Hip Strains and Sprains | Orthopedics

What is hip strain or sprain?

A hip strain or sprain occurs when a muscle (strain) or ligament (sprain) that supports the hip is stretched or torn beyond its limit. If the injury is severe, you may not be able to move the hip properly.

The hip joint is the anchor for many muscles in the body, so other areas, such as the abdomen, buttocks and legs, may also feel the symptoms of a hip strain or sprain.

Causes of hip strains or sprains

Most hip strains or sprains are caused by car accidents or trauma directly to the hip.

Other causes of a hip strain or sprain:

• Overstretching the muscles and ligaments in the hip
• Insufficient warm-up prior to activity
• Doing too much activity too soon

Risk factors for hip strains or sprains

People who have had hip strains or sprains in the past are more likely to have another hip strain or sprain.

Symptoms of hip strains or sprains

The most common symptoms of hip strain or sprain is pain over the hip. Pain typically intensifies with increased activity. You may also feel swelling, tenderness, stiffness, muscle spasm and bruising along the hip. You could also lose muscle strength or flexibility and have difficulty walking.

Other symptoms of a hip strain or sprain include:

• Sudden sharp pain in the back of the lower leg
• Tenderness in the calf
• Swelling or bruising

Diagnosis of hip strains or sprains

Your doctor will diagnose a hip strain or sprain in a physical examination.

• Medical history — your physician will take a full medical history to determine when symptoms began, activities that cause the symptoms, symptom severity and what makes the symptoms worse.
• Physical exam — the physician will also perform range of motion tests, checking the stability of the joints and muscle strength.
• Diagnostic testing — your provider will likely also order an x-ray or MRI to rule out more serious hip injuries.

Treatments for hip strains or sprains

Treatments for mild hip strains or sprains include rest, ice, compression, and elevation in combination with anti-inflammatory medication. These therapies will work together to reduce pain and swelling.

For more severe strains or sprains, your doctor may recommend the following:

• Physical therapy — physical therapy may include massage, strengthening exercises, therapeutic ultrasound or heat therapy.
• Surgery — more severe hip strains or sprains that tear a muscle or ligament completely may require surgery and rehabilitation.
• Plasma rich protein (PRP) injection — PRP therapy for hip strains or sprains can speed healing by injecting concentrated growth factor platelets from the patient into the affected area.

Recovery from hip strains or sprains

Patients who suffer from mild to moderate sprains or strains will heal with conservative treatment within a few weeks to a couple months as long as they follow the doctor’s orders.

Patients who have more severe hip strains or sprains where surgery is required can completely heal with physical therapy and rehabilitation.

Injuries should heal completely before regular activity is resumed. If overuse caused the injury, activity modification may also be required.

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8 Symptoms of a Twisted Pelvis

Back pain, hip pain, and knee pain can creep into your daily life and interrupt even the most simple of activities. But what is the culprit of your achy ailments?

Believe it or not, you may have a twisted pelvis. And it could be caused by nothing more than going through your day-to-day life (no obvious injuries needed).

Often referred to as a tilted pelvis, pelvic misalignment can create a dramatic chain reaction through your body – causing pain and tightness to arise in surprising places. It is easy to attribute pain in your lower back or even hip pain to things like arthritis, but there is a far more common reason that can be easy to overlook: muscle tightness that leads to pelvic tilt.

When you think about all the movements your hip region is responsible for, it’s not surprising that they may be feeling overworked.

Your hip flexor muscles are even engaged while you are sitting as they stabilize your core! And when these muscles are allowed to remain tight, they add strain to neighboring joints, muscles, tendons, and ligaments.

Over time, this muscle tightness has the potential to cause your pelvis to be pulled out of alignment. This leaves you with a twisted pelvis and a tight core.

The anatomy of your pelvic region

Before we jump into defining what a twisted pelvis is, and how to identify some possible twisted pelvis symptoms, it’s important to know how all the parts of your pelvic region interact together.

The bones and joints that are the main players in your pelvis include your femur (thigh bone), pelvic bone, and spine (vertebrae). Your thigh bone is what connects to the pelvic bone, making up your hip joint.

Your pelvis then is made up of three separate bones that connect: the ilium bones that join in front to make your pubic joint, and then one in back called the sacrum that connects to the ilium. This connection in the back is your sacroiliac joint. You’ve probably heard the sacrum referred to as the “tailbone.”

Now, to set the anatomical stage for your pelvis, let’s think of your bones as puppets.

Without your muscles, your bones would not be able to move around. The muscles grab hold of the bones at their connection points and pull on them like strings in a puppet show. Essentially, without your muscles (and ligaments or tendons), your bones are inanimate.

There are 19 different muscles that cross through your hip region. All of the muscles in your pelvis region play important roles and cross joints at different angles. Some of your muscles are very long, extending all the way from your pelvis to your knee joint, while others are only a few inches in length.

Two of the primary muscles are the iliacus and the psoas muscles. All of your muscles have their own specific job when it comes to movement, but they all work in conjunction with your iliopsoas.

They’re either working with your hip flexors or in opposition to them.

The iliopsoas muscles have two primary roles: they help your hip flex or move forward, and they hold the spine in place relative to your pelvis.

Essentially they are what keep you upright, whether in motion or sitting/standing still.

Your iliacus crosses over your hip joint and attaches to your pelvis which is why it affects your sacroiliac joint as well. Then, your psoas muscle crosses over your hip joint and the pelvis all the way to your lower spine.

These two muscles are also commonly known as your hip flexors or the iliopsoas muscles. And when not properly taken care of, they can be the culprit of your hip pain, back pain, and a whole other slew of issues. These muscles are NOT quiet about expressing their unhappiness!

There are other major muscle actors that help with hip flexion, including the pectineus, rectus femoris, tensor fasciae latae (connects to your IT band), and part of your gluteus medius on the outside of your hip. All of these muscles help the iliopsoas perform hip flexion, but there are also many muscles that pull in the opposite direction.

These opposing muscles are in a sort of tug-of-war, working to keep the bones in the proper alignment.

Most of the muscles that help with hip flexion and forward leg movement are on the front of your body, and the opposing muscles are on the back of your body. Your glute muscles are the primary muscles that help pull your leg backward (called hip extension), but these opposing muscles also include your quadratus lumborum, hamstring muscles, and the piriformis muscle.

Your body is at its optimal alignment when your spine, pelvis, and hip are all lined up and held together properly. But when your iliacus and psoas are too tight, they begin to pull too much in one direction or on one side, causing other aspects of your hip region to topple out of place.

For instance, when your iliacus is constantly pulling and tightening, it can pull your pelvis forward – adding tension to your piriformis muscle and SI joint. This can cause hip pain and even change your posture as the iliacus pulls on the hip and spine bones.

Once your bones are out of alignment, it can start to cause knee pain as your posture is compromised more and more. That effect will start to trickle down your whole leg and can manifest as knee or leg pain. It can even change your walking stride.

It’s clear to see that, without healthy hip flexors, you don’t have a strong foundation. And you are likely set up for a domino effect of issues – including a twisted pelvis.

What is a twisted pelvis?

It is good to know how your muscles and bones are working together, and that tight muscles can cause a twisted pelvis, but what exactly does that mean?

The short definition of a twisted pelvis or pelvic tilt is an abnormal positioning of your pelvic bone.

When your pelvis is in a neutral position, your ilium (the large, flared portion of your pelvic bone) forms a joint with your lower spine (the tailbone or sacrum). As I mentioned above, this junction is known as the sacroiliac (SI) joint.

There is also a socket that forms at the base of your pelvic bone which is where your hip joint ball and socket junction with your thigh bone.

A neutral pelvis position is when the hip points and your pubic bone are aligned and in the same plane. This means that they are vertical when standing – and horizontal when you are lying down – and that both sides of your hip points are also aligned in the same plane.

A twisted pelvis occurs when there’s a misalignment of the pelvic bone itself, which is why a twisted pelvis is often referred to as pelvic misalignment.

There are several causes of a pelvic misalignment, but they are usually either structural or functional problems within your legs, hips, or spine. The most common causes of pelvic tilt include:

• Muscle imbalances
• Uneven leg lengths
• Spinal scoliosis
• Tight iliopsoas muscles

The primary cause of your pelvic tilt is also a determining factor in the exact type of pelvic misalignment you have. There are three main types:

1. Anterior pelvic tilt: Anterior pelvic tilt is when your hip bones are pushed or pulled forward. This occurs when the bottom of your pelvic bone tips back and up. This type of pelvic tilt is the most common one associated with tight hip flexor muscles. It is also a common issue during pregnancy.
2. Lateral tilted pelvis: A lateral pelvic tilt (or pelvic upslip) is when the pelvis is misaligned side to side. This means that one side of your hip is sitting slightly higher than the other, causing a tilt. This type of pelvic tilt is most often caused by uneven leg lengths or spinal scoliosis.
3. Posterior tilted pelvis: Posterior pelvic tilt is the opposite of an anterior pelvic tilt. It happens when your pelvic bone scoops under the body towards the front. This type of misalignment pushes your hip bones backward and stretches your lower back muscles, flattening the natural curvature of your lower spine. A common cause of posterior pelvic tilt is tight hamstring muscles.

Since there are varying causes for each type of pelvic tilt, the culprit of your own issue can sometimes be difficult to identify. But, more often than not, you will start off with an innocent sensation, like tight hip flexor muscles. As the pelvic tilt worsens over time due to poor posture, excessive sitting, or general muscle weakness and imbalances your symptoms may become more noticeable.

8 clues or twisted pelvis symptoms

The first step toward a twisted pelvis correction is identifying if you have a pelvic misalignment to begin with. This can get tricky because not everyone that has a pelvic tilt can visually see it. In fact, they may not have any obvious symptoms!

The symptoms of pelvic misalignment often begin to occur in patients with severe pelvic tilts, whereas minor tilts may not have any pain or discomfort associated with the issue.

If your twisted pelvis does cause symptoms, they will often occur in a variety of places in your body, not just the pelvic region. For example, if…

1. You are experiencing hip pain, lower back pain, or leg pain
2. Your gait is uneven or you are having trouble walking normally
3. You are experiencing SI joint irritation and inflammation
4. You have pain in your buttocks
5. You feel numbness, tingling, or weakness of your legs
6. The height of your hip bones is uneven
7. You are experiencing pelvic floor muscle weakness
8. You have an extreme lower back arch or lack of an arch

…then you may be experiencing twisted pelvis symptoms.

Identifying a pelvic tilt can be difficult when basing it solely on symptoms because it can mirror several other issues, including sciatica pain. Consulting a medical professional or doing an at-home pelvic tilt test can help you narrow down the possible causes of these symptoms.

To properly and officially diagnose a twisted pelvis, your doctor will likely perform a physical exam and measure the angle of your pelvis to determine the type and severity of the tilt. The physical examination will usually be accompanied by various questions to help determine the best course of treatment.

Remember, there is no replacement for an official diagnosis. It’s always important to work with a licensed professional before beginning any treatment program.

Twisted pelvis treatment options

A twisted pelvis can cause several issues, including pain that interrupts your daily life. But I have good news for you: It can be corrected relatively easily – and without surgery in almost all cases.

Once the cause of your pelvic tilt has been determined, then you and your doctor can decide the best type of treatment for your specific needs.

For instance, if you have a twisted pelvis that is caused by muscle problems like tight hip flexors, then treatment will involve extended pressure release of the psoas and iliacus muscles, hip flexor stretches, and the appropriate strengthening of the hips, glutes, and core.

Keep in mind that although this is likely to treat anterior pelvic tilt, tight hip flexors can also pull on and tighten muscles on the back of your hip like your piriformis. So, stretching, strengthening, and pressure release should occur on both sides.

When working on how to fix a rotated pelvis, it can be beneficial to work with a physical therapist to target specific needs. We can teach you how to do exercises and stretch properly to avoid creating more issues and avoid pain.

A physical therapist can also perform pressure release of your muscles for you. This is often the easiest and only way to target your iliacus and psoas muscles responsible for an anterior pelvic tilt.

That’s because it’s nearly impossible to find the right angle and apply the right amount of pressure needed to release these muscles on your own.

But I have more good news for you.

With the help of the Hip Hook, you can perform this much-needed muscle release at home. This is a great supplement between your appointments, making treatment more accessible and effective.

If you experience severe pain due to a twisted pelvis, some doctors may recommend certain injections to alleviate pain as you begin treatment. Although surgery is uncommon, if the pelvic tilt is due to a structural problem of some kind, it may be necessary.

Frequently asked questions about having a twisted pelvis

Is a tilted pelvis painful?

One tilted pelvis symptom can be pain or tightness in the muscles and areas around your hips. The level of discomfort you feel often depends on the severity of the tilt or misalignment.

If you are experiencing pain in your hips, lower back, and knees you may want to discuss the possibility of having a tight iliopsoas and/or pelvic tilt with your doctor or physical therapist.

Can a tilted pelvis cause bladder issues?

Yes, a severely tilted pelvis can cause some incontinence, if left untreated. When your pelvis is misaligned, it can impact the strength of your pelvic floor muscles which can make it more difficult for you to control your bladder. This is a normal symptom that can be managed or may even go away with an effective treatment plan.

Should I see a chiropractor for my twisted pelvis?

A chiropractor can be a helpful resource during your treatment of a pelvic tilt but they should not be the sole treatment provider. A combination of chiropractic work, physical therapy, and consistent at-home exercise can help move your pelvis back into alignment over time.

But remember, to keep your pelvis and hip muscles happy, you’ll need to make some changes to your daily habits, posture, and stretching routine.

Fracture of the femoral neck – causes, symptoms, diagnosis

What is a fracture of the femoral neck

The femur is the longest bone in the human body. It serves as an attachment point for more than 10 different muscles. These are the femoral, pelvic, gluteal, and iliopsoas muscles that are responsible for the movement of the legs and pelvis.

Conventionally, the femur can be divided into three sections: proximal (upper), distal (lower) and central (bone body).

Femur

The distal (lower) part of the femur is straight, wide, passes into the knee joint. The proximal (upper) section is a little more complicated. It consists of two small outgrowths – skewers located on the sides of the main body of the bone. Many muscles are attached to them.

Between the trochanters of the femur, the neck of the femur extends towards the pelvis. Normally, it is inclined by an average of 130° relative to the body of the femur. The femoral neck ends with a spherical femoral head, which enters the cup-shaped depression of the pelvic bone – the acetabulum. Together, the femoral head and acetabulum form the hip joint. It works like a hinge, that is, it allows the hip to move in almost all directions.

Hip joint – the articulation of the pelvis and femur

Fracture of the femoral neck – destruction of the bone tissue between the main body of the femur and the femoral head. It is considered a severe injury that completely limits the movement of the leg, causes very severe pain and can lead to a person’s disability.

Prevalence of hip fracture

Femoral fractures account for 6.4% of all fractures, of which 25% are hip fractures.

Fractures of the proximal (upper) femur, including the femoral neck, are most common in the elderly. Women over 60 are especially susceptible to them. With age, the risk of hip fracture increases: about 18% for people over 70 years old, 24% for people over 90 years old.

Among all fractures of the proximal (upper) femur, 52% of cases are fractures of the femoral neck.

Causes and risk factors for hip fracture

Fracture causes are low-energy and high-energy.

Low energy fracture – an injury that a person receives when a blow is not very strong. Most often occurs in older people when falling from their own height.

The main cause of a low-energy femoral neck fracture is an unsuccessful fall on a straightened, twisted leg or on the side of the pelvis, when the blow falls on the greater trochanter, and the main load falls just on the femoral neck.

Elderly people often break their hips by slipping on ice or at home

Low-energy fractures are common among people with osteoporosis, a condition in which bones become too brittle and brittle. Osteoporosis is considered an endocrine disease, as it is associated with metabolic disorders. The disease can develop against the background of genetic pathologies, malnutrition, vitamin D and calcium deficiency. In older people, osteoporosis appears due to age-related hormonal changes. In women, this is menopause; in men, it is an age-related deficiency of male sex hormones.

The fact is that sex hormones have a very strong effect on metabolism. When a person ages, their concentration naturally decreases, which leads to various metabolic disorders. Older people are prone to weight gain, their skin loses elasticity, and their bones lose strength due to a slowdown in metabolism and a decrease in its efficiency.

High energy fractures occur in all people regardless of age or gender. They are associated with an unnaturally high load on the upper part of the femur. A high-energy fracture can be caused by a car accident, falling from a height sideways or landing on a hard surface with straight legs, as well as other injuries in which a large force is applied to the femoral neck. However, in such cases, the fracture can be combined – that is, not only the femoral neck breaks, but also the head, the bone itself or the pelvis.

Factors that increase the risk of hip fracture:

• osteoporosis is a metabolic disease in which the bones become brittle;
• female – in women, bone density is naturally lower than in men;
• age over 60 years – during this period, the production of sex hormones naturally decreases in a person, which leads to a change in metabolism and often to osteoporosis;
• rarely – tumors and metastases that disrupt the structure of bone tissue;
• osteomyelitis – an inflammatory infectious disease of bone tissue;
• bad habits – smoking and alcohol abuse (they disrupt metabolism, causing osteoporosis).

Types of hip fractures

Pathology is distinguished by localization, type, displacement and its type. In addition, specialists use the Garden and Pauwels classifications – they help determine the complexity of the fracture and select a treatment method.

By location:

• B1 – subcapital (medial): fracture at the base of the femoral head;
• B2 – transcervical: the fracture passes through the central part of the femoral neck;
• B3 – basicervical (basal) fracture: a fracture at the base of the femoral neck, but above the trochanters of the femur.

Hip fractures by location

By type of fracture:

• complete – the fracture passes through the entire thickness of the femoral neck;
• incomplete – part of the tissues along the fracture is intact.

Offset:

• with displacement — the broken part of the femoral neck with the head is displaced relative to the body of the femur;
• no offset – the angle between the femur and the femoral neck does not change.

By offset type:

• impacted fracture – parts of the neck do not move up or down, but “press” into each other;
• valgus fracture – a situation in which the angle of the femoral neck in relation to the body of the bone increases. Part of the femoral neck with the head goes a little higher. Often such a fracture is impacted;
• varus fracture – the angle between the body of the bone and the femoral neck decreases. Part of the neck with the head is shifted lower.

In medicine, two classifications of femoral neck fractures are widely used – Garden and Pauwels.

Garden classification:

• type I – incomplete fractures without displacement;
• II type – complete fracture without displacement;
• type III – complete fracture with slight displacement;
• IV type – complete fracture with significant displacement.

Pauwels classification:

• Type I — fracture line angle horizontally up to 30°;
• type II — fracture line angle up to 50°;
• III type — fracture line angle up to 70°.

Hip fracture symptoms

The first thing a person feels in case of a hip fracture is severe pain in the area of ​​the hip joint, which radiates to the groin. Often, due to pain, he cannot get up on his own, and if he does, it becomes almost impossible to lean on his leg. In some situations, for example, with an impacted fracture without displacement, the patient can move independently, albeit with difficulty. However, this is strongly discouraged.

External rotation of the leg is also common with a fracture. That is, in the prone position, the foot itself turns outward, towards the little finger. In addition, the injured leg can become several centimeters shorter – this is noticeable visually when comparing the level of the feet.

One of the first diagnostic parameters of a hip fracture is the “stuck heel” syndrome. A person lying on his back cannot independently raise his straightened leg and tear his heel off the surface. When bending the leg at the knee and hip joint, the foot and heel also do not rise.

Complications of hip fracture

The main threat in case of a fracture of the femoral neck is necrosis, that is, the death of a broken off area of ​​the bone with the femoral head. This pathology leads to further destruction of the hip joint.

The femoral head receives oxygen and nutrients through the blood vessels inside the femoral neck, as well as external vessels – they are located in the hip joint and its ligaments.

With age, the blood supply to the lower body in people becomes worse – this is due, among other things, to a decrease in the activity of sex hormones. In the elderly, the femoral head receives blood only through intraosseous blood vessels. When the femoral neck is fractured, the blood vessels rupture and the blood supply stops. If not treated, the damaged area of ​​the bone will begin to die and collapse.

A fracture of the femoral neck disrupts the blood supply to the femoral head. As a result, necrosis develops

Since a person with a broken femoral neck cannot walk, stand and sit, then if he has not received treatment within a few days after the fracture, he is forced to lie down all this time. As a result, congestive pneumonia and respiratory failure may develop.

In addition, bedridden patients often experience deep vein thrombosis of the legs. A blood clot that has broken away from a vein can move to the heart, and from there to the lungs – in this case, pulmonary embolism occurs. PE has a high risk of mortality, so the pathology requires emergency hospitalization and treatment.

Bed sores are also a frequent companion of bedridden patients. These are difficult-to-heal ulcers that appear at the points of skin contact with the surface of the bed. Under the pressure of the patient’s own weight, blood circulation in the skin is disturbed and its cells begin to die. In patients with an untreated hip fracture, bedsores appear especially often, since turning over causes a lot of pain to a person.

The photo may seem shocking.
Click to view.

Bedsores appear if a bedridden patient is not turned every 2-3 hours

To avoid complications, surgical treatment should be carried out in the first two days after the injury.

Diagnosis of hip fracture

Diagnosis of a femoral neck fracture is carried out by doctors and paramedics of the ambulance, the doctor of the hospital emergency department, as well as the traumatologist.

The first step in diagnosis is taking an anamnesis. An ambulance or emergency department specialist is interested in the patient’s complaints and the situation in which he was injured. This is important, since a fall from the height of one’s height, for example, during loss of consciousness, can indicate various diseases of the brain or cardiovascular system.

To make a decision on pain relief, the doctor may ask the patient to describe the pain: assess its intensity, localization and, possibly, the conditions in which it becomes stronger.

The decision on the admissibility of surgical treatment is made by a traumatologist, an anesthesiologist and other specialists. In case of concomitant cardiovascular diseases, a cardiologist is involved in the consultation, and in case of neurological disorders (for example, with a stroke), a neurologist is involved.

On examination, the doctor will assess the position of the legs: the injured limb is often shorter, and its foot is turned outward. On the skin in the area of ​​the hip joint, a specialist may notice a hematoma from a bruise, if any, and swelling of the tissues.

Also, the doctor will conduct a test for “stuck heel” – ask the patient lying on his back to raise the straightened leg. With a fracture of the proximal femur, the patient will not be able to tear the heel off the surface.

It is not recommended to carry out a “stuck heel” test on your own, it is not recommended to move and lift a person. Such manipulations will harm him.

After the examination, the doctor will assess the general condition of the patient – measure the temperature, blood pressure. If necessary, take a cardiogram. Along the way, he will take an interest in diagnosed chronic diseases and medications taken – the tactics of preparing for the operation depend on them.

The doctor prescribes laboratory tests for the same purpose. Blood is taken from the patient for clinical analysis – it allows you to assess the general condition of the body, identify inflammation, anemia. Your doctor may also recommend an infection test.

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Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear when pathological changes are detected) (venous blood)

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Additionally, evaluate kidney and liver function. An analysis for AST makes it possible to exclude acute myocardial infarction – it can cause a fall from the height of one’s own height, which is important for older people with a suspected hip fracture.

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It is also recommended that all patients have their blood glucose checked to rule out diabetes.

Glucose

Code 1.14.2.

The test detects blood glucose levels and helps diagnose diabetes and pre-diabetes, as well as monitor the condition of patients with these diseases and monitor the effectiveness of treatment.

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A doctor may prescribe a coagulogram before a planned operation. The result of the study will allow the specialist to anticipate possible complications (for example, bleeding) and conduct preliminary treatment in order to avoid them.

Hemostasiogram (Coagulogram)

Code 27.4.1.

Hemostasiogram (coagulogram) is a comprehensive study of the blood coagulation system.

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The final preoperative diagnostic step is visualization of the proximal femur. For this, the patient is referred for X-ray. Based on the picture, the doctor will be able to identify the fracture, determine its type and location, and also decide on the method of surgical treatment.

If the fracture is not visible on x-ray (2-10% of hip fractures), but symptoms are consistent with the diagnosis, computed tomography is required. This is a more in-depth version of the survey. The doctor makes the final diagnosis only on the basis of X-ray or CT scan results.

Fracture of the femoral neck on x-ray

Treatment of hip fracture

Conservative treatment of a femoral neck fracture is considered extremely ineffective – the mortality of patients on drug therapy alone in the first year is more than 70%.

First of all, emergency physicians anesthetize the patient. This allows him to endure transportation to the hospital and the necessary examinations without suffering. The leg is immobilized with special splints. If necessary, the victim is stabilized – blood pressure is normalized, bleeding is stopped.

After being delivered to the admission department, doctors continue the course of anesthesia and treatment of comorbidities during the examination period. If there are no life-threatening contraindications, the patient is transferred to the traumatology department. If additional training is needed, go to the intensive care unit.

The operation is carried out in the first 48 hours after injury, but the first 6-8 hours are considered the best operating period. However, it is not always possible to carry it out during this period. The fact is that the operation is performed under anesthesia and preparation is required for it – the fasting interval. From the moment of the last meal to anesthesia, at least 6 hours must pass, and after drinking water – at least 2.

Depending on the type of fracture, patients are prescribed osteosynthesis or hip arthroplasty. Self-fusion of the femoral neck is possible only in young patients and not in all cases.

Fractures of type I–II according to the Garden classification (without displacement) and type I according to the Pauwels classification (fracture line up to 30°) are considered more favorable options for osteosynthesis, since the blood supply to the femoral head is not completely disrupted.

Fractures of type III–IV according to Garden (with displacement) and type II–III according to Pauwels (break line 50–70°) — unstable, with impaired blood supply to the femoral head. For such injuries, joint arthroplasty is recommended.

Osteosynthesis is an operation in which a fragment of the femoral neck with a head is fixed to the main part of the bone using large screws or other structures. They provide a snug fit of the fragment, prevent its displacement. After osteosynthesis, the bone fuses on average after 4–6 months. During the rehabilitation period, the patient should not lean on the injured leg.

Variant of osteosynthesis of the femoral neck. The screws fix the head of the femur, and the fracture heals.

However, osteosynthesis is not performed in patients older than 60 years: their fracture is highly likely not to heal.

There are two types of hip arthroplasty:

• total – with replacement of the femoral neck, head, and acetabulum;
• partial (hemiendoprosthetics) – only the femoral neck and head are replaced, the pelvic part of the joint remains intact.

Total hip replacement

Total arthroplasty is recommended for patients with an active lifestyle and without severe mental impairment (eg, dementia or Alzheimer’s disease). Total hip replacement allows a person to remain active, play sports, walk and run. The pelvic part of the joint will not wear out: the acetabulum will be replaced by a cup made of artificial material and the bone implant will rotate in it.

Hemiarthroplasty is an option for inactive elderly and senile patients (over 75 years of age), as well as for elderly patients over 60 years of age with obvious cognitive (mental) impairment.

Hip prostheses are available in metal, ceramic and plastic. The doctor will help you choose the right material based on the situation

After surgical treatment (or in case of refusal of it), the patient may be assigned I-III disability groups. It is determined depending on the state of a person, his ability to move independently and serve himself. After full restoration of activity and return to the usual way of life, disability is removed. If the function of the hip joint is not restored, the disability persists.

Rehabilitation after hip fracture

The recovery of the patient depends on the type of surgical treatment that has been performed.

After osteosynthesis with screws, a person is forbidden to step on the injured leg with all his weight for 4-5 months – until the femoral neck heals and the bone density in the fracture area becomes sufficient to perform the support function.

If osteosynthesis is performed with three bone screws and a plate, full loading can be allowed after 6 weeks. To monitor bone fusion, the doctor will periodically refer the patient for x-rays or CT scans.

However, limited mobility does not mean that the patient must lie down during the initial period of rehabilitation. A person should move with the help of crutches or a walker. After splicing, the load on the leg is given gradually and very smoothly. Full rehabilitation in some cases can take up to six months.

After hip arthroplasty, the load on the leg with all the weight is given almost immediately – on the next day after the operation. Physical activity is limited only to soft tissue healing – it is important to prevent the postoperative suture from divergence. After a week, the patient can independently descend the stairs and climb them.

The sooner the patient begins to move after arthroplasty, the sooner he will return to his usual way of life

Prognosis for hip fracture

Without treatment, the prognosis for a hip fracture is poor. As mentioned above, in such a situation, the risk of death of the patient within a year exceeds 70%. Within six months, the risk of death is slightly less – 62%. This is due to various complications that a forced recumbent lifestyle leads to.

After osteosynthesis, young patients recover quite quickly and after six months they can lead a normal life. Endoprosthetics puts a person on his feet even faster – in most cases, a full load can be given the very next day after the operation. The prognosis for surgical treatment of a hip fracture is favorable.

Prevention of hip fractures

There is no specific method for preventing hip fracture. Patients who are prone to osteoporosis are advised to treat the underlying disease. Take medicines, vitamins and dietary supplements as prescribed by a doctor, eat right, lead a moderately active lifestyle and avoid injury.

For early diagnosis of osteoporosis, patients over 60 years of age are advised to undergo densitometry, a procedure for determining bone density using an X-ray-like machine. Diagnosis is desirable to be carried out every 2 years.

For older people and patients whose osteoporosis is associated with hormonal changes, doctors may prescribe hormone replacement therapy to help fight bone fragility.

Sources

1. Fractures of the proximal femur: clinical guidelines / Ministry of Health of the Russian Federation. 2021.
2. Deandrea S., Lucenteforte E., Bravi F. , et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis // Epidemiology. 2010 Vol. 21(5). P. 658–668. doi:10.1097/EDE.0b013e3181e89905
3. Kazley J., Bagchi K. Femoral Neck Fractures / StatPearls. 2022.
4. Crist B. D., Eastman J., Lee M. A., et al. Femoral Neck Fractures in Young Patients // Instr Course Lect. 2018 Vol. 67. P. 37–49.

Pediatric orthopedic traumatologist

New parents always have many questions about the development of their child. We asked the most frequently asked questions to the traumatologist-orthopedist of the Evromed clinic, Dmitry Olegovich Sagdeev.

– A small child is recommended to be shown to an orthopedist quite often: a month, three months, six months, a year … What is the reason for this, what exactly does the orthopedist evaluate?

– The orthopedist watches how the child’s musculoskeletal system develops during periods of its active development in order to notice possible deviations in its development in time and correct them. At an early stage – a month – we do an ultrasound of the hip joints, so as not to miss any congenital pathology. At three to four months, ultrasound is repeated for control in order to see the dynamics of joint development.

According to the results of an ultrasound examination, the doctor may suspect violations of the formation and dynamics of the development of the hip joint.

The doctor of ultrasound diagnostics evaluates the formation of the joint according to a special scale (Graf’s scale), and then the orthopedist determines whether correction is required with therapeutic exercises, whether any physiotherapy is needed, etc.

The earlier deviations in the development of the child are detected, the more effective the treatment will be.

At about six months, the child begins to sit down, then he will get up, walk, and it is important to know how his hip joint is formed and, if there are violations, to have time to correct them before that moment.

Hip dysplasia is a defect in the formation of the hip joint, which in severe forms leads to the formation of subluxation or dislocation of the femoral head.

– When hip dysplasia is detected, orthopedic structures are usually prescribed: Freik pillows, Vilensky splints, etc. They look pretty scary, and parents are afraid that the child will be uncomfortable in them.

– The child will not experience discomfort. He still does not have a stable understanding of what position his lower limbs should be in, so the design will not interfere with him.

At the same time, due to the impact of these structures, the child’s legs are located at a certain angle, and in this position the femoral head is centered in the cavity, it is in the correct position, any deforming load is removed from it, which allows the joint to develop properly. If this is not done, then a constant deforming load will be placed on the head of the femur, which will ultimately lead to subluxation and dislocation of the hip. This will be a severe degree of hip dysplasia.

– In addition to dysplasia, ultrasound always looks at the formation of ossification nuclei in the hip joint. Why is their proper development so important to us?

The head of the femur is made up of cartilage. The ossification nucleus is located inside the femoral head and, gradually increasing, it seems to reinforce it from the inside and give the structure stability under axial load. In the absence of the ossification nucleus, any axial load on the thigh leads to its deformation, as a result of which subluxation and further dislocation of the hip may develop. Accordingly, if the core of ossification does not develop or develops with a delay, any axial loads are strictly prohibited: you can’t stand, and even more so, you can’t walk.

– Can I sit down?

– With a slow rate of ossification (ossification, bone formation), sitting is not prohibited, provided that the roof of the acetabulum is normally formed, the femoral head is centered. This is determined by ultrasound.

— What influences the formation of ossification nuclei, how can their development be stimulated?

– First of all – activity. Therefore, we recommend that you engage in therapeutic exercises with your child immediately from birth. Mom needs to do gymnastics with the child every day. Moreover, it is important that this should be a normal load, the so-called static load – when the child lies, and the mother spreads his arms and legs. I categorically do not recommend the “dynamic gymnastics” that is gaining popularity now – a set of exercises in which the child is twisted, twirled, swayed, rotated by the arms and legs, etc. to dislocation with rupture of the ligaments of the joint.

From 2.5 months, the child can and even needs to visit the pool. Individual lessons with a trainer in the water are very useful for the development of the musculoskeletal system, cardiovascular and respiratory systems, muscle training, and strengthening of the immune system.

As an auxiliary procedure, massage is useful.

Vitamin D is also needed, it stimulates the development of bone tissue. Vitamin D is recommended to be given to almost all children under two years of age, and to some even later. This issue is resolved jointly by a pediatrician and an orthopedist, doctors select the dosage of the drug and the duration of its administration. There is little sunlight in our region, which provokes vitamin D deficiency in almost all children, which leads to rickets. In Siberia, most children who do not take vitamin D have some degree of rickets.

If there are indications, the doctor may prescribe physiotherapy: magnetotherapy, electrophoresis, applications with polymineral mud wipes. These are effective, time-tested methods.

– Doctors say that the child should not be planted before he sits down on his own, put, stimulated for early standing, walking. What is it connected with?

– This is due to the fact that in a small child the musculoskeletal system is still immature, and both it and the central nervous system are not ready for active axial loads. If we begin to actively verticalize the child, stimulate him to sit, stand, this can lead to spinal deformity, disruption of the formation of joints. At the start, they should develop without axial loads, as laid down by nature. The systems, and, first of all, the central nervous system, must mature so that the signal from the brain from the so-called “central computer” to the periphery reaches the periphery undistorted and the response from the periphery to the center is also adequate. No need to rush. When these structures are ready, the child himself will sit down, and crawl, and stand up.

– What are the age norms when a child sits down, gets up?

— There are indeed certain norms, but we should not focus too much on them. Each child develops according to his own individual program, there is no need to adjust everyone to one standard. To assess its development, it is necessary to take into account many different circumstances, ranging from the characteristics of the course of pregnancy and the birth of a child. I think doctors need more time and norms to adequately assess whether the child is developing correctly or not, and if there is a delay, see it in time and help the baby.

Children begin to sit down at about six months, crawl – at 7-8 months. Classical development: the child first sat down, then crawled, then begins to get up, move around with support. Then, when he felt that he was ready, he broke away from the support and took the first independent steps. This happens when the musculoskeletal system has matured, the central nervous system, the vestibular apparatus have adapted. And all these systems have learned to work together correctly.

Some babies start crawling before they sit down, others will get up before they can crawl. It happens that a child does not crawl at all, but immediately got up and went. All these are features of individual development.

– Why are such devices as a walker bad, allowing the child to “go” much earlier, entertaining him?

– Walkers knock down the “program” of the correct interaction between the central nervous system, the vestibular apparatus and the musculoskeletal system. In walkers, the child occupies an unnatural position, he does not take a full step in them, but simply hangs, pushes off with his toes and moves in space. His brain and muscles remember this incorrect program of vertical position and movement, and later, when the child tries to start walking without a walker, these incorrect settings work for him, the wrong muscle groups that should keep him in an upright position turn on, and the child falls. After a walker, it is very difficult for a child to maintain balance on his own, and subsequently it is quite difficult to correct this.

– Another problem associated with the fact that the child was placed before he was ready is flat feet. Right?

– Flat feet can be congenital and functional (acquired).

If the child is placed too early, he may develop an incorrect foot placement. And often as a result, doctors diagnose flat-valgus deformity of the feet. This flat-valgus planting of the feet is usually not pathological. On examination, the doctor determines whether the foot is movable or rigid (inactive), and if the foot is movable, it is easily brought into the correction position, then we are not talking about deformity, this is just an incorrect setting, which is corrected by therapeutic exercises, the correct distribution of loads.

All these attitudes that mothers complain about: raking with toes, an apparent curvature of the limbs – this is a consequence of the transition of the child from a horizontal position to a vertical one and his adaptation to upright posture. During the prenatal period of development, the fetus is tightly “packed” inside the uterus: the arms are pressed to the body, and the legs are folded in a rather unnatural way for a person – the feet are turned inward, the bones of the lower leg and thigh are also twisted inward, and the hips in the hip joints, on the contrary, turn outward as much as possible . When the baby is just learning to stand, the incorrect position of the feet is imperceptible, because the turn of his legs in the hip joints and the twisting of the bones of the thighs and lower legs occurred in opposite directions – that is, they compensated for each other, and the feet seem to stand straight. Then the ratio in the hip joint begins to change – the head of the femur is centered, and this happens a little faster than the change in the rotation of the bones of the legs. And during this period, parents notice “clubfoot” and begin to worry. But in fact, in most cases, this is an absolutely normal stage of development, and there is no need to panic that the child somehow walks unevenly, puts his foot in the wrong way. Nature is smart, it has provided the whole mechanism for the development of the lower extremities, and you should not interfere in this process. Of course, if this worries you, then it makes sense to consult a doctor to determine whether these changes are physiological or pathological. If pathology – we treat, if physiology – no need to treat.

For the prevention of incorrect installation of the foot, passive therapeutic exercises, the choice of the correct orthopedic regimen, are necessary.

A small child cannot yet actively fulfill the direct wishes of his parents and do gymnastics himself, therefore, at this stage, a passive effect is recommended: walking barefoot on uneven surfaces, on grass, on sand, on pebbles (of course, we make sure that the child is not injured, that the surfaces are safe). As the child grows up (after about three years), we move on to active exercise therapy in a playful way. For example, we run on our heels to wash our faces, to have breakfast on our toes, we go to the bedroom like a penguin, watch cartoons like a bear. Try to make it interesting for the child to do this, and then he will get used to it and will be happy to do the exercises himself.

It is important for the correct installation of the foot and the selection of shoes. Shoes should be light, with an elastic sole, arch support – lined arch. If the arch on the sole is laid out, no additional insoles are needed (unless the doctor has prescribed). The height of the shoe is up to the ankle (you don’t need to buy high berets), so that the ankle can work freely and the short muscles of the lower leg can develop correctly – the very ones that hold the transverse and longitudinal arch of the foot.

For a child starting to walk, it is optimal that the shoes have a closed heel and toe – this is how the toes are protected from possible injuries if the child stumbles.

Is real flat feet treated differently?

– Yes, “real” flat feet cannot be cured by gymnastics. If this is congenital flat feet, then it is treated quite difficult and multi-stage. There are many surgical techniques that the doctor selects depending on the severity of the case and its features. Treatment begins with staged plaster casts. There are minimally invasive surgical aids on the tendon-ligamentous apparatus with the subsequent use of special devices – brace. There are also various surgical benefits associated with intervention on the joints of the foot, aimed at correcting the ratio of the bones of the foot and eliminating plano-valgus deformity.

Why treat flat feet and clubfoot?

– Because these violations lead to the deformation of the entire skeleton. From the bottom up, like a snowball, there are violations. Incorrect support leads to incorrect installation of the hip, the position of the pelvis changes, the knee joints suffer, receiving a modified load. To even out the load on the knee joint, the hip begins to rotate, trying to bring some kind of support position. The hip turned around, began to dislocate from the hip joint. To prevent him from dislocating, the pelvis tilted. The pelvis tilted – the angle of inclination of the spine changed. Accordingly, the spine bent to leave the head straight. As a result: gross violations of gait and the entire musculoskeletal system, scoliotic deformities of the spine. These conditions do not pose a threat to life, but the quality of life in a person with orthopedic problems suffers greatly.

– Another very common diagnosis that is made to newborn children is torticollis. How serious is this pathology?

– Many children are diagnosed with neurogenic functional torticollis, often they are diagnosed with subluxation of the first cervical vertebra (C1). Most often, this is a functional disorder that resolves on its own with minimal intervention from us, and it does not pose any threat to the health of the child.

Children with functional torticollis are observed jointly by a neurologist and an orthopedist, usually corrective styling, an orthopedic pillow and a soft fixing collar are enough to resolve this situation without any complications.

Functional torticollis is important to separate from congenital muscular torticollis. If the latter is suspected, an ultrasound of the sternocleidomastoid muscles of the neck is performed in two months, which allows us to make the correct diagnosis with a high dose of probability. If an ultrasound examination reveals any changes in the sternocleidomastoid muscle, then we begin to conduct a comprehensive treatment aimed at eliminating torticollis and restoring the functional ability of the sternocleidomastoid muscle. The treatment includes fixing the head with an orthopedic collar, physiotherapy courses are prescribed, aimed at improving muscle nutrition and restoring their structure. With unsuccessful conservative treatment, if the deformity increases, then after a year, surgical treatment of congenital muscular torticollis is performed.

If you have any doubts, questions, worries, do not be afraid to consult a doctor. A pediatric orthopedist, neurologist, pediatrician are specialists who are always ready to answer your questions and help your baby grow up healthy.

Elbow subluxation

A very common injury in children is subluxation of the head of the radius in the elbow joint. Three bones join at the elbow joint: the humerus, ulna, and radius. To hold these bones, there are ligaments. In young children, the ligaments are very elastic, loose and can easily slide over the bone. With age, the ligaments become stronger, and subluxation no longer occurs so easily.

This injury happens when the child is pulled sharply by the arm: dad twisted, just abruptly lifted the child by the wrists (the child must be lifted, supporting the armpits) or it even happens that the parent of the child is leading the hand, the baby slipped, hung on the arm – and subluxation occurs .

At the moment of injury, you can hear how the joint clicked. Usually, with an injury, the child experiences short-term sharp pain, which disappears almost immediately. The main sign of injury is that the child stops bending the arm at the elbow – children keep the injured arm fully extended.

As soon as possible after the injury, the child should be shown to a traumatologist who will set the subluxation and return the ligament to its place.

When should I contact a traumatologist?

Children often fall, hit, get injured in one way or another. How to determine when you can get by with a band-aid and iodine, and when you need to go to the emergency room?

• Any cut, stab wound should be shown to the doctor. Do not fill the wound with brilliant green or iodine! This will add a chemical burn to the cut. It is not necessary to apply cotton wool to an open wound – its fibers are then extremely difficult to remove from the wound. If the injury site is heavily soiled, rinse with clean water. Then cover the wound with a clean cloth (sterile bandage, handkerchief, etc.), apply a pressure bandage, and go to the emergency room as soon as possible. The doctor will carry out the primary surgical treatment of the wound, thoroughly clean it (you are unlikely to be able to do this on your own), restore the integrity of all structures and apply a bandage.
• If there is noticeable swelling at the site of injury. This may indicate that this is not just a bruise, but also a fracture, dislocation or rupture of the ligaments.
• If the child has lost consciousness, even briefly. This may indicate a traumatic brain injury, which can have serious consequences.
• If the child vomited after the injury. Vomiting, nausea, pallor also indicate the possibility of a traumatic brain injury.
• If the child hit his head. The consequences of a blow to the head may not be immediately noticeable, and at the same time have very serious consequences.
• If the child hits the stomach. A blow to the stomach may damage internal organs and cause internal bleeding.
• If a child falls from a height (from a chair, table, etc.), falls off a bicycle, etc. It happens that outwardly it does not manifest itself in any way, but internal organs are damaged.
• If the child is worried, behaves unusually.

In general – in case of any doubt, it is better to play it safe and see a doctor. Injuries in children is such a question when it is better, as they say, to overdo it than underdo it. There is no need to be shy, to be afraid that you are distracting ambulance doctors or emergency room doctors for nothing. Your child’s health is the most important!

Beware of the trampoline!

Trampoline is a very popular entertainment among modern children. Unfortunately, this fun can lead to serious problems. The most common injury that children and teenagers get on trampolines is a compression fracture of the spine. Recently, there have been a lot of cases of compression fractures of the spine, including those who are professionally involved in trampoline sports.