When studying the anatomy of the thigh, it is first necessary to pay attention to the structure of the femur. It is she who is the thickest and longest bone human body, which bears a significant part of the load of the body and is responsible for its balance. In this regard, a huge proportion of pathologies in this area falls on damage to the femoral bone.

What is the femur made of?

The normal anatomy of the femur suggests the presence of the following main parts:

• body;
• proximal epiphysis;
• distal epiphysis.

These parts need to be considered separately. For a better understanding of the features of the structure, you can watch the video.

Body

This is a section of a cylindrical shape, which is distinguished by a slight bend in the front side. Its surface is smooth in front, and a rough line runs from the back. Its main function is to strengthen the muscles. She, in turn, is divided into lateral and medial lips. The first in the upper part passes into the gluteal tuberosity, and in the lower part it passes to the lateral condyle when tilted to the side. The second also deviates downward, but departs to the medial condyle. In the upper part, it merges with the comb line. Together, these lips and supracondylar lines define the popliteal surface at the lower zone of the femur bone.

For reference! In the middle of the body of the femur there is a so-called nutrient hole. It leads to a nutrient canal with numerous vessels. It is they that provide nutrition to the bone, so such a hole performs a very important function in the human body.

proximal epiphysis

In this zone, there is a femoral head, in the center of which there is a fossa. The attachment of the head to the acetabulum is provided by its articular surface. The area in which it is connected to the body of the bone is called the neck. The latter forms an angle of approximately 130 degrees with the body.

In the area where the neck passes into the body of the bone, there are large and small skewers. They are interconnected by an intertrochanteric line and a ridge - from the front and from the back, respectively.

The greater trochanter can be palpated with outside thigh, and the lesser trochanter extending from the femur is visible from behind and from the inside. There is a trochanteric fossa near the femoral neck. Such protrusions help to strengthen the muscles.

Distal epiphysis

The distal end or end of the femur becomes wide downwards and diverges into two parts. At this point, the medial and lateral condyles are separated by the intercondylar fossa. It is clearly visible from the back. The surface of the condyles is covered with joints that provide connection with the patella and tibia.

On the sides of the femur bone are the lateral and medial epicondyles. Ligaments are attached to them. They can be felt from the inside and outside of the limb.

For reference! The right femur is presented in detail in the photo, which clearly shows that the structure of the femur bone behind and in front differs significantly.

thigh muscles

It is the muscles of the thigh, together with the bone, that play a special role in providing motor movements in this area. There are three main muscle groups:

• front;
• medial;
• back.

Each group is represented different types muscles that perform specific functions.

Muscles of the anterior group

The quadriceps muscle has four heads, hence its name. Each of them represents individual muscle. They perform the function of hip flexion and lower leg extension.

The tailor is the longest human muscle. With its help, it is possible to bend the thigh and lower leg. With hip abduction and flexion, it is clearly visible under the skin.

Muscles of the medial group

This includes the following muscles:

1. Adductor long: similar to a triangle in its shape, provides hip adduction.
2. Adductor short: involved in the drive and partly in hip flexion.
3. Large adductor: connects with the medial epicondyle and the rough line. She plays the main role in the drive.
4. Comb: involved in flexion, drive and supination of the thigh.
5. Thin: adducts the thigh and helps to flex the lower leg.

This group consists mainly of the muscles involved in the hip drive. They play a special role in its proper functioning.

Muscles of the back group

These include the following muscles:

1. Double-headed: it can be felt in the area of ​​​​the fossa under the knee. It is involved in flexion and supination of the lower leg, and also extends the thigh.
2. Semitendon: performs the same functions and has common beginning with biceps.
3. Semimembranous: helps to extend the thigh, takes part in flexion and pronation of the lower leg.

You can see the location of the femoral muscles in the photo.

congenital anomalies

The main anomalies of the human femur include the following congenital pathologies:

• underdevelopment;
• hip dislocation and joint dysplasia;
• valgus and varus deformities.

State data left unattended in childhood, may lead to serious consequences further. Some of them can make a child disabled for life.

Bone underdevelopment

This deviation is more than 1% of the number of skeletal deformities innate character. Often similar condition combined with other pathologies, including the absence of the patella. The main symptom of underdevelopment is lameness.

Important! The dysfunction of the leg in this case is associated with the severity of the deviation and the degree of its shortening.

incomplete development of the femur big bone has the following features:

1. In cases of pathology of the diaphysis, the joints retain their function.
2. With violations of the distal pelvis falls in the direction of the lesion.
3. The femoral and gluteal muscles atrophy.
4. The gluteal fold is not observed or smoothed.
5. Pathology is easily detected by X-ray examination.

At the same time, it is necessary surgical treatment in order to restore the length of the leg, which depends on the age of the patient and the severity of the pathology. The following methods can be used:

1. Surgical intervention aimed at stimulating the growth zones. It is performed in early age.
2. Osteotomy with distraction apparatus. This method is used for patients aged 4-5 years.
3. Foot amputation. It is used if the shortening is too strong, and therefore the restoration of the length is impossible. In some cases, the operation is combined with arthrodesis of the knee joint.
4. Orthopedic means and footwear. They can help with a slight underdevelopment of the child's bones in the early stages.

The earlier such a pathology is detected, the easier it will be to eliminate it. The methods of treatment in each case are determined by the doctor.

Congenital dislocation and joint dysplasia

A dislocation of this type is diagnosed in very rare cases, while unilateral hip dysplasia is a fairly common occurrence. It is expressed by lameness and shortening of the leg. If the pathology is bilateral, the so-called duck gait is formed in the child.

For reference! At x-ray examination in such a situation, flattening and reduction of the femoral head, as well as its displacement from the acetabulum, are revealed.

If the disease is diagnosed at an early age, therapy is carried out with conservative means using special splints, pillows and other devices that correct the articular structure. When the dislocation has not been eliminated before 3 years, surgical treatment and a long rehabilitation period will be required.

Varus and valgus deformities

Such pathologies are the result of cervical ossification. Often the cause is also damage to the cartilage in the womb. In almost 30% of cases, the deformation is bilateral.

Valgus deformity is rarely diagnosed, as it occurs without symptoms. Whereas varus significantly limits the movement of the leg and leads to lameness. Its manifestations are similar to a hip dislocation.

X-ray examination shows thinning and shortening of the bone, as well as violations of the ossification of the femoral head. The treatment is carried out with the help of surgery and corrective osteotomy.

Injuries

• sharp and severe pain;
• limb dysfunction;
• swelling;
• leg deformity.

More intense pain syndrome characteristic of a trochanteric fracture. On palpation and during movement, it increases significantly.

For reference! For a fracture of the femoral neck, the so-called stuck heel symptom is primarily characteristic. It is a condition where the victim is unable to rotate the limb at an angle of 90 °.

There are extra- and intra-articular injuries of the femur.

Extra-articular fractures

This type of injury to the human femur includes fairly common intertrochanteric and pertrochanteric fractures, which are distinguished by the location of the injury line. These lesions occur predominantly in elderly patients. This is due age-related changes in the structure of skewers: voids gradually form in their spongy substance, and the crust becomes fragile and thin.

Trochanteric injuries are characterized by good fusion as after surgical intervention, as well as during conservative treatment. This fact is explained by the covering of this area by the periosteum and the presence of a large number surrounding muscles. In addition, this area has a good blood supply, which also contributes to the rapid fusion of the bone.

Conservative therapy in such situations is based on skeletal traction. This procedure makes it possible to prevent the displacement of bone particles, eliminate them or provide correct position until complete growth. The traction period is usually one and a half to two months.

Important! In cases of elderly patients, such long-term conservative treatment may be unacceptable: many of them cannot withstand a long lying position. Therefore, in these cases, more often surgical intervention in the form of osteosynthesis of a fracture. Half a month after it, the patient can walk on crutches.

intra-articular fractures

The most common types of such injuries are fractures of the neck and head of the femur. In traumatology, this category is usually divided into fractures of the following types:

1. Transcervical: in this case, the fracture line runs in the neck area.
2. Capital: the line is located in the region of the femoral head.
3. Basiscervical: the fracture occurred at the junction of the neck with the body of the bone.
4. Subcapital: The fracture line passes directly under the femoral head.

With impacted fractures (when a piece of the thigh bone enters another bone), the patient is prescribed conservative therapy. At the same time, he should be in a lying position on a bed with a wooden shield. Often in such cases, the Beller tire is used. After that, skeletal traction is necessary.

If a displaced fracture is diagnosed, which is characterized by an incorrect position and deformation of the leg, the doctor, as a rule, prescribes surgery. With intra-articular fractures of the femur, except for x-ray examination MRI of the hip joint may be needed.

The greater femur is the longest tubular bone in the human skeleton. It is able to take heavy loads, since the bulk of the body weight falls on it. The femur plays an important role in the structure of the body and the ability of a person to move. With injuries and damage to this bone, serious complications arise. To have an idea of ​​the importance of the femur, you need to know its structure.

Bone Anatomy

Like any tubular bone, the femur has a body, as well as a distal and proximal epiphyses. The anterior side of the bone is distinguished by a smooth surface, while the posterior side has a rough line divided into medial and lateral parts. The lateral lip from below deviates to the side towards the lateral condyle, and from above it passes into tuberosity. The medial lip in its lower part also passes to the lateral condyle. Thus, both lips form a surface bounding the popliteal region.

Upper epiphysis

In the body of the bone there is a hole, which is the entrance to the nutrient canal. Many vessels pass through it. On the proximal epiphysis are the greater and lesser skewers. The outer surface of the greater trochanter is easy to feel through the skin. Its inner surface has a trochanteric fossa. Between the greater and lesser trochanters, an intertrochanteric line begins and goes down, turning into a pectinate strip.

The posterior part of the upper epiphysis gives rise to the intertrochanteric crest, which ends at the lesser trochanter. The remaining part of the upper epiphysis forms the head of the femur. On it is the fossa of the head, which is the place of attachment of the ligaments. The head is continued by the neck of the femur, the most prone to fractures, especially in the elderly. In the case of such an injury, a complex operation is necessary, followed by a long rehabilitation period.

lower epiphysis

The distal epiphysis differs somewhat in its structure from the proximal one. It consists of two condyles (medial and lateral). The first has an epicondyle on its inside, and the second - on the contrary, on the outside.

Slightly above the medial epicondyle is the adductor tubercle - the site of attachment of the adductor muscle.

As you can see, the structure of the large femur cannot be called simple, therefore, the diagnosis of diseases of this anatomical structure is problematic. Also, the femur has a complex anatomy for the reason that it is the link between the upper and lower half of the human body. The hip joint together with the femur are important structural components of the human body. Sometimes by different reasons they get pain.

Causes of pain

In total, there are four groups of reasons why the hip joint and femur can hurt.

1. The most common group is injuries and injuries of various kinds. In this case, very severe pain occurs at the site of injury, immediate hospitalization is required.
2. The second group includes various diseases of the joints and bones: arthrosis, tendinitis, osteoporosis.
3. The third group includes sometimes appearing pain, the cause of which is difficult to establish accurately. They do not indicate joint disease, but are symptoms of neurological diseases.
4. This group includes systematic pain, which can be caused by gout, common tuberculosis and many allergic diseases.

Fracture diagnosis

Really dangerous consequences characterized by a fracture of the femur. Young people can get such an injury as a result of an accident, an accident or a fall from a height. And for older people, even a banal fall can cause a fracture. If you are concerned about hip pain that does not go away for a long time, you should seek medical care. Fracture is fairly easy to diagnose using x-rays, in more complex cases, computed tomography may be required.

Skeleton of the free lower limb (skeleton membri inferioris liberi) consists of the femur, two bones of the lower leg and the bones of the foot. In addition, a small (sesamoid) bone, the patella, adjoins the thigh.

Femur

Femur, femur, represents the largest and thickest of all long tubular bones. Like all such bones, it is a long lever of movement and has a diaphysis, metaphyses, epiphyses and apophyses, according to its development.

The upper (proximal) end of the femur bears a round articular head, caput femoris (pineal gland), somewhat downward from the middle on the head there is a small rough fossa, fovea captits femoris, - the place of attachment of the ligament of the femoral head.

The head is connected to the rest of the bone through the neck, collum femoris, which stands to the axis of the body of the femur at an obtuse angle (about 114-153 °); in women, depending on the greater width of their pelvis, this angle approaches a straight line. At the point of transition of the neck into the body of the femur, two bone tubercles, called skewers (apophyses), protrude.

Big skewer, trochanter major, represents the upper end of the body of the femur. On its medial surface, facing the neck, there is a fossa, fossa trochanterica.

Lesser trochanter, trochanter minor, is placed at the lower edge of the neck on the medial side and somewhat posteriorly. Both skewers are connected to each other on back side femur with an obliquely running crest, crista intertrochanterica, and on the front surface - linea intertrochanterica. All these formations - skewers, crest, line and fossa are due to the attachment of muscles.

The body of the femur is somewhat arched anteriorly and has a triangular-rounded shape; on its back side there is a trace of attachment of the thigh muscles, linea aspera (rough), consisting of two lips - lateral, labium laterale, and medial labium mediale.
Both lips in their proximal part have traces of attachment of the same muscles, the lateral lip - tuberositas glutea, medial - linea pectinea. At the bottom of the lips, diverging from each other, limit ^ to rear surface hips smooth triangular platform, facies poplitea.

The lower (distal) thickened end of the femur forms two rounded condyles that wrap back, condylus medialis and condylus lateralis(epiphysis), of which the medial protrudes more downward than the lateral.

However, despite such an inequality in the size of both condyles, the latter are located at the same level, since in its natural position the femur stands obliquely, and its lower end is located closer to middle line than the top one.

From the front side, the articular surfaces of the condyles pass into each other, forming a slight concavity in the sagittal direction, facies patellaris, since it is adjacent to it with its back side patella when extended in knee joint. On the posterior and inferior sides, the condyles are separated by a deep intercondylar fossa, fossa intercondylar.

On the side of each condyle above its articular surface is a rough tubercle called epicondylus medialis at the medial condyle and epicondylus lateralis at the lateral.

Ossification. On x-rays of the proximal end of the femur of a newborn, only the femoral shaft is visible, since the epiphysis, metaphysis and apophyses (trochanter major et minor) are still in the cartilaginous phase of development.

The X-ray picture of further changes is determined by the appearance of an ossification point in the femoral head (pineal gland) at the 1st year, in the greater trochanter (apophysis) at the 3-4th year, and in the lesser trochanter at the 9-14th year. The fusion goes in the reverse order at the age of 17 to 19 years.

Femur Anatomy Instructional Video

Fracture of the femoral neck is one of the most complex and dangerous injuries, they account for approximately 6% of all fractures.

In most cases, this kind of fracture affects the elderly, this is due to a disease such as osteoporosis.

With this disease, the density decreases bone tissue, which significantly increases the risk of fracture, even with a slight traumatic force.

The hip joint is the most large joint in the human body.

It also performs the main supporting functions and carries a significant load when walking, running, lifting weights.

The shape of the hip joint is presented in the form of a ball placed in a rounded cavity.

The articular cavity is formed by the pelvic bone, it is called the acetabular or acetabular cavity. It contains the head of the femur, which is connected to the body of the femur through the neck.

In the common people, the neck of the femur is called the "neck of the femur." At the base of the neck are bone elevations - a large and small trochanter, to which muscles are attached.

Mechanism and causes

If you are examining an elderly person who, while walking down the street or around the apartment, fell on his side and was unable to stand up on his own, then first of all the thought of a fracture of the femoral neck should arise.

It is due to a fall on the side, on the site of the greater trochanter in the elderly that fractures of the femoral neck and acetabular area occur.

As you know, older and older people always have a pronounced progressive osteoporosis.

The degree of its manifestation depends not only on the age of the person, but also on concomitant diseases, physical activity. In addition to these general factors, the condition of the proximal end of the femur is affected by the quality of blood supply, especially to the head and neck.

With age, the blood supply to the head and neck becomes more complicated due to obliteration of the artery of the femoral head, which runs in the round ligament, and the state of the vessels in the sclerotic fibrous capsule joint.

All these factors lead to an intensive increase in osteoporosis in the proximal end of the femur, especially in the region of Ward's triangle, Adams' arch.

Due to the loss of spongy tissue, the strength of the bar architectonics of the proximal end of the femur is significantly reduced.

In addition, in older and elderly people, significant manifestations of degenerative-dystrophic changes in the spine (osteochondrosis, deforming spondylosis with secondary recurrent polyradiculitis) worsen muscle trophism against the background of involutive processes.

Muscles lose their elasticity, strength, endurance, especially in the case of limited range of motion in hip joint, their defensive reaction, grouping ability is reduced.

This leads to a decrease protective function, and so the impact of the fall falls directly on the greater skewer, which protrudes.

In cases where the head more or less retains its structure and the acting traumatic force is directed along the axis of the neck, a fracture of the bottom of the acetabulum or a central hip dislocation occurs.

When the traumatic force acts somewhat at an angle from below outside the acetabular region with the femur adducted with external rotation, the neck under the head rests against the lower edge of the acetabular fossa, a subcapital fracture occurs.

Traumatic force and contraction of the gluteal muscles displace the distal fragment upwards, an adduction fracture (coxa vara traumatica) occurs.

Due to the action of a traumatic force outside and somewhat above the acetabular area, aimed at extension of the cervical-femoral angle, an abduction fracture (coxa valga traumatica) occurs.

Under the action of a traumatic force from above and from the outside on the trochanter site, isolated fractures of the greater trochanter occur.

In adolescents who have not yet experienced synostosis of the greater trochanter, a sudden sharp contraction of the gluteal muscles leads to the separation of the greater trochanter, and with the tangential action of a traumatic force, epiphysiolysis of the greater trochanter occurs.

Avulsion fractures of the lesser trochanter also occur due to sudden sudden contractions of the iliopsoas muscle.

Thus, in the occurrence of fractures of the proximal end of the femur, involutive changes, neurotrophic bone lesions, osteoporosis, loss of muscle elasticity, limitation of the range of motion in the joint, a decrease in the protective reaction of muscles in older and elderly people, the direction, area and strength of the traumatic force play a role.

Symptoms

For fractures of the femoral neck and trochanters

Complaints in the victims are similar: pain in the hip joint, lack of active movements and loss of function of the injured leg.

But with a detailed clinical examination to conduct differential diagnosis Maybe.

For abduction fractures

Significant external rotation of the limb is not typical for abduction fractures of the femoral neck. There is a slight inward displacement of the axis of the lower limb, the tip of the greater trochanter is on the Roser-Nelaton line, there is no relative shortening of the limb.

Pressure on the heel along the axis of the lower limb or tapping on it causes exacerbation of pain in the hip joint, Briand's triangle is isosceles, Shemaker's line passes above the navel.

For adduction fractures

The injured limb is externally rotated, has a significant relative and functional shortening, the tip of the greater trochanter is located above the Roser-Nelaton line.

Shemaker's line passes below the navel, the isosceles triangle of Briand is broken. Passive movements and loads along the axis of the limb exacerbate pain in the hip joint.

In people with not very developed subcutaneous fatty tissue, the pulsation of the femoral artery under the inguinal ligament is clearly visible.

Acetabular site

The injured limb is significantly externally rotated.

The outer surface of the acetabular area is flattened, the contour of the greater trochanter is smoothed, expanded, its apex is higher than the Roser-Nelaton line.

Briand's triangle is broken and Shemaker's line passes below the navel. On palpation, the intensity of pain increases with direct touch to the swivel itself.

In case of displacement of fragments, a protrusion is palpated at the site of the fracture of the greater trochanter. active movements limbs are impossible, passive ones are significantly limited due to exacerbation of pain in the acetabular region.

greater trochanter

Occur due to direct trauma in young and middle-aged people.

In young men, with the tangential action of a traumatic force and a sudden sharp, excessive contraction of the gluteal muscles, the greater trochanter comes off.

Arises sharp pain along the outer surface of the hip joint.

The victim can walk independently, but at the same time, the injured limb does not actively move forward, but pulls it up with a healthy step. Can actively bend the leg in the hip joint, feeling a moderate exacerbation of pain.

The victim is unable to actively abduct the hip at the hip joint. Rotational movements exacerbate pain in the greater trochanter.

In people with insufficiently developed subcutaneous tissue, with fractures of the greater trochanter with displacement of fragments or multi-comminuted fractures, deformation of the contours of the greater trochanter is clearly visible, its apex is located above the Roser-Nelaton line.

On palpation, the pain is aggravated by direct contact with the greater trochanter, and with significant displacement, there is diastasis between the fragments.

Isolated fractures of the lesser trochanter

Another of the injuries of the femur, is rare.

Fractures of the lesser trochanter are observed in adolescence, when synostosis with the femur has not yet occurred, and, in fact, a fracture of the lesser trochanter is an avulsion fracture of the apophysis.

Detachment of the lesser trochanter occurs mainly in boys during jumping, that is, due to a sharp, sudden, excessive contraction of the iliopsoas muscle, with a sharp pain in the depths of the base of the femoral triangle.

The victim loads the lower limb, walks independently, tilting his torso forward, dragging his leg. On palpation, the severity of pain is localized in the projection of the lesser trochanter.

The injured hip adducts, abducts, but cannot actively bend it, while passive flexion is possible in full ( positive symptom Ludloff).

So, when the lesser trochanter is torn off, only the function of the iliopsoas muscle is disturbed, and the function of the gluteal muscles, adductor and rotational, does not suffer.

The final diagnosis is established after an X-ray examination, which makes it possible to confirm clinical diagnosis, to reveal the structure of the proximal end of the femur, which is necessary for justification and selection effective tactics and method of treatment.

With fractures of the femoral head, the number of fragments, their position are detected, with fractures of the neck - the place of the fracture, features of the fracture plane, the nature of the angular displacement of the fragments.

Neck fractures

Most often they are subcapital, less often - transcervical or basal.

Due to the fact that fractures of the femoral neck are intra-articular, the joint capsule limits significant displacements in length and width, and the displacement occurs mainly at an angle, that is, there is a decrease or increase in the neck-diaphyseal angle.

Among the fractures of the femoral neck are:

• fractures with a decrease in the cervical-diaphyseal angle - adduction (drive);
• varus with a vertical or vertically oblique fracture plane.

From a biomechanical point of view, adduction fractures are unfavorable for the process of reparative regeneration due to the instability of fragments, which is due to the constant contraction of the gluteal muscles.

In addition, with a vertical or vertically oblique fracture plane, a shear force is constantly acting, which destroys the restoration. vascular network and disrupts reparative regeneration.

This causes the formation of false joints and resorption of the femoral neck.

With abduction (valgus) fractures of the femoral neck, the cervical-diaphyseal angle increases, which in turn leads to an increase in the tone of the gluteal muscles and chipping of fragments with the exclusion of any mobility between them.

This becomes a positive factor for the process of reparative regeneration.

So, abduction fractures in the absence of circulatory disorders and degenerative-dystrophic changes in the head, prognostically favorable for fusion.

For transcervical fractures, a vertically oblique fracture plane is typical, and basal fractures are mostly impacted with a decrease in the neck-diaphyseal angle (traumatic coxa vara).

Among the fractures of the acetabular area, the first place is occupied by pertrochanteric ones with a fracture or detachment of the lesser trochanter, the second place is occupied by multi-comminuted ones, and the intertrochanteric ones are third.

With acetabular fractures, fragments are displaced in length and width more than with neck fractures. This is explained by the fact that all fractures of the acetabular region are extra-articular and the displacement of fragments is not limited to the capsule.

Isolated fractures of the greater trochanter have a transverse-oblique fracture plane and are often multi-comminuted.

Most isolated fractures of the lesser trochanter have an oblique fracture plane. The proximal displacement of the lesser trochanter occurs under the action of the iliopsoas muscle.

Treatment

Fractures of the neck of the femur

Depends on the age of the victim, the type and nature of the fracture.

Considering that fractures of the femoral neck occur predominantly in the elderly, all conservative methods, as experience has shown, are not indicated.

After all, conservative methods of treatment of elderly patients on long time chain them to the bed in a forced position, which leads to such life threatening complications like decompensation of cardio-vascular system, hypostatic pneumonia, bedsores, pulmonary embolism.

This gave grounds to G.I. Turner to declare that nothing pushes the arrow of life in the elderly so quickly as fractures of the femoral neck.

It is necessary to take into account the fact that in elderly victims, in addition to involutive changes in the structure of bones, muscles, vessels in the joints, there are, to a greater or lesser extent, pronounced degenerative-dystrophic processes, which also negatively affect the regeneration process.

At the site of a fracture, especially an adduction fracture, there are constant movements between fragments that disrupt the process of reparative regeneration and lead to the development of such a severe complication as a false joint.

Therefore, until recently, the main method of treating adduction fractures of the femoral neck was surgical closed comparison of fragments with stable osteosynthesis with a three-bladed nail.

But it is possible to achieve stable osteosynthesis only in the presence of normal bone structure the proximal end of the femur, which occurs in people of middle and young age.

As for older or elderly people, the proximal end of the femur, especially the central fragment, has significant involutive changes and degenerative-dystrophic lesions of the head and vascular network.

Under such conditions, to obtain stable osteosynthesis in the vast majority of victims impossible.

This is evidenced by statistical data, according to which unsatisfactory consequences in osteosynthesis of adduction fractures of the femoral neck due to nonunion are observed in 30-38% of the victims, due to aseptic necrosis heads after fracture union - in 24-26% of cases.

In addition, the disadvantage of osteosynthesis is that the victims have to walk with the help of crutches, which is not so easy for an elderly person.

Therefore, in the last decades of the 20th century, all traumatological schools of the world switched to implantation of artificial joints for fractures of the femoral neck in elderly patients.

Experience surgical treatment fractures of the femoral neck in affected older age groups suggests that the introduction of artificial joints in clinical practice made it possible to apply an active functional method of treatment, free the victims from long-term use of crutches, significantly reduce the time of the victim's stay in the hospital and prevent fatal complications that are the cause of high mortality.

Method of osteosynthesis of the femoral neck

Fractures of the femoral neck in young and middle-aged people who do not have neurotrophic and degenerative-dystrophic changes in the proximal end of the femur are treated with closed osteosynthesis of fragments with a Smith-Petersen three-blade nail or Klimov's T-nail, Bokicharov's fixator.

Many methods of closed osteosynthesis of femoral neck fractures have been proposed (Belera, Klimov, Ozerova, Grutsi, etc.).

But now, with the advent of new X-ray equipment, the control guide pin in the center of the neck is carried out under visual control. The operation became technically simple.

The operation of closed osteosynthesis of a fracture of the femoral neck is performed under anesthesia or local anesthesia. First, a closed reposition of fragments is performed.

The assistant fixes the pelvis to the operating table with his hands, and the surgeon flexes the thigh to 90°, makes thrust along the axis and, without reducing, without jerking, slowly unbends the leg to 180° and abducts it to 30°, rotating it inward.

The same position is given to the opposite lower limb. The feet are fixed with flannel bandages, keeping the tension of the lower extremities to the feet of the orthopedic table, preventing the pelvis from being distorted.

Make control x-rays in two projections, make sure that the fragments are compared, treat the surgical field with an antiseptic.

By outer surface of the hip joint, from the greater trochanter down the projection of the femur, an incision is made 6-8 cm long. subcutaneous tissue and fascia, carry out hemostasis.

Sharply and bluntly separate the lateral broad muscle under the trochanter to the bone. A hole is made along the outer surface of the femur under a large swivel for inserting a nail into the cortical layer of the bone with a chisel or drill.

Under the control of the X-ray machine in the center of the neck at an angle of 127-130°, a guide pin is passed through both fragments, which serves as a guide.

After that, the needle is removed, the surgical wound is sutured in layers. A derotational boot or a plaster splint is applied to the foot and lower leg up to the middle third.

Splicing occurs in 5-6 months. Efficiency in people of non-physical labor returns after 6 months, and physical - after 10-12 months.

Acetabular fractures

In young and middle-aged people, they are treated conservatively ( skeletal traction or immobilization with a plaster cast).

Unlike femoral neck fractures, acetabular fractures heal well after 8 weeks.

As for older and elderly people, their method of choice for the treatment of acetabular fractures is surgical.

The victim is placed on an orthopedic table and, by traction along the axis with a tap, internal rotation of the limb, the fragments are compared. Both lower limbs are symmetrically fixed to the footrests of the orthopedic table.

Make a check X-ray, make sure that the fragments are compared, treat the surgical field with an antiseptic and cut soft tissues to the bone along the outer surface of the upper third of the thigh.

The incision starts 1-1.5 cm above the tip of the greater trochanter and is led down along the axis of the femur 8-10 cm long. After hemostasis, outer surface greater trochanter and femur.

Under the base of the greater trochanter in the cortical layer of the femur, an electric drill makes a hole with a size corresponding to the width of the latch, after which the bent proximal part of the L-shaped latch is driven into the greater trochanter and neck, and the distal plate is applied throughout its entire length directly to the outer surface of the femur and fixed .

The surgical wound is sutured in layers. A derotational plaster boot is placed on the lower third of the lower leg and foot.

After 3-5 days, the victims are allowed to get up, and after removing the stitches - on the 12-14th day - to walk with the help of crutches, without loading the operated limb.

1 month after the operation, the victims are allowed to load the operated limb up to 50%, and after 2 months - full. Working capacity returns 3-4 months after the operation.

Isolated fractures of the greater trochanter with no or slight displacement

Isolated fractures of the greater trochanter without displacement or with slight displacement are treated conservatively.

Regardless of the method (coxite gypsum bandage indicated for young functional treatment in bed - for elderly victims) the injured limb should be abducted (to relax the gluteal muscles and restore the cervico-diaphyseal angle) and the real estate of the fragments at the fracture site should be provided.

In fractures with displacement of the greater trochanter or with the presence of diastasis between fragments, surgical treatment is indicated - an open comparison of fragments with osteosynthesis with screws.

In case of fragmentation fractures with displacement, the latter are repositioned and fixed transosseously with lavsan threads with additional suturing of adjacent soft tissues.

In cases where the fragments cannot be compared or they are too small, the latter are removed, and the gluteal muscles are sutured transosseously to the central fragment of the greater trochanter.

Fractures of the lesser trochanter

Fracture of the lesser trochanter is treated conservatively. The victim is laid on the bed, the injured limb is placed on the Beller splint.

The femur should be flexed at the hip joint to an angle of 110-100° and slightly rotated outward. Fracture union occurs in the fifth or sixth week.

Rehabilitation

With proper rehabilitation, the patient can avoid most of the possible complications.

Recovery requires comprehensive measures.

Need to remember: the sooner the patient gets on his feet and begins to move independently, the higher the chances of recovery.

Rehabilitation measures should be started as early as possible, within a few days after the injury (in the case of conservative treatment) or surgery (in the case of surgery).

One of the most important components of rehabilitation is physiotherapy. Lack of mobility can be extremely dangerous, but exercise should not be overdone.

Loads should be carried out under the supervision of a doctor, and increase gradually. At the initial stage, all exercises are performed lying down.

To maintain normal blood circulation in the tissues during bed rest, the patient needs to learn how to perform simple exercises - contractions of the muscles of the press, back, hips and legs.

Joint work is also important for recovery. The patient performs flexion and extension of the fingers, turns and inclinations of the neck, arms, work with expanders and small dumbbells.

After removing immobilization, it is necessary to develop joints that have been immobile for a long time. The next stage - the patient tries to walk with the help of special walkers.

After two weeks, they can be replaced with a cane, then completely left aids. To speed up recovery, massage and physiotherapy are used.

Nutrition is also of great importance for a speedy recovery. During rehabilitation, the body needs calcium and collagen, which contribute to the healing of the fracture.

To maintain immunity and vitality you need to take vitamins. Very helpful dairy products, vegetables fruits.