The femur is the longest and strongest bone in the human body. For its fracture to occur, the effect of a sufficiently high force is necessary. One of these reasons could be, for example, a car accident.
The long, straight part of the femur is called the diaphysis. The fracture can occur at any part of it. Such fractures almost always require surgical treatment.
TYPES OF HIP FRACTURES
Depending on the energy of the injury, the nature of femoral fractures can vary greatly. Fragments may remain in their normal position (stable fractures) or significantly displaced (displaced fractures). The skin in the area of the fracture may be intact (closed fracture) or it may be damaged, and the fracture may communicate with the external environment (open fracture).
Fractures are referred to by orthopaedic doctor in Delhi according to various classification systems. Hip fractures are classified according to:
- Fracture localization (femur diaphysis is divided into thirds – distal, middle and proximal)
- The nature of the fracture (the fracture line can be located in different ways: transversely, obliquely, etc.)
- Damage to the skin and soft tissues in the area of the fracture.
The most common types of hip shaft fractures are:
Transverse fracture. In this fracture, the line runs horizontally across the long axis of the thigh.
Oblique fracture. The fracture line is located at an angle to the axis of the thigh.
Spiral fracture. The fracture line is located in a spiral, as if surrounding the diaphysis of the thigh. The mechanism of such fractures is twisting along the long axis of the thigh.
Comminuted fracture. With such fractures, three or more bone fragments are formed. In most cases, the number of bone fragments is proportional to the severity of the traumatic effect that caused the fracture.
Open fracture. In such cases, the bone fragment can perforate the skin, or there is an open wound in the fracture area that communicates with the fracture zone. Open fractures are often characterized by greater damage to the surrounding muscles, tendons, and ligaments. These fractures have the highest risk of complications, especially infections, and usually take longer to heal.
CAUSES OF HIP FRACTURES
Fractures of the femur in young people are often the result of some kind of high-energy impact. The most common cause of hip shaft fractures is car accidents. Other common causes are pedestrian collisions with a moving vehicle and falls from a height.
Low-energy injuries, such as falls from their own height, can cause hip shaft fractures in older people with poor bone quality.
SYMPTOMS AND DIAGNOSIS OF FRACTURES
A hip shaft fracture usually immediately results in severe pain in the affected area. The victim loses the ability to lean on the injured leg, the hip may look deformed – it may be shorter and take an uncharacteristic position.
HISTORY AND PHYSICAL EXAMINATION
The orthopaedic in Delhi must know the circumstances of your injury. This information will help the orthopaedic surgeon in Delhi assess the energy of the injury and the presence of possible collateral damage.
It is important that the orthopaedic in Dwarka knows about any comorbidities you have – hypertension, diabetes, asthma, or allergies. The doctor will also ask you if you smoke or take any medications.
After discussing with you the nature of the injury and history, the orthopaedic in Janakpuri will perform a thorough physical examination. In doing so, the doctor will assess your general condition and then the condition of the injured limb. In this case, the orthopaedic in West Delhi will pay attention to details such as:
- Visible limb deformity (unusual angle, rotation, or shortening of the limb)
- Damage to the skin
- Hemorrhage
- Perforation with bone fragments of the skin
After a visual examination, the best orthopaedic in Delhi palpates the thigh, lower leg and foot, not the subject of possible pathological changes, tension of the skin and muscles in the fracture area. Also, the doctor will assess the nature of the pulse on the foot. If you are awake, your doctor will evaluate sensitivity and movement in your lower leg and foot.
RADIATION RESEARCH METHODS
Radiation testing allows the doctor to obtain more detailed information about your injury.
Radiography. It is the most commonly used method for diagnosing bone fractures. It allows not only to see the fracture, but also to characterize its type and localization.
Computed tomography. If the doctor needs more information about the nature of the fracture than is shown on the x-ray, the doctor may prescribe a CT scan. Sometimes the fracture line is very thin and almost invisible on radiographs. CT can help visualize these fractures more clearly.
TREATMENT OF HIP FRACTURES
CONSERVATIVE TREATMENT
Most hip shaft fracture treatment in Delhi require surgical intervention and rarely can be treated conservatively. So, the method of plaster immobilization is sometimes used to treat hip fractures in young children.
SURGERY
The timing of the operation. Most hip fractures are best operated within the first 24 to 48 hours after injury. Sometimes the operation is postponed due to the presence of life-threatening conditions or the need to stabilize the patient’s condition. To reduce the risk of infection in open fractures, patients are given antibiotics right after hospitalization. During the operation, open wounds, tissues and bone fragments are treated from contamination.
During the waiting period between admission to the hospital and surgery, the orthopaedic surgeon in Dwarka may temporarily fix your leg with a cast or skeletal traction. This allows you to maintain a more or less optimal position of the fragments and the length of the limb.
Skeletal traction is a system of blocks and weights with which bone fragments are held in one position. It allows not only to achieve the correct position of the fragments, but also to stop the pain syndrome.
External fixation. During such an operation, metal wires or rods are inserted into the femur above and below the fracture site, which are fixed to an external fixation device. This allows you to keep the fragments in the correct position.
External fixation is most often used as a method of temporary stabilization of a fracture in patients with multiple injuries, whose condition does not allow performing a more traumatic operation of internal fixation of the fracture. The second stage in such cases is performed after the patient’s condition has stabilized. In some cases, the external fixator is left on until the fracture is completely healed, but this is not common.
Intramedullary osteosynthesis. Today it is the most commonly used method of internal fixation of hip shaft fractures. In this case, special metal rods are used, which are inserted into the medullary canal of the femur. The rod passes through the fracture zone and holds the fragments in the correct position.
An intramedullary nail is inserted into the medullary canal from the side of the hip or knee joint. Above and below the fracture site, the rod is locked with screws to exclude mobility in the fracture area.
Intramedullary rods are usually made of titanium. They come in various lengths and diameters to fit most of the thigh bones.
Plates and screws. In such operations, the bone fragments are repositioned first, i.e. returning them to their normal position, after which the fragments are fixed from the side of the outer surface of the bone with a metal plate and screws.
This method is used when intramedullary osteosynthesis is not possible, for example, when the fracture line extends to the hip or knee joint.
RECOVERY AND REHABILITATION
Most fractures of the femoral shaft will heal within 3-6 months. Sometimes, for example, with open or comminuted fractures, as well as in smokers, it takes longer.
PAIN RELIEF
Pain after injury or surgery is a natural component of the healing process. Your doctor and nurses will do whatever is necessary to reduce pain and make your recovery more comfortable.
Various medications are usually used to relieve pain after an injury or surgery. These are paracetamol, non-steroidal anti-inflammatory drugs, muscle relaxants, opioids and topical drugs. In order to optimize the analgesic effect and reduce the patient’s need for narcotic analgesics, these drugs are often used in combination with each other. Some of these drugs can have side effects that affect your ability to drive or engage in other activities. The doctor will definitely tell you about the possible side effects of the drugs prescribed to you.
LOAD
Many doctors recommend starting movements in the joints of the operated limb as early as possible, but you need to load the leg when walking only in this way and only when and as your doctor permits.
In some cases, almost full loading is allowed immediately after the operation, but sometimes this is possible only after the first signs of fracture union appear. Therefore, we recommend that you strictly follow all the instructions of your orthopaedic surgeon in West Delhi.
You will need to use crutches or walkers when walking.
PHYSIOTHERAPY
After surgery, the muscles in the area of the fracture are likely to be significantly weakened, so exercises to help restore muscle strength are very important during the rehabilitation process. Physiotherapy in Dwarka will restore normal muscle strength and joint mobility. It can also help you cope with postoperative pain.
A physiotherapist in Dwarka will likely start working with you while you are still in the hospital. He will also teach you how to use crutches or walkers correctly.
