemoglobin. A significant amount of blood loss can occur with a femur fracture, which can lead to hypotension. If the wound is open, cultures should be obtained.

Treatment / Management

Open Fractures

In instances of an open fracture, prompt antibiotics should be given in accordance with the facility’s protocol. Weight-based cefazolin is commonly used. Bedside irrigation and debridement should be performed. Operative irrigation and debridement should ideally be performed within 2 hours of presentation.

Ipsilateral Femoral Neck Fractures

In the rare setting of a femoral shaft fracture with an ipsilateral femur fracture, it is recommended that the femoral neck fracture takes fixation precedence. [5] Authors recommend an anatomic reduction of the femoral neck first to decrease the risk of non-union and avascular necrosis (AVN) of the femoral head. After femoral neck fixation, the femoral shaft fracture is then addressed.   

End of Bed Skeletal Traction

Traction provides the patient with pain control and assists the surgeon with maintaining anatomic length. The strong thigh muscles immediately contract upon injury, causing shortening of the femur. After radiographic assessment of the knee joint, a traction pin may be placed in the distal femur or the proximal tibia under local anesthesia. For femoral traction, a 4 mm Steinman pin is inserted two fingerbreadths above the superior border of the patella to ensure that it is extra-articular. It is placed in the anterior third of the femur to allow passage of the nail in the event sterile traction is required intra-operatively. For tibial traction, the pin is inserted three fingerbreadths distal to the superior aspect of the tibial tubercle. Some have argued against tibial traction due to ligamentous strain and the reported incidence of concurrent ligamentous injury with diaphyseal femur fractures.[6] Most often, the pin is simply placed to avoid the zone of injury. Twelve pounds (five kilograms) of traction is applied in a longitudinal fashion and can be adjusted based on the patient’s weight and muscular tone. Relief is noted by the patient after the thigh muscle fatigue.

External Fixation

External fixation may be required in the setting of damage control orthopedics.[7] If the patient is hemodynamically unstable and is taken to the operating room for another procedure, it may be prudent to proceed with external fixation. External stabilization also may be indicated in the setting of vascular repair. Schanz pins are inserted proximally and distally to the fracture and traction is applied to approximate length, alignment, and rotation. Some constructs may require the surgeon to span the knee. Studies have shown an approximate 10% infection rate of external fixator pins.[8] Patients with multiple injuries are transitioned to definitive fixation when stable.

Intramedullary Nailing

IM nailing is the mainstay of treatment for diaphyseal femur fractures. Nailing provides relative stability at the fracture and the femur heals through secondary bone healing.  

Fracture fixation with IM nailing can be achieved through an antegrade or retrograde fashion. Retrograde nailing utilizes a start point in the center of the intercondylar notch of the distal femur. Antegrade IM nailing uses 2 distinct start points, greater trochanter, and piriformis fossa starting points.  Trochanteric and piriformis entry nails have been studied extensively, with the general consensus of equivalent outcomes.[9] The advantage of using the piriformis entry point is its colinear orientation with the long axis of the femur. This reduces the risk of varus malalignment. The disadvantages of this starting point are the technical skill needed to establish this point, especially in obese patients. [10] This entry point puts the piriformis muscle insertion at risk of iatrogenic injury resulting in an abductor limp. There is also an increased risk of AVN of the femoral head in pediatric patients. The greater trochanter entry point offers the advantage of reduced risk of injury to adductors, it is less technically demanding and is a more appropriate option for obese patients. The disadvantage to the greater trochanter entry point is that it is not colinear with the axis of the femur. This mismatch necessitates the use of an IM nail that is specifically designed for this entry point, in order to avoid varus malalignment. [10]

In regard to nail design, the radius of curvature of the IM nail must match the radius of curvature of the patient’s femur. [2] An IM nail with a radius of curvature greater than that of the patient’s femur (i.e. a straighter nail), can cause perforation of the anterior cortex of the femur during insertion. 

Patients may generally be made weight-bearing as tolerated following IM nailing.

Submuscular Plating

Submuscular plating is generally relegated to complex or peri-prosthetic fractures in which the start site is compromised or not available due to a separate implant. A lateral plate can be applied through a vastus splitting or sub-vastus approach. Weight-bearing is generally protected after plating.

Timing of Surgery

It is recommended that femur fractures be managed within 2-12 hours after injury, provided that the patient is hemodynamically stable. Studies show significant benefits when intervention is undertaken within the first 24 hours. Immediate fixation lowers pulmonary complications, decreases mortality, and avoids long ICU stays. However, the type of fixation remains debatable

Differential Diagnosis

Patients with a femoral shaft fracture, an ipsilateral femoral neck fracture must be ruled out. Depending on the mechanism of injury patients may have a variety of concomitant injuries. In a high energy scenario, compartment syndrome must be ruled out. Patients with a low energy mechanism, the fracture may be caused by a pathologic process due to neoplasm or metabolic derangement, in which case a thorough workup is warranted. 

Prognosis

The prognosis of patients with diaphyseal femur fracture varies on age, comorbidity, presence of osteoporosis, and type of treatment. IM nailing has good results, but a significant number of patients require removal of hardware in the future because of pain. Deaths after surgery in elderly patients are not uncommon. Other complications include infection, blood loss, nonunion, delayed union, malunion, and need for repeat surgery. External fixation is effective but is also associated with pin infections and angulation problems. Patients also need prolonged stay in the hospital, followed by extensive rehabilitation. Gait problems and pain continue to be present in a significant number of patients.

Complications

Non-unions are rare but do occur.[11] In these instances, the root of the non-union must be established. Revision surgery can be pursued when a specific aspect of fixation, such as stability or biology, is to be addressed. Hypertrophic, aseptic non-unions can be addressed with compression and exchange nailing.[12] In atrophic non-unions, infection must be ruled out, especially in the setting of previously open fractures. The patient’s nutrition status must be assessed with labs. Revision of atrophic non-union is often supplemented with bone grafting.

Deaths related to deep vein thrombosis/pulmonary embolism, infection, nerve injury, and compartment syndrome are not uncommon.

Deterrence and Patient Education

Patients who sustained femoral shaft fractures require close follow-up to monitor fracture healing. Insufficiency fractures of the femoral shaft are uncommon, however, prevention of these fragility fractures can be mitigated through appropriate screening and medical management for those at risk, i.e. elderly, or vitamin D deficient individuals. 

Enhancing Healthcare Team Outcomes

Patients with diaphyseal femur fractures are usually managed by an interprofessional team that includes an orthopedic surgeon, trauma surgeon, emergency department physician, physical therapist, nurse practitioner, radiologist, and an intensivist. These fractures are usually caused by high impact energy and may be associated with other injuries. The patient with a femur fracture can develop significant bleeding and may require blood transfusions. The decision for the type of treatment depends on the type of injury and patient stability. After treatment, most patients need prolonged rehabilitation to regain muscle strength and function. For isolated injuries of the femur, the prognosis is good but pain and gait difficulty may be residual problems.[13][14]

References

1.

Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br. 1998 Mar;80(2):243-8. [PubMed: 9546453]

2.

Egol KA, Chang EY, Cvitkovic J, Kummer FJ, Koval KJ. Mismatch of current intramedullary nails with the anterior bow of the femur. J Orthop Trauma. 2004 Aug;18(7):410-5. [PubMed: 15289685]

3.

Tornetta P, Kain MS, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol. J Bone Joint Surg Am. 2007 Jan;89(1):39-43. [PubMed: 17200308]

4.

Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984 Apr;66(4):529-39. [PubMed: 6707031]

5.

Peljovich AE, Patterson BM. Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg. 1998 Mar-Apr;6(2):106-13. [PubMed: 9682073]

6.

Walker DM, Kennedy JC. Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med. 1980 May-Jun;8(3):172-4. [PubMed: 7377448]

7.

Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000 Jun;82(6):781-8. [PubMed: 10859097]

8.

Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003 Aug;17(7):503-7. [PubMed: 12902788]

9.

Ricci WM, Schwappach J, Tucker M, Coupe K, Brandt A, Sanders R, Leighton R. Trochanteric versus piriformis entry portal for the treatment of femoral shaft fractures. J Orthop Trauma. 2006 Nov-Dec;20(10):663-7. [PubMed: 17106375]

10.

Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg. 2009 May;17(5):296-305. [PubMed: 19411641]

11.

Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P. Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br. 2000 Jul;82(5):655-8. [PubMed: 10963160]

12.

Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg Am. 2007 Jan;89(1):177-88. [PubMed: 17200326]

13.

Ibrahim JM, Conway D, Haonga BT, Eliezer EN, Morshed S, Shearer DW. Predictors of lower health-related quality of life after operative repair of diaphyseal femur fractures in a low-resource setting. Injury. 2018 Jul;49(7):1330-1335. [PubMed: 29866624]

14.

Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop. 2018 Nov;42(11):2675-2683. [PubMed: 29516238]

Hip Fracture & Broken Hip

Overview

Hip fracture common occurs on the upper femur – on the femoral neck or intertrochanteric area.

What is a hip fracture?

A hip fracture happens when the upper part of the thighbone (femur) breaks. The injury usually results from a fall or car accident. Hip fractures are more common in older people because bones weaken and become more brittle with age.

Most hip fractures cause severe pain and require surgery immediately. Some people need a total hip replacement after a hip fracture. Physical therapy (PT) can improve the outlook for people with hip fractures.

How common is a hip fracture?

Fractures of the hip are common. In the United States, more than 300,000 people fracture a hip every year. Risk factors for a hip fracture include:

• Age: Hip fractures are more common in people over 65. With age, bones break down, weaken and become more brittle. Older people are more likely to have problems with movement and balance, which can lead to a fall.
• Gender: Almost 75% of hip fractures happen to older women. Women lose bone mass after menopause. Weak bones are more likely to break.
• Lifestyle: People who live a sedentary lifestyle (don’t get much exercise) are more likely to fracture a hip. Drinking too much alcohol can also weaken bones and increase your fracture risk.
• Medications: Some medications increase the risk of falls. Drugs that cause drowsiness or a drop in blood pressure can cause you to lose your balance. Talk to your provider about taking these medications safely.
• Osteoporosis: This disease causes bones to become weak and porous, increasing the risk of fracture. Women are four times more likely to have osteoporosis than men.
• Overall health: People who don’t get enough vitamin D, calcium and other nutrients have a higher fracture risk. Some health conditions, such as dementia and Parkinson’s disease, increase the risk of a fall.

What part of the hip can break?

The ball-and-socket hip joint includes the upper part of the thighbone (femur) and the curved hip socket (acetabulum) of the hipbone (pelvis). The round top of the femur (the “ball,” or femoral head) fits into the hip socket to form the joint. Muscles, tendons, ligaments and soft tissues support the joint.

Hip fractures can occur in several areas of the upper femur. The most common types of hip fractures are:

• Femoral neck fracture: The neck is the area of bone just below the femoral head (ball).
• Intertrochanteric fracture: The intertrochanteric area is the part of the femur that lies between the femoral neck and the long, straight part of the femur.

Symptoms and Causes

What are the symptoms of a hip fracture?

Symptoms of a hip fracture typically come on suddenly. But they can appear gradually and worsen with time. Signs of a hip fracture include:

• Pain: Usually, hip pain is severe and sharp. But it can also be mild or achy. Most people feel pain in the thigh, outer hip, pelvis and groin area. Pain may radiate down your buttock to your leg (sciatica). You may also feel pain in your knee.
• Limited mobility: Most people with a hip fracture can’t stand or walk. Sometimes, it may be possible to walk, but it’s extremely painful to put weight on the leg.
• Physical changes: You may have a bruise on your hip. One of your legs may appear shorter than the other. The hip might look like it’s out of position, twisted or rotated.

What causes a hip fracture?

Most hip fractures result from an accident, such as a fall or car crash. Athletes, especially long-distance runners, can fracture a hip with repeated use (stress fracture).

In older people, hip fractures can result from a minor fall or from twisting or pivoting suddenly. People with osteoporosis can break a hip doing everyday activities such as walking or getting out of a chair.

Diagnosis and Tests

How is a hip fracture diagnosed?

Your healthcare provider will examine the area and ask about any recent accidents or falls. To check for nerve damage (neuropathy), your provider may touch your foot or leg and ask if you feel any sensation.

To diagnose a fracture and check for damage to soft tissues, your provider orders imaging studies. These may include:

• X-ray, which uses radiation to produce images of your bones.
• MRI, an imaging test that uses a high-powered magnet to create pictures of bones and soft tissues.
• CT scan, a test that uses a computer and several X-rays to allow your provider to see detailed images of the damaged area.

Management and Treatment

Can hip fractures be treated?

Hip fracture treatment depends on your age, overall health and type of injury. Most hip fractures require surgery within a day or two after the injury. But some people aren’t healthy enough for surgery due to their age or other conditions.

Your provider will recommend the most appropriate treatment for you, which may include:

• Surgery: Most hip fractures need surgical repair. There are several hip surgery techniques. Your provider may use metal screws, nails or plates to secure the bones and keep them in place.
• Hip replacement: Depending on the type of injury, you may need a partial or total hip replacement. After hip replacement surgery, your provider may recommend that you recover in a rehabilitation facility.
• Physical therapy (PT): Your physical therapist will create a PT program to help you regain movement, flexibility and strength. If you had a hip replacement, special exercises after hip replacement surgery can significantly improve your range of motion.
• Medications: Over-the-counter and prescription pain medications can help you manage pain and reduce inflammation. If you had surgery for a hip fracture, you may receive antibiotics to reduce the risk of infection.

Prevention

Can I prevent a hip fracture?

You may not be able to prevent a broken hip. But you can lower your risk of a fracture by:

• Being active: Exercise increases muscle strength and helps you prevent bone loss. Swimming, tai chi and weight-bearing exercises improve strength and balance.
• Eating right: A diet that includes vitamin D and calcium can strengthen your bones.
• Getting regular checkups: Talk to your provider about bone density tests that spot signs of osteoporosis. Your provider may recommend medications called bisphosphonates that slow bone loss and strengthen bones.
• Preventing accidents: Keep your home free from hazards (such as throw rugs) that might cause a fall. Take care when using stairs or walking in icy conditions. If you have Parkinson’s disease, talk to your provider about how to prevent falls and maintain your balance.
• Staying healthy: Maintain a healthy weight, don’t smoke and avoid drinking too much alcohol.
• Updating your eyeglasses: Vision problems can increase your risk of a fall. Get your vision checked with regular eye exams. Make sure your eyeglass and contact lens prescriptions are updated.

Outlook / Prognosis

What is the outlook for people with hip fractures?

A hip fracture can be life-changing. Many older people don’t regain full mobility or independence after a hip fracture. Some people need a cane or walker to get around. Other people may need full-time care.

The outlook depends on several factors, including:

• Age: Older people may not heal from a fracture as quickly, and some aren’t healthy enough for surgery. Without surgery, many people stay in bed because they can’t move without pain. Long-term bed rest can lead to serious health problems, including bedsores, blood clots and pneumonia.
• Overall health: People who move soon after hip surgery have a much better prognosis. If you’re otherwise healthy, you should get up and walk around within a day or two after surgery. Moving speeds the healing process and reduces the risk of complications from bed rest.
• Type of fracture: A femoral neck fracture can cut off the blood supply to the femoral head, causing the bone to break down and die (osteonecrosis). If the injury also damaged other tissues (such as nerves or blood vessels), recovery usually takes longer.

Living With

When should I see my healthcare provider about a hip fracture?

A fractured hip is an emergency. Call your provider right away or go to the emergency room if you have signs of a hip fracture.

A note from Cleveland Clinic

A broken hip can be life-changing, especially for older people with other health conditions. Physical therapy can significantly improve outcomes for people with a hip fracture. To prevent a hip fracture, you should stay healthy, get plenty of exercise and visit your provider for regular checkups. If you have osteoporosis, talk to your provider about medications that can slow bone loss and help you avoid a fracture.

90,000 Fracture of the femoral neck – treatment, surgery for a fracture of the femoral neck in Moscow, Clinical Hospital on Yauza

The femoral neck is an important component of the hip joint, it connects the head and body of the bone, it carries a significant load when walking. In this case, the neck is the thinnest and most vulnerable part of the joint. 68% of all hip fractures are hip fractures.

Causes of occurrence

In older people, a hip fracture can occur even after a minor injury.At risk are people over 60 years of age, suffering from osteoporosis, leading to increased fragility of bones. These are the so-called pathological fractures. In this case, a fracture can occur even from a banal fall while walking. They account for up to 90% of all cases of fractures of this localization. Recovery in this case is extremely long and difficult. However, young people also face trauma. In healthy people in the absence of osteoporosis, a hip fracture occurs much less frequently and is usually the result of severe trauma and wounds.They often have damage to the femoral neck when falling from a height, as well as as a result of road accidents and industrial injuries.

Among the main factors provoking fragility of bones, it is worth highlighting:

• the onset of menopause in women;
• overweight;
• malnutrition, starvation;
• insufficient physical activity;
• neurological diseases leading to poor coordination of movements;
• oncology.

In the presence of serious diseases, this fracture is a great danger, as it can lead to immobility and even death, due to the development of congestive pneumonia, thrombotic complications characteristic of bedridden patients.

Make an appointment with a doctor

Symptoms of the disease

Considering that a hip fracture in people with osteoporosis can occur from even the most minor injuries, and pain in the hip joint is familiar to them, many patients sometimes do not even suspect that they have received a fracture.This is dangerous because the patient continues to move and delays with treatment, which threatens to aggravate the problem. That is why it is so important to know exactly about the symptoms.

Groin pain is the main symptom. At first, it may not be strong and may be mistaken by the patient for something insignificant. However, over time, the pain begins to build up, intensifying when resting on the heel of the sore leg.

Also, the presence of a fracture may indicate:

• slight shortening of the injured leg;
• turn of the foot outward;
• gait disturbance;
• femoral artery pulsation;
• joint crunch when walking;
• painful sensations when exposed to an injured joint;
• the appearance of a hematoma.

The appearance of any of these symptoms, and especially a combination of several of them at once, requires immediate medical attention.

State-of-the-art diagnostics at the Clinical Hospital on Yauza

Diagnosis of fractures at the Yauza Clinical Hospital begins with examination and questioning of the patient. Much attention is paid to the sensations experienced by the patient.

If a fracture is suspected, the doctor prescribes an X-ray examination, which is carried out in the hospital using modern low-dose X-ray equipment of the latest generation.Its distinctive feature is the high accuracy of images and low radiation exposure, which is comparable to the radiation received by the passengers of the airliner.

If a pathological fracture is suspected and the diagnosis is in doubt, the patient is prescribed MRI (to assess the condition of the surrounding tissues, exclude metastasis as the cause of the fracture). The examination is carried out on a Philips 1.5 T digital tomograph.

An important diagnostic step is the determination of bone density to exclude osteoporosis.For this, our hospital uses multispiral computed tomography (CT) and densitometry.

The presence of all the necessary equipment in one place allows you to conduct an examination and make an accurate diagnosis in the shortest possible time.

Cross-fracture fixation devices that are placed either directly on the bone or externally for the treatment of hip fractures located outside the hip joint

Hip fractures that are outside the hip joint capsule (extracapsular hip fractures) can be fixed surgically with metal implants.Often these are extramedullary devices consisting of a screw or rod inserted into the top of the femur (thigh) to fix the fracture, connected to a plate that is attached to the femur. External clamps are sometimes used. In these cases, the stabilizing component is held on the outside of the thigh using pins or screws driven into the bone on either side of the fracture.

The 18 randomized clinical trials included in this review tested seven comparisons in a total of 2615 people (mostly women and the elderly).In all trials, there were methodological flaws that could affect the validity of the results, and there was insufficient evidence for long-term effects and functional recovery. Some extramedullary implants appear to be associated with an increased risk of complications in fixation and reoperation. Specifically, three trials comparing a nail-anchored plate (Jewett or MCLaughlin) with a retractable femoral screw (the “standard” extramedullary device for these fractures) found an increased risk of failure of fixation with nail-anchored plates.Less invasive implants, such as an external fixator, requiring fewer incisions, resulted in less blood loss and faster surgery than a retractable femoral screw.

We have concluded that the retractable hip screw appears to be superior over the older nail-retained plates, given the high incidence of implantation and fixation failures. However, the evidence was insufficient to draw conclusions for other comparisons of extramedullary implants or the use of external fixators.

Successful treatment of a patient with a nonunion femoral fracture – Our news

OUR WORLD: Successful treatment of a patient with a nonunited femoral fracture

Fractures of the proximal femur is one of the most common pathologies in elderly and senile patients. According to localization, the fracture lines are divided into fractures of the femoral neck, pertrochanteric and subtrochanteric fractures. For fractures of the femoral neck, the preferred method of treatment is hip arthroplasty; for more distal fractures, an operation is performed – osteosynthesis.The choice of the method of surgical treatment is due to the peculiarities of the anatomy and physiology of the proximal femur. However, in some cases, against the background of pronounced osteoporosis and massive destruction of the bone as a result of a fracture, even osteosynthesis performed according to all the rules may turn out to be untenable.

A 75-year-old female patient was operated on in February 2017 for a comminuted transodrochanteric fracture of the femur. The patient was prepared for surgical treatment, osteosynthesis of the femur with a “gamma” pin with blocking was performed.The name “gamma” was given to the implant for its resemblance to the Greek letter “ γ ” on radiographs.

The essence of the operation consists in the reduction (installation in the correct position) of the fragments at the fracture site and insertion through several incisions up to 2-3 cm inside the femur of metal implants under the control of a portable X-ray machine. Metal implants fix bone fragments in the position specified during reduction. The duration of this operation is usually an average of 45 minutes; Due to the minimally invasive technique, intraoperative blood loss is minimal, which, as a rule, allows even elderly patients to tolerate such surgical interventions well.

The patient was activated with a walker the next day after the operation with the ability to support the operated limb. After 5 days, the patient was discharged under the supervision of a local traumatologist. Early activation of patients in old and senile age is a very important point in any pathology, trauma and disease, since it is hypostatic complications (inactivity) that often lead to fatal outcomes than the underlying disease or injury.

Despite the timely and correct operation, the patient was admitted 7 months later to the trauma department again due to the fracture of the fixator (“gamma” pin) against the background of a nonunited fracture of the femur.The reasons for this outcome of treatment were pronounced bone loss (osteoporosis), which is a constant companion of people in old age, especially women, as well as the multifragile nature of the primary fracture, which affected almost the entire proximal femur. Therefore, despite the well-performed operation, the fracture did not heal.

A similar result in the treatment of this type of fracture, according to the world literature, occurs in about 20% of cases.The bones of the skeleton are made up of living bone tissue. Therefore, experiencing systematic loads, they are denser and renewed. The implants used in traumatology and orthopedics are designed to hold the fragments in a given position while the fracture is fused. In the case of non-union of the fracture, the entire load falls on the metal fixator. As a result, the so-called “fatigue” fracture of the implant occurs. In this patient, the post “withstood” for 7 months, but the fracture did not heal, and additional misaligned loads broke the implant at the site of the non-fused fracture.

Considering the presence of a broken fixator, a non-fused hip fracture, the presence of osteoarthritis and osteoporosis, it was decided to refuse to perform the osteosynthesis again at the consultation. Our doctors decided to perform total hip arthroplasty (joint replacement with an internal prosthesis). Since there was an ununited fracture of the proximal femur, the standard type of prosthesis, which is used for the surgical treatment of coxarthrosis or a fracture of the femoral neck, could not be used.A special revision endoprosthesis was used, which made it possible to fix the fragments of the femur. Thus, all the main tasks of treatment were solved: fixation of the fracture with adaptation of bone fragments in the correct position, elimination of contracture and coxarthrosis, the patient’s ability to move with support on the broken limb. In a satisfactory condition, the patient was discharged for outpatient follow-up care, having spent less than two weeks in the hospital (from the moment of treatment), having also received a set of rehabilitation measures necessary in such cases.

At the time of discharge, there were no complaints of pain; the patient walks with additional support on her own. This case clearly shows that due to the variety of modern implants and the possession of various surgical techniques, in the treatment of traumatological and orthopedic pathologies, it is possible to solve the most non-standard problems and even their combination in one patient.

90,000 Half of patients with hip fracture die within a year

According to international standards, all patients who have suffered a hip fracture should be operated on in the first three days after the fracture.

“In our country, only a third of such patients are hospitalized, the rest stay at home, deprived of surgical care. Only 13-15% are operated on. This determines such terrible outcomes of the disease,” – explained the President of the Russian Association for Osteoporosis, Professor Olga Lesnyak in a video message to the participants press conferences.

Osteoporosis is called a silent killer, said Natalya Toroptsova, head of the osteoporosis laboratory at the Research Institute of Rheumatology, Russian Academy of Medical Sciences. This disease has practically no symptoms.For example, with a fracture of the vertebrae, pain syndrome is not always present, and a diagnosis can only be made by a change in posture, the doctor explained.

One of the most effective methods for diagnosing osteoporosis is densitometry, says Ershova. “The study allows you to make a diagnosis when there is no clinic yet: pain, fractures,” she explained.

According to her, there are about 190 densitometers in Russia, and more than 80 of them are located in Moscow. Accordingly, the survey is not available to most of the country’s population.Such devices should be both in large cities and in rural areas, the doctor said.

Chances of salvation

As for the prevention of osteoporosis, according to Lesnyak, there are many effective drugs. However, access to them is limited by the fact that the majority of patients with osteoporosis are elderly people who do not have the means to provide themselves with medicines. Experts see the solution to the problem in the inclusion of these drugs in the list of vital drugs, then they will become available to the population.

According to Ershova, the task of the association is to achieve recognition of osteoprosis as a priority health problem, to organize a system of surgical treatment for hip fractures, and to include densitometry in the program of state guarantees.

“Every patient has a chance of salvation, and we must give him that chance, regardless of age,” she said.

Contusions and fractures of the pelvic bones

Pelvic contusions and fractures of the pelvic bones: treatment and rehabilitation.

Contusions of the pelvis

Contusions of the soft tissue that surround the pelvic ring are usually accompanied by bruising, skin detachment, and the formation of deep intramuscular hematomas, which slowly dissolve and become easily infectious.Treatment is most often offered non-operative: rest, warming up, resorption therapy. With skin detachment and the formation of a hematoma, they resort to puncture. In case of hematoma suppuration, surgery is indicated. If the perineal area is slightly bruised, for example, by a kick or falling on the edge of a hard object, etc., subcutaneous damage to the membranous part of the urethra is possible. The prognosis for cure for uncomplicated injury is favorable.

Fractures of the pelvic bones

The causes of pelvic fractures are varied, most often they are: falling from a height on the side or on the buttocks, squeezing the pelvis in car accidents, collapses, the fall of large loads on the pelvic area.The mechanism of pelvic fractures depends on the direction of the compressive forces.

• Sagittal compression of the pelvis is most likely to cause bilateral pubic and ischial fractures, transverse sacral fractures, and ruptures of the sacroiliac joints.
• With frontal compression of the pelvis, multiple fractures of the anterior semi-ring of the pelvis, fractures of the wings and bodies of the ischial bones, longitudinal fractures of the sacrum and ruptures of the sacroiliac joints are likely.
• With diagonal compression of the pelvis, fractures of the bodies of the pubic bones, rupture of the pubic symphysis, longitudinal fractures of the sacrum, ruptures of the sacroiliac joints can occur.
• With a strong lateral impact to the femur, the most likely occurrence of fractures of the bottom of the acetabulum, the bodies of both ischial and pubic bones, and rupture of the sacroiliac joints on the opposite side of the pelvis.

The main forces acting on the pelvis are outward rotation, inward rotation and vertical shear forces.Each of these forces results in different types of pelvic fracture.

There are three types of pelvic fractures:

• Fracture type A – stable, with minimal displacement and without compromising the integrity of the pelvic ring.
• Type B fracture – there is a rupture of the pubic symphysis, as a result, the pelvis seems to “open”, this damage is called an “open book”. The halves of the pelvis are unstable in the outward rotation position. In this type of injury, the posterior ligamentous structures are not damaged.
• Type C fracture – characterized by rupture of the entire pelvic floor, destruction of the posterior sacroiliac complex. Damage can be one-sided and two-sided. Diagnosis of vertical instability is best done clinically and with computed tomography.

Often, with multiple fractures of the pelvic bones, hemorrhages are observed in the surrounding tissues. A finger examination through the vagina or rectum allows you to determine fractures of the sacrum, coccyx or bones of the anterior pelvic ring, as well as the nature of their displacement.The diagnosis is clarified by a radiograph of the entire pelvis. Volumetric three-dimensional reconstruction of the CT image creates a holistic picture of fractures and facilitates the choice of treatment methods.

Fractures of the anterior parts of the pelvis can be combined with damage to the urethra and bladder. Less commonly, the rectum, iliac vessels, sciatic and obturator nerves are affected. Failure to detect or late detection of these injuries leads to infectious and neurological complications, often resulting in the death of the patient.Fractures of the posterior semicircle, ruptures of the sacroiliac joints are always accompanied by massive retroperitoneal bleeding up to 2 liters or more.

Treatment of stable fractures of the pelvis and fractures without displacement of fragments.

The victim must be laid on a rigid stretcher, a roller made of clothes should be placed under the knee joints, painkillers should be administered and sent to the hospital by ambulance or a specialized ambulance team should be called. Treatment of pelvic fractures begins with anesthesia.Assign bed rest on the shield for 3-4 weeks. From the very first days of damage, exercise therapy is prescribed. With fractures of the sacrum and coccyx, working capacity is restored in 4-5 weeks. Subsequently, if the patient is worried about constant pain in the coccyx, then surgical removal of the distal part of the coccyx is indicated.

Treatment of unstable pelvic injuries.

Treatment of all patients begins with the use of non-operative methods. Bed rest is prescribed for 5-8 weeks.Intrapelvic blockade is performed for anesthesia. The cessation of pain in the area of ​​fractures is an indication for the appointment of exercise therapy. With pronounced vertical displacements, skeletal traction is used for the bones of the thigh and lower leg with a gradual increase in traction with weights up to 14-16 kg. A hammock is used to treat a tear in the pubic symphysis. The hammock is pulled so that the pelvis is suspended, then the convergence in the symphysis is due to the patient’s weight. Intra-pelvic and retroperitoneal hematomas are tamponed and drained.

Surgical methods of treatment of unstable pelvic injuries: transosseous osteosynthesis. On the basis of morphological studies of the pelvic bones and the pelvis as a whole, apparatuses for fixation of multi-plane controlled action were developed based on the designs of G.A. Ilizarov. Their main advantages:

• pins and rods of the apparatus are inserted into the pelvic bones, taking into account the optimal zones at a certain angle
• way is less traumatic
• possible controlled metered reduction in three planes

Transosseous osteosynthesis stabilizes the pelvic ring, compensates for fracture sites, reducing the intrapelvic space, which helps to reduce bleeding, and significantly improves the functional results of treatment.

Rehabilitation of patients with pelvic fractures.

The complex of rehabilitation treatment for patients with fractures of the pelvic bones includes exercise therapy, FTL, massage. Additionally, a method of magnetotherapy and a device for local hypothermia are used. Stable fixation of fractures is the main way to prevent the development of respiratory distress syndrome and multiple organ failure. Rehabilitation includes 4 stages:
Thus, the combined use of external fixation devices and early rehabilitation of patients with severe pelvic trauma can improve the anatomical and functional results and shorten the time of inpatient and outpatient treatment.

What is a hip fracture and how dangerous it is

A hip fracture is a serious injury that threatens the lives of older people, especially during the winter months. Gazeta.Ru was trying to figure out what are the consequences of the fracture and how to prevent it.

In winter, due to icy conditions, hundreds of people go to emergency rooms with bruises and fractures. The most vulnerable category of the population is the elderly, for whom an unsuccessful fall on ice can result in a hip fracture.

Up to 4.5 million people suffer from a hip fracture a year, and every year their number is growing steadily.According to the researchers, the mortality rate among patients with a hip fracture can reach 90,081 up to 10% during the first month, and up to 36% during the year. Among the survivors, 11% remain bedridden, 16% need long-term rehabilitation in the hospital, and 80% use walking aids even a year after the fracture.

A hip fracture is often associated with osteoporosis, a decrease in bone density, therefore, postmenopausal women most often suffer from it – this is due to a deficiency of the female sex hormones estrogen.Women, in general, 90,081 account for 90,082 to 75% of hip fractures, most of which occur after age 50.

For a fracture, even a fall from the height of one’s own growth is enough.

It is characterized by severe pain in the groin and in the area of ​​the hip joint, the inability to lift a leg or lean on it. Radiography is used to make an accurate diagnosis.

Treatment of a fracture using plaster is not recommended – this method is considered ineffective, in addition, prolonged bed rest is fraught with various complications, from the formation of pressure sores to the development of thromboembolism.In most cases, surgical treatment is recommended, in particular, replacement of the femoral neck and head with a metal prosthesis.

The operation should not be postponed – even an extra 24 hours increase the patient’s chances of death, say experts from Canada and the United States.

They analyzed the results of 42 thousand operations performed in 72 hospitals in Ontario in 2009-2014. As it turned out, the risk of death within a month for patients operated on within the first 24 hours after fracture was 5.8%.For those who were operated on by the surgeons only the next day, this figure reached 6.5%. In addition, these patients were at increased risk of heart attack, thrombosis, pneumonia, and blockage of the pulmonary artery by a thrombus.

In addition, as shown by 90,081 work of 90,082 Australian researchers, mortality from a hip fracture is already quite high, especially in the elderly. Observation of almost ten thousand patients over 65 years old showed:

with such a fracture, the risk of death within a year is more than 3.5 times higher than without it.

72% of deaths reported during the study period were in patients with a recent hip fracture. At the same time, men died more often.

Although surgery can restore mobility and relieve pain, it is also a risk factor that increases the likelihood of premature death of a patient. Scientists from France 90,081 reviewed 90,082 medical data of 691 thousand patients, about half of whom underwent elective hip replacement surgery, and the rest underwent emergency surgery after a hip fracture.

The analysis revealed that the first category had a probability of death of only 0.3%, while the second – 1.8%.

The probability of postoperative complications was 2.3% and 5.9%, respectively.

“Patients who underwent surgery after a hip fracture were older and had more comorbidities than those who underwent elective surgery,” the authors of the work note.

However, even if the operation is successful, half of the elderly patients will no longer be able to regain their former mobility.Researchers from the United States compared the physical performance of 733 patients over 65 years of age before and after the fracture and 90,081 found out 90,082 whether they can wash, dress, eat, walk down the street or climb stairs on their own.

Only 31% of patients fully returned to their previous life.

34% and 41%, respectively, could move and climb stairs as before the fracture. The situation was slightly better among patients who were most physically active before the injury – 36% of them were able to self-serve themselves.

“There is less than 50% chance of returning to pre-fracture activity levels. It turned out to be especially low for patients over 85 years old who suffer from concomitant diseases or dementia, ”notes Victoria Tang, lead author of the study.

To reduce the likelihood of a hip fracture, it is necessary to address the main risk factor – low bone density. As shown in a recent study , study , fermented milk products, especially yogurt, when combined with fruits and vegetables, successfully cope with this.

Among almost 40 thousand participants who consumed a lot of milk (up to three glasses a day) and few vegetables and fruits, the risk factor for a hip fracture (i.e., the likelihood of a fracture compared to another group) was 2.49 in relation to the group who ate little milk (less than a glass a day) and a lot of vegetables and fruits (up to five servings a day). Among those who drank a lot of milk and consumed a moderate amount of vegetables and fruits, the figure was 2.14.

The lowest risk coefficient compared with milk lovers – 0.81 – was found in women who regularly consumed yogurt (from two servings a day) and ate a lot of vegetables and fruits.

It is also necessary to monitor the content of vitamin B6 in the body – as shown by work of Norwegian scientists, the more it is, the higher the risk of hip fracture.

Of almost 7 thousand participants, some received folic acid and vitamins B6 and B12, some received folic acid and vitamin B12, some received folic acid and vitamin B6, and the rest received placebo. As it turned out, the use of vitamin B12 did not affect the risk of fractures, but with the use of vitamin B6, the risk increased over time.A short reception, however, did not have a significant impact.

First aid for fractures • Alpagama

Updated: 10/16/2020

Mountains, rock climbing, hiking, mountaineering, travel, adventure, impressions – it’s all undeniably great. But, unfortunately, with our comrade, or even not with ours, but with someone we met on the way, such a misfortune as a fracture can happen. The normal response of a good person is to help.

So what are we doing?

It is unlikely that contemplation of a damaged person will bring us joy or peace, therefore, first of all, we will want to get confused, panic, run with hands raised to the sky and shout “we will all die.”Unfortunately, as a first aid for a fracture, it is ineffective. Therefore, we calm down and do not show fear to the one who is now already hurt and scared. We are trying to assess the scale of the disaster: location, weather, condition of the victim. If there is a connection, call and clearly report the victim and the incident. Then try to talk to the victim, if he is conscious, to instill in him hope for the brightest future. Very carefully examine the victim, feel in an attempt to diagnose damage or fracture.It is important not to turn the person back and forth, there is the possibility of such a manifestation of activity inflicting even greater damage on him, up to finally collapsing his neck or damage the spine.

We follow the rule: Do no harm !!!

Generally, human bones are very strong, but fractures do occur. This happens when the direction of the extraneous force acting on the bone does not correspond to the location of the bone bars. Most often, limb fractures occur.

How to recognize a bone fracture?

Signs of a fracture:
– sharp pain, aggravated by any movement and load on the limb, dysfunction, change in shape and length,
– the appearance of swelling and bruising,
– shortening and pathological mobility of bones.
Unlike a bruise, the function of a limb is impaired immediately – from the moment of injury.

A fracture can be detected by external examination of the damaged part of the body. If necessary, the site of the alleged fracture is probed.With a fracture, bone irregularities, sharp edges of fragments and a characteristic crunch with light pressure are observed. To feel, especially to determine the mobility of the bone outside the joint area, you need to be extremely careful, with both hands, trying not to cause additional pain and injury to the victim.

A fracture is always accompanied by damage to soft tissues, the degree of violation of which depends on the type of fracture and the nature of the displacement of bone fragments. Damage to large vessels and nerve trunks is especially dangerous, the formidable companions of which are acute blood loss and traumatic shock.In the event of an open fracture, there is a risk of wound infection.

Providing first aid for fractures, it is necessary to perform first of all those techniques on which the victim’s life depends, namely:
– to stop arterial bleeding;
– to prevent traumatic shock;
– after putting a bandage on the wound, create immobility of the limb with the help of splints and improvised materials, in exceptional cases, transport immobilization is allowed by bandaging the injured limb to a healthy part of the body: the upper – to the body, lower – to the healthy leg.

What not to do when providing assistance:

– you cannot match bone fragments or correct a limb defect;
– bone fragments that have come out of it must not be inserted into the wound;
– Do not take off your clothes and cause additional pain, clothes and shoes are cut, especially with open fractures.

A well-done and timely help will protect the victim from mixing of fragments, reduce pain during transportation and prevent the occurrence of traumatic shock.

A broken limb must be immobilized with a splint. Immobility at the fracture site is provided by splints fixation of two nearby joints above and below the fracture site. Under the splint, wrapped with a bandage or some kind of soft material, cotton wool or soft tissue is thrown in the places of the bone protrusions to prevent strong pressure and pain. But it is not always possible to find a tire at the scene of an accident. Then it is made from a wooden board, a strip of thick cardboard, etc.n. To prevent the tire from pressing on the fracture site, a soft pad is placed under it. When no suitable material can be found for making a splint, the broken arm is, in extreme cases, bandaged to the body, and the injured leg to the healthy one.

Fracture of the bones of the skull.

Fractures of the skull bones are often accompanied by trauma or damage to the brain. The victim is sometimes unconscious, so special care must be taken. The victim is placed on a stretcher with his stomach down, under his head (face) put a soft bedding with a depression or a cotton-gauze circle.

Fracture of the clavicle.

In case of fractures of the clavicle, two cotton-gauze rings are placed on the shoulder girdle and tied on the back. The hand is suspended from a kerchief. If there is a suspicion of displacement of the bone, then the rings are not superimposed, and the hand is applied with the palm of the hand to the body, and is fixed (tied) with a bandage to the body. It is necessary to transport the victim in a sitting position, leaning back slightly. It is not recommended to bend forward while getting into the car, as this may cause additional displacement of bone fragments.

Rib fracture.

No splint is applied for a rib fracture. The victim needs to try to exhale as much air as possible from the lungs and then breathe not deeply. In this position, the chest is tightly bandaged. The ribs contracted in the exhalation position make very limited movements during breathing. This is to prevent the sharp ends of the broken rib from damaging the lungs. If the victim has an open injury to the abdominal cavity, in this case, a sterile cotton-gauze pad or napkin is first applied to the wound.On top of them, like compresses, a material impervious to air is applied from a film, a bag. The sealing material is strengthened with a bandage. It is necessary to transport the victim in a half-sitting position.

Fracture of the pelvic bones.

In case of a fracture of the pelvic bones, the victim is laid with his back on a hard shield, wide board, door or sheet of plywood, a rolled coat or blanket is placed under his knees so that the lower limbs are bent at the knee joints and slightly apart.In this position, the limbs are fixed with a spacer and bandages.

Fracture of the phalanges of the fingers, fracture of the hand.

In case of open fractures of the phalanges of the fingers and bones of the hand, a sterile bandage is applied to the wound, a dense lump of cotton wool wrapped with gauze or a clean rag or a small ball to give the fingers a half-bent position is put into the palm, and then the hand is fixed with bandages to a piece of plywood or a board. The injured arm can be suspended on a kerchief, while the elbow joint is fixed in a position bent up to 90 °.

Fracture of the forearm (the forearm is between the hand and the elbow).

In case of forearm injury, a splint (board) is applied from the fingers of the hand to the elbow joint or the middle of the shoulder. In the absence of splints, the arm is bent at the elbow, turned with the palm to the stomach and bandaged to the body or suspended with a kerchief or the hem of clothing.

Hip fracture.

Fractures of the femur, especially open ones, often lead to bleeding and shock.First, the bleeding is stopped, a sterile bandage is applied to the wound. Femur fractures, especially open fractures, often result in bleeding and shock. First, the bleeding is stopped, a sterile bandage is applied to the wound. After that, splints or other improvised materials (boards, fragments of skis, sticks) are applied on the sides of the thigh and fix them to the limb and torso with a wide bandage, waist belt, towel in such a way as to ensure the immobility of the entire limb – the hip, knee and ankle joints.A cotton wool roll is placed on the bony protrusions in the joint area, as well as in the armpit and groin area. The foot is set at an angle of 90 degrees.

Shin fracture.

In case of leg fractures, immobility is created in the ankle and knee joints, for which splints or improvised means are placed along the outer and inner surfaces of the leg from the foot to the upper third of the thigh. To fix the bones of the foot, two half-meter splints or plywood scraps are used, which are also bandaged along the lateral surfaces of the limb from the foot to the upper third of the lower leg.The third splint is bandaged to the plantar surface of the foot.

Fracture of the spine.

Fracture of the spine is the most severe and painful injury. The fate of the victim in these cases depends to a decisive extent on the correct provision of first aid and the method of transportation. In such cases, you do not need to try to help the victim yourself. You must immediately call an ambulance. If it is impossible to call an ambulance, it is necessary to give an anesthetic, the victim is very carefully laid on a flat hard surface, for example, on a long wide board, carefully and carefully bandaged to the shield.In the absence of a shield, the victim is laid down with his stomach on a regular stretcher so that the weight of the body does not press on the spine, a cloth roller is placed under the patient’s head and shoulders, and then the victim is delivered to the medical center. It must be remembered that such victims do not at all tolerate the transfer in the usual way from the ground to the shield.