Is there any disability for a hip fracture? Fractures of the bones of the extremities Surgical treatment for a fracture of the femoral neck

1. My mother, 76 years old, fell on a bus and broke her hip. The ambulance took me to the hospital, after 3 days I was discharged home - to seek and wait for a quota for hip replacement, since without surgery the neck will not heal. What insurance compensation is due from the carrier? The fact is that according to the standards (in the law), in case of damage to the hip joint (femoral neck fracture), the percentage of insurance compensation is 10%, and in case of damage to the lower limb, resulting in surgical intervention (joint replacement) - 15%. In addition, if a person has become disabled in group 2, then 70% of the amount of insurance compensation is due. And my mother was already on group 2 disability, but she used to walk, but now she is bedridden. Lots of nuances.

Lawyer Merny M.A., 3013 answers, 1667 reviews, on the site from 05/11/2018
1.1. Indeed, there are many nuances and you need to look at the documents.
Please contact a specific lawyer for assistance.

2. Am I entitled to disability under the following conditions: on April 6, 2015, I broke the femoral neck - a closed medial fracture of the neck of the left femur with displacement.. On April 14, 2015, an operation was performed - osteosynthesis of the left femoral neck with compression screws. And so with crutches, because I was in pain and moved within the apartment. At the beginning of 2016, on the way from the hospital, the car hit a bump and one screw broke, causing severe pain. I did not get the prosthetic surgery because at that time I had to spend a month in the Salekhard district hospital with metatypical skin cancer. Therefore, I only got to the Kirov specialized prosthetics clinic for surgery in November 2016. But, since there were wounds and a lot of scars at the site of the fracture, they cleaned the wound and invited me to undergo prosthetics in four months. I agreed on a place for May 11, because... They are renovating this floor in April. Concomitant diseases - type 2 diabetes for more than 10 years, seropositive rheumatoid arthritis, late stage, severe secondary osteoporosis with a history of fractures (there were fractures of the arms and legs), stage 11 hypertension, grade 3, risk 4. IHD HF FC 11.Can Do I apply for a disability group? My traumatologist said: That as long as you have a leg, you are not entitled to a disability. But if they cut it off, then only then can we give him disability. You, they say, can walk, albeit on crutches. But I can walk within the apartment, I can’t go up and, especially, down the stairs, so I don’t go out at all without the help of healthy people, when I need to go to the hospital. If you can, please answer me, I will be grateful.

Lawyer Kandakova A.V., 48513 answers, 7491 reviews, on the site from 07/12/2012
2.1. If the traumatologist refused to refer you to the medical examination, then go to court.
He will determine the legality of the doctor's action.
Art. 219 CAS RF gives 3 months. on this.
If this Code does not establish other deadlines for filing an administrative claim in court, an administrative claim may be filed with the court within three months from the day when a citizen, organization, or other person became aware of a violation of their rights, freedoms and legitimate interests.
The doctor himself cannot say whether he is entitled to disability?
The commission looks at the entire body.
Decree of the Government of the Russian Federation dated February 20, 2006 N 95 reads:
"5. The conditions for recognizing a citizen as disabled are:


c) the need for social protection measures, including rehabilitation.
6. The presence of one of the conditions specified in paragraph 5 of these Rules is not a sufficient basis for recognizing a citizen as disabled."

Lawyer Ligostaeva A.V., 237177 answers, 74620 reviews, on the site since November 26, 2008
2.2. --- hello LARISA, issues of establishing a disability group are dealt with ONLY BY MEDICS, and we can suggest an algorithm for applying to the ITU. To establish the disability group (or strengthen it), you need to contact your attending physician and ask to fill out a mailing list on the ITU form Form No. 080/u. You receive this sheet and visit all the doctors listed on it, and then go through the ITU, in accordance with the Decree of the Government of the Russian Federation No. 95 of February 20, 2006 “On the procedure and conditions for recognizing a person as disabled.” Form No. 080/u-06 is signed by the head of the department, as the chairman of the Medical Commission. And if you refuse to establish a disability group, you will appeal the refusal in court within 3 months from the date of receipt. The court will appoint a commission examination and make its decision. Good luck to you and all the best. :sm_ax:

Lawyer Parfenov V.N., 140972 answers, 61243 reviews, on the site from 05/23/2013
2.3. Dear Larisa! You asked the lawyers a purely medical question about whether you are entitled to disability
Disability in accordance with Decree of the Government of the Russian Federation No. 95 of February 20, 2006 “On the procedure and conditions for recognizing a person as disabled” is established by the ITU, consisting of medical specialists.
If a traumatologist refuses to refer you to an ITU, then it is not at all necessary to challenge such a refusal in court. According to the Procedure and conditions for recognizing a person as disabled, you can independently contact the ITU to establish your disability. If there is a refusal, then the refusal can be appealed either to a higher ITU bureau or on the basis of Article 218 of the CAS of the Russian Federation in court.

Lawyer Cherepanov A. M., 31094 answers, 11231 reviews, on the site from 03/28/2013
2.4. Hello. You never know what he says, you can say anything you want. I believe that in your case, if you have concomitant diseases, you can apply for the establishment of a disability group, but in any case this is decided by MSEC, not your traumatologist.
When establishing disability status and the degree of disability, MSEC authorities are guided by the following criteria: by the severity of the disease; according to the specificity of the disease, as a result of which a person is partially or completely unable to ensure full-fledged life activities; according to the restrictions that the disease imposes on a person’s ability to care for himself; due to the causes of the disease.

IV. The procedure for conducting medical and social
citizen examination

20. A medical and social examination of a citizen is carried out in the bureau at the place of residence (at the place of stay, at the location of the pension file of a disabled person who has left for permanent residence outside the Russian Federation).
21. At the main bureau, a medical and social examination of a citizen is carried out if he appeals the decision of the bureau, as well as upon referral from the bureau in cases requiring special types of examination.
22. In the Federal Bureau, a medical and social examination of a citizen is carried out in the event of an appeal against the decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination.
23. A medical and social examination can be carried out at home if a citizen cannot appear at the bureau (main bureau, Federal Bureau) for health reasons, as confirmed by the conclusion of a medical organization, or in a hospital where the citizen is being treated, or in absentia by decision of the relevant bureau.


24. A medical and social examination is carried out at the request of a citizen (his legal or authorized representative).

(see text in the previous edition)
The application is submitted to the bureau in writing, accompanied by a referral for a medical and social examination issued by a medical organization (the body providing pensions, the body for social protection of the population), and medical documents confirming the impairment of health.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
25. Medical and social examination is carried out by specialists of the bureau (main bureau, Federal Bureau) by examining the citizen, studying the documents submitted by him, analyzing the social, professional, labor, psychological and other data of the citizen.
26. When conducting a medical and social examination of a citizen, a protocol is kept.
27. Representatives of state extra-budgetary funds, the Federal Service for Labor and Employment, as well as specialists of the relevant profile (hereinafter referred to as consultants) can participate in conducting a medical and social examination of a citizen at the invitation of the head of the bureau (main bureau, Federal Bureau).
27(1). A citizen (his legal or authorized representative) has the right to invite any specialist, with his consent, to participate in a medical and social examination with the right of an advisory vote.
(clause 27 (1) introduced by Decree of the Government of the Russian Federation of August 10, 2016 N 772)
28. The decision to recognize a citizen as disabled or to refuse to recognize him as disabled is made by a simple majority of votes of the specialists who conducted the medical and social examination, based on a discussion of the results of his medical and social examination.
The decision is announced to the citizen who underwent the medical and social examination (his legal or authorized representative), in the presence of all the specialists who conducted the medical and social examination, who, if necessary, give explanations on it.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
29. Based on the results of the medical and social examination of the citizen, an act is drawn up, which is signed by the head of the relevant bureau (main bureau, Federal Bureau) and the specialists who made the decision, and then certified with a seal.
The conclusions of consultants involved in conducting a medical and social examination, a list of documents and basic information that served as the basis for making a decision are entered into the act of a medical and social examination of a citizen or attached to it.
The procedure for drawing up and the form of the act of medical and social examination of a citizen are approved by the Ministry of Labor and Social Protection of the Russian Federation.

(see text in the previous edition)
The paragraph is no longer valid. - Decree of the Government of the Russian Federation dated August 10, 2016 N 772.
(see text in the previous edition)
29(1). An act of medical and social examination of a citizen, a protocol for conducting a medical and social examination of a citizen, an individual rehabilitation or habilitation program for a citizen are formed into the file of a medical and social examination of a citizen.
A citizen (his legal or authorized representative) has the right to familiarize himself with the act of the medical and social examination of the citizen and the protocol of the medical and social examination of the citizen.
At the request of a citizen (his legal or authorized representative), submitted in writing, he is given copies of the medical and social examination report of the citizen and the protocol of the medical and social examination certified by the head of the bureau (main bureau, Federal Bureau) or an official authorized by him in the prescribed manner. citizen.
Documents generated during and based on the results of a medical and social examination, in the form of electronic documents, are signed with an enhanced qualified electronic signature of the head of the bureau (main bureau, Federal Bureau) or with an enhanced qualified electronic signature of an official authorized by him.
(clause 29 (1) introduced by Decree of the Government of the Russian Federation of August 10, 2016 N 772)
30. When conducting a medical and social examination of a citizen in the main bureau, the case of the medical and social examination of the citizen with the attachment of all available documents is sent to the main bureau within 3 days from the date of the medical and social examination in the bureau.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
When conducting a medical and social examination of a citizen at the Federal Bureau, the case of the medical and social examination of the citizen, with all available documents attached, is sent to the Federal Bureau within 3 days from the date of the medical and social examination at the main bureau.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
31. In cases that require special types of examination of a citizen in order to establish the structure and degree of disability, rehabilitation potential, as well as obtain other additional information, an additional examination program can be drawn up, which is approved by the head of the relevant bureau (main bureau, Federal Bureau). This program is brought to the attention of the citizen undergoing a medical and social examination in a form accessible to him.
(as amended by Decree of the Government of the Russian Federation dated December 30, 2009 N 1121)
(see text in the previous edition)
The additional examination program may include conducting the necessary additional examination in a medical organization, an organization engaged in rehabilitation, habilitation of the disabled, obtaining an opinion from the main bureau or the Federal Bureau, requesting the necessary information, conducting a survey of the conditions and nature of professional activity, the social and living situation of the citizen, and others Events.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
32. After receiving the data provided for by the additional examination program, specialists from the relevant bureau (main bureau, Federal Bureau) make a decision to recognize the citizen as disabled or to refuse to recognize him as disabled.
33. If a citizen (his legal or authorized representative) refuses an additional examination and provides the necessary documents, the decision to recognize the citizen as disabled or to refuse to recognize him as disabled is made on the basis of available data, about which a corresponding note is made in the protocol of the medical and social examination citizen in the federal state institution of medical and social examination.
(clause 33 as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
34. For a citizen recognized as disabled, specialists from the bureau (main bureau, Federal Bureau), who conducted a medical and social examination, develop an individual rehabilitation or habilitation program.
If it is necessary to make corrections to an individual rehabilitation or habilitation program in connection with a change in the personal, anthropometric data of a disabled person (disabled child), the need to clarify the characteristics of previously recommended types of rehabilitation and (or) habilitation measures, as well as in order to eliminate technical errors (misprint, typo , grammatical or arithmetic error or a similar error) for a disabled person (disabled child), at his or her application or at the request of a legal or authorized representative of the disabled person (disabled child), instead of the previously issued one, a new individual rehabilitation or habilitation program is drawn up without additional examination of the disabled person (disabled child) ).
(clause 34 as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
35. An extract from the medical and social examination report of a citizen recognized as disabled is sent to the relevant bureau (main bureau, Federal Bureau) to the body providing his pension within 3 days from the date of the decision to recognize the citizen as disabled in the form of an electronic document with using a unified system of interdepartmental electronic interaction or in any other way in compliance with the requirements of the legislation of the Russian Federation in the field of personal data protection.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
The procedure for drawing up and the form of the extract are approved by the Ministry of Labor and Social Protection of the Russian Federation.
(as amended by Decree of the Government of the Russian Federation dated September 4, 2012 N 882)
(see text in the previous edition)
Information on all cases of recognition as disabled of citizens who are registered with the military or who are not registered with the military, but are required to be registered with the military, is submitted by the bureau (main bureau, Federal Bureau) to the relevant military commissariats.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
36. A citizen recognized as disabled is issued a certificate confirming the fact of disability, indicating the disability group, as well as an individual rehabilitation or habilitation program.
(as amended by Resolutions of the Government of the Russian Federation dated December 30, 2009 N 1121, dated August 6, 2015 N 805)
(see text in the previous edition)
The procedure for drawing up and the form of the certificate are approved by the Ministry of Labor and Social Protection of the Russian Federation.
(as amended by Decree of the Government of the Russian Federation dated August 10, 2016 N 772)
(see text in the previous edition)
A citizen who is not recognized as disabled, at his request, is issued a certificate of the results of a medical and social examination.
37. For a citizen who has a document on temporary disability and is recognized as disabled, the disability group and the date of its establishment are indicated in the specified document.

Lawyer Levichev D.A., 36625 answers, 9496 reviews, on the site from 05/01/2015
2.5. You need to undergo a medical and social examination.
Decree of the Government of the Russian Federation of February 20, 2006 N 95 (as amended on August 10, 2016) “On the procedure and conditions for recognizing a person as disabled”
III. The procedure for referring a citizen
for medical and social examination

15. A citizen is sent for a medical and social examination by a medical organization, regardless of its organizational and legal form, by the body providing pensions, or by the social protection body.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
16. A medical organization sends a citizen for a medical and social examination after carrying out the necessary diagnostic, therapeutic and rehabilitation or habilitation measures if there is data confirming a persistent impairment of body functions caused by diseases, consequences of injuries or defects.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
At the same time, in the direction for medical and social examination, the form of which is approved by the Ministry of Labor and Social Protection of the Russian Federation and the Ministry of Health of the Russian Federation, data on the citizen’s health status are indicated, reflecting the degree of dysfunction of organs and systems, the state of the body’s compensatory capabilities, as well as the results of the rehabilitation or habilitation activities.
(as amended by Resolutions of the Government of the Russian Federation dated 09/04/2012 N 882, dated 08/06/2015 N 805, dated 08/10/2016 N 772)
(see text in the previous edition)
17. The body providing pensions, as well as the body for social protection of the population, has the right to refer for a medical and social examination a citizen who has signs of disability and needs social protection, if he has medical documents confirming impairment of body functions due to diseases, consequences of injuries or defects.
The form of the corresponding referral for medical and social examination, issued by the body providing pensions or the social protection body, is approved by the Ministry of Labor and Social Protection of the Russian Federation.
(as amended by Decree of the Government of the Russian Federation dated September 4, 2012 N 882)
(see text in the previous edition)
18. Medical organizations, bodies providing pensions, as well as social protection bodies are responsible for the accuracy and completeness of the information specified in the referral for a medical and social examination, in the manner established by the legislation of the Russian Federation.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
19. If a medical organization, a body providing pensions, or a social protection body refuses to send a citizen for a medical and social examination, he is issued a certificate, on the basis of which the citizen (his legal or authorized representative) has the right to contact the bureau independently .
(as amended by Resolutions of the Government of the Russian Federation dated 08/06/2015 N 805, dated 08/10/2016 N 772)
(see text in the previous edition)
The bureau's specialists conduct an examination of the citizen and, based on its results, draw up a program for additional examination of the citizen and implementation of rehabilitation or habilitation measures, after which they consider the question of whether he has any disabilities.
(as amended by Decree of the Government of the Russian Federation dated 06.08.2015 N 805)
(see text in the previous edition)
19(1). The referrals for medical and social examination provided for in paragraphs 16 and 17 of these Rules and the certificate specified in paragraph 19 of these Rules, within 3 working days from the date of issue, are sent by a medical organization, a body providing pensions, or a social protection body to the bureau in the form of an electronic document using a unified system of interdepartmental electronic interaction and regional systems of interdepartmental electronic interaction connected to it, and in the absence of access to this system - on paper in compliance with the requirements of the legislation of the Russian Federation in the field of personal data.
(clause 19 (1) introduced by Decree of the Government of the Russian Federation dated April 16, 2012 N 318; as amended by Decree of the Government of the Russian Federation dated August 6, 2015 N 805)
(see text in the previous edition)
Also, if you disagree, you can appeal.

3. Is an 81-year-old grandmother entitled to disability due to a hip fracture, having undergone surgery, but moving only with the help of a walker? Thank you.

Lawyer Titova T.A., 113285 answers, 49840 reviews, on the site since 02/17/2012
3.1. Sketlana Evgenievna, this issue is in the exclusive competence of the medical and social examination, contact them directly - through the surgeon.

Lawyer Vanteeva M.V., 49212 answers, 19417 reviews, on the site since November 23, 2009
3.2. Call your local doctor, there are grounds for prescribing disability. The doctor will issue a referral for medical examination. It can be done at home. The doctor should explain everything to you in detail. But, only ITU medical experts will decide the issue.

4. Five years ago, my wife, at the age of 65, was walking home and fell on a slippery sidewalk (winter). Neighbors helped us enter the apartment. Having applied for honey. help, a femoral neck fracture was diagnosed. They operated on meth and found meth. plate and after a long period (about 2 months), the wife was able to move, initially with the help of crutches. Then sticks, and then without it. but with a severe limp on his right leg. All this time she has been taking medicine to reduce pain, rubbing herself with ointments, and two years after the fracture she decided to go work as a cleaner in a production workshop part-time. Now the condition is worsening, the pain is becoming more frequent, and pinching of the sciatic nerve on the left is also diagnosed. But “through tears,” she continues to work to somehow increase her small pension. Moreover, she is a Labor Veteran of the Chelyabinsk region. Is it possible for her to apply for disability? What is the prognosis for success and what needs to be done? Thank you in advance for your consultation. Nikolai.

Lawyer Zhuikova Yu.V., 16936 answers, 5368 reviews, on the site from 06/03/2011
4.1. Hello Nikolay!
The conditions for recognizing a citizen as disabled are:
a) health impairment with a persistent disorder of body functions caused by diseases, consequences of injuries or defects;
b) limitation of life activity (complete or partial loss by a citizen of the ability or ability to carry out self-service, move independently, navigate, communicate, control one’s behavior, study or engage in work);
c) the need for social protection measures, including rehabilitation and habilitation.
Contact a medical facility.
Please note that the pension can be assigned on one basis, at the discretion of your spouse.
As an option, it is possible to recover the damage caused in court. For a more accurate answer, it is necessary to study the available documents and the circumstances of the case. Seek help from a lawyer/attorney in person.

5. Can a 1st disability group be assigned to a hip fracture?

Lawyer Antyukhin A.V., 328986 answers, 123201 reviews, on the site since 08/16/2011
5.1. Good afternoon no, they can't.

If you find it difficult to formulate a question, call the toll-free multi-line phone 8 800 505-91-11 , a lawyer will help you

Femoral neck fracture- an injury in which the integrity of the femur occurs in the neck area - the thinnest part connecting the body of the bone with its head.

Femoral neck fractures account for 6% of all types of fractures. Statistics show that most often it is pathological and occurs as a result of minor trauma in a person with osteoporosis. The pathology is most common among women after menopause. 90% of cases occur in people over 65 years of age.

This type of injury is characterized by the fact that the fusion of fragments always occurs poorly, over a long period of time (the reasons will be discussed below). Often, patients tolerate surgical intervention much easier than long-term conservative treatment.

Due to the fact that the injury in most cases occurs against the background of osteoporosis, this does not require a significant traumatic effect. A femoral neck fracture can occur when a person falls from their own height, for example, if a person slips or stumbles while walking.

The most severe complication of this type of fracture is aseptic necrosis(death) of the head of the femur. It resolves and this leads to the need for prosthetics.

Anatomical features of the femoral neck and hip joint. Mechanism of femoral neck fracture.

Elements that make up the hip joint:

• glenoid cavity, located on the bones of the pelvis, has a cup-shaped shape;
• articular cartilage located around the glenoid cavity, additionally covers the head of the femur and strengthens the joint;
• femoral head spherical in shape is located in the articular cavity, a thin ligament extends from its top to the center of the cavity;
• femoral neck– the thin part of the femur that connects its head to the body;
• greater trochanter and lesser trochanter– bony protrusions located behind the neck of the femur, muscles and the capsule of the hip joint are attached to them;
• joint capsule The hip joint covers the socket, head and neck of the femur.

• the femoral neck is located inside the articular cavity, covered by the articular capsule and not covered by the periosteum (the outer layer responsible for the growth and nutrition of the bone);
• the neck of the femur comes off from her body at an angle, which normally can be from 115⁰ to 135⁰: the smaller the angle, the greater the load on the femur, increasing the likelihood of a fracture;
• main arteries, supplying blood to the neck and head, penetrate the bone along the lower edge of the articular capsule and in the recess between the trochanters;
• to the head of the femur Only one artery is suitable, located in the ligament connecting it to the center of the glenoid cavity: in older people it becomes overgrown.

Typically, a femoral neck fracture occurs when a traumatic force is applied along the axis of the leg. For example, when a person falls on a straightened leg. When a traumatic force is applied perpendicularly (a blow to the hip joint area from the side, a fall on the hip joint area), a fracture of the pelvic bones most often occurs, but the femur may also be damaged.

Causes of hip fractures

Causes of hip fracture in older people

Factors predisposing to pathological fractures of the femoral neck in older age:

• oncological diseases;
• visual impairment;
• sedentary lifestyle;
• malnutrition, starvation;
• menopause in women;
• diseases of the nervous system accompanied by movement disorders;
• atherosclerosis, obliterating endarteritis and other vascular pathologies.

Causes of hip fractures in young people

The most common causes of hip fractures at a young age:

• traffic accidents;
• work injuries;
• falling from a great height;
• combat wounds in places of military conflicts.

Types of femoral neck fractures

Types of fractures by level of location:
The fracture line can run horizontally or vertically. The more vertical it is, the higher the risk of displacement and complications.

The prognosis is influenced by the degree and direction of displacement of fragments.

Types of displacements in femoral neck fractures:

• varus fracture– the head of the bone moves downwards and inwards, the angle between the neck and the body decreases;
• valgus fracture– the head moves upward and outward, and the angle between the neck and the body of the bone increases;
• impacted fracture- one fragment is driven into another, most often such a fracture is simultaneously valgus.

Symptoms of a hip fracture

Peculiarities of symptoms in impacted femoral neck fractures

A few days later, the fracture “breaks apart.” The impacted fragment comes out of the second one, they become separated. All the symptoms described in the table above occur.

X-ray for femoral neck fractures

What does a patient with a hip fracture look like? Photo:

Treatment of femoral neck fractures

Is it possible to treat a hip fracture without surgery?

• impacted fractures;
• fractures in the lower part of the neck, the line of which passes through the greater and lesser trochanters;
• patient's serious condition, which is a contraindication to surgical treatment.

Conservative treatment of impacted femoral neck fractures

Treatment of impacted femoral neck fracture in young patients.

A plaster splint is applied to the hip joint area, extending to the knee joint. Wearing period is 3 – 4 months. Patients are allowed to walk on crutches without relying on the injured leg.

Treatment regimen for hip fracture in elderly patients:

• conservative treatment is carried out in a hospital setting, in a traumatology and orthopedics clinic;
• skeletal traction is applied for 1.5 - 2 months, usually with a load weighing 2 - 3 kg;
• from the first days of treatment, the specialist engages in physical therapy with the patient;
• after removing skeletal traction, the patient is allowed to walk on crutches without leaning on the sore leg;
• after 3–4 months, small, strictly dosed loads are allowed under the supervision of a specialist;
• after 6 months it is allowed to lean on the injured leg while walking;
• After 6–8 months, the patient’s ability to work is completely restored.

Conservative treatment of lateral femoral neck fractures

Conservative treatment of a non-displaced fracture:

• a bandage is applied to the hip joint area for a period of 2.5 - 3.5 months, until complete fusion occurs;


• After 1.5 - 2 months from the start of treatment, dosed loads on the injured leg are allowed.

• application of skeletal traction to the leg, usually weighing 6–8 kg, treatment in a hospital setting;


• after removing skeletal traction, wear a plaster cast.

Conservative treatment for contraindications to surgery

Indications for early immobilization:

• general serious condition of the patient, general contraindications to surgical interventions (exhaustion, increased bleeding, etc.);


• senile insanity and other mental disorders;


• if the patient could not walk independently before the fracture.

• local anesthesia joint areas (injection with novocaine, lidocaine);
• skeletal traction within 5 – 10 days;
• after removing traction the patient is allowed to turn on his side, hang his legs off the bed, and sit down;
• walking on crutches start from the 3rd week from the start of treatment;
• further the patient cannot walk independently; he moves only with the help of crutches.

Surgical treatment for hip fracture

When is surgery indicated for a broken neck?

If there are no indications for conservative treatment described above, surgical intervention is always performed.

It is advisable to perform the operation as quickly as possible. When the patient is admitted to the hospital, it is carried out urgently. If the operation is not performed immediately, then skeletal traction is first applied.

General principles of surgical treatment of femoral neck fractures

• the operation can be performed under local anesthesia or general anesthesia, depending on the patient’s condition and the scope of the intervention;
• before fixing the fragments, they are performed reposition– correct comparison;
• if the fracture is simple enough and it is possible to intervene under X-ray control, then reposition is performed in a closed way– the capsule of the hip joint is not opened;
• in difficult cases when X-ray control is not possible, perform open reduction with opening of the capsule.

Types of surgical interventions for femoral neck fractures

Type of intervention	Description
Osteosynthesis– connection of fragments using metal fixing structures
Osteosynthesis using three-blade Smith-Petersen nails	The Smith-Petersen nail is thick and has a three-bladed cross-section. It securely holds the femur fragments. It is driven into the femoral neck using a special hammer from the side of the trochanters of the femur.
Osteosynthesis using three screws	A more reliable method compared to using a nail. It is used mainly in young patients. Progress of surgery: the doctor makes an incision and accesses the joint; from the side of the trochanters, several thin knitting needles are twisted into the femoral neck using a drill; take x-rays; the three most well-placed knitting needles are left in place, the rest are removed; along the left knitting needles, as if along conductors, screws are tightened, which look like a hollow tube and are threaded on the outside.
Osteosynthesis using a dynamic hip screw - Dynamic Hip Screw (DHS)	The DHS is a metal structure with several screws that are screwed into the femur. It is quite bulky and its installation is difficult. Therefore, many orthopedic traumatologists prefer to use several separate screws instead.
Hip replacement– replacement of the femoral head and acetabulum with prostheses. It is carried out with a high risk of complications. Indications: the patient is old and the fracture line passes directly under the head of the femur; significant displacement of fragments; compound fractures; the presence of several fragments, fragmentation of the head and neck of the femur; already developed aseptic necrosis of the femoral head.
Endoprosthesis replacement with total hip joint prostheses.	Total prosthesis replaces the head and neck of the femur, the acetabulum of the pelvis. Methods of fixation of total hip joint prostheses: Cementless. Suitable for young patients with normal bone tissue. Between the surface of the prosthesis and the bone there is a spongy layer. Over time, the bone tissue grows into it, and reliable fixation is achieved. Cement. Typically used in older patients with osteoporosis. Prosthetic leg fixed in the bone using special cement. Despite the fact that modern hip replacements are durable, over time, as a rule, there is still a need to replace them.
Monopolar femoral head prosthesis.	Only the head and neck of the femur are replaced. The prosthesis is not installed on the acetabulum. Such prostheses have one big drawback: as a result of constant friction of the artificial head against the acetabulum, its articular cartilage wears out more quickly.
Bipolar femoral head prosthesis	The head of the prosthesis is placed in a special capsule, which is in contact with the acetabulum. The main friction occurs not between the prosthesis and the socket, but within the prosthesis itself. This reduces wear on the joint.

What is the approximate cost of surgery for a hip fracture?

• type, complexity and duration of surgical treatment;
• type and cost of the metal structure and prosthesis used;
• the clinic where the treatment is carried out, the doctor who cares for the patient;
• prices in Russian and foreign clinics often differ greatly.

The average cost of surgical treatment of a femoral neck fracture in Russia is $2000. This figure can vary greatly. There are social support programs in which the operation can be free for the patient.

How is rehabilitation carried out for patients operated on for a femoral neck fracture?

Massage

After a hip fracture, a light massage of different muscle groups is performed during the rehabilitation period.

Purposes of massage:

• improving blood circulation and lymph outflow;
• prevention of trophic disorders, bedsores;
• prevention of congestive pneumonia(inflammation of the lungs, which develops as a result of prolonged immobility) - for this purpose a chest massage is performed;
• normalization of muscle tone, preventing their atrophy and preventing osteoporosis;
• improving the function of the respiratory and cardiovascular systems.

Physiotherapy

Purpose of therapeutic exercises:

• preventing complications;
• preventing muscle atrophy, normalization of their tone and movements;
• prevention of osteoporosis;
• restoration of the patient's motor activity.

Drug therapy*

Medications used for hip fractures:

• local anesthetic agents: Novocaine, Lidocaine, etc.: the doctor performs local injections that help cope with pain;
• painkillers: Analgin, Baralgin, Ketorol, etc.
• sedatives and hypnotics: Phenazepam, Motherwort infusion, Valerian infusion, Novopassit, etc.
• agents that improve blood flow in small vessels: Picamilon, Vinpocetine, Nicotinic acid, Cinnarizine, etc.;
• anticoagulants (Clexane, Warfarin, Fragmin, Xarelto, Arixtra)– drugs that reduce blood clotting and prevent the formation of blood clots in blood vessels.

Psychotherapy

Patients with a hip fracture are often depressed due to prolonged immobility. For most patients, sessions with a psychotherapist are recommended.

How to care for a patient with a hip fracture before surgery?

Bedridden patients with a hip fracture require constant care.

Care measures:

• frequent change of underwear and bed linen;
• it is necessary to ensure that there are no folds on the bed, crumbs and dirt do not accumulate;
• if the patient is in skeletal traction, then his leg should be placed in the correct position using sandbags;
• regularly wash the patient with a damp cloth and special products;
• regular supply of the vessel if necessary, careful adherence to intimate hygiene;
• the patient is assisted in daily washing and brushing of teeth;
• if after surgery there is urinary retention or incontinence (in most cases this is a temporary phenomenon), then a urinary catheter is installed;
• When caring for a patient in serious condition, the caregiver's responsibilities include feeding the patient.

What are the traditional methods of treating a hip fracture?

Ring magnets

Magnets with an induction of no more than 100 mT, which are usually used in water filters and loudspeakers, are suitable for treatment. For treatment, a magnet is applied to the skin in the area of ​​the damaged hip joint and moved clockwise for 10 minutes. Then the magnet is turned over and the other side is done the same.

Mumiyo

Take a certain amount of mummy and mix with vegetable or rose oil until a homogeneous mass is obtained, resembling an ointment in consistency. Rub into the skin over the affected joint 1 – 2 times a day.

Potato

Raw potatoes are used to relieve pain from hip fractures. Take one medium-sized potato and grate it on a fine grater. The resulting pasty mass is applied to the joint area.

Geranium leaves

Pour 1 - 2 teaspoons of dried geranium leaves with a liter of water. Boil, strain. The resulting decoction can be used as a bath or compress on the hip joint area.

Are patients with a hip fracture entitled to disability?

Complications and consequences of a hip fracture

1. Aseptic necrosis of the femoral head. Its necrosis and resorption occurs as a result of circulatory disorders. If there is a high risk of this complication, then in order to prevent it, preference is given to joint replacement before osteosynthesis.


2. Pseudarthrosis formation. Occurs when fragments fail to union - a movable joint is formed between them. In this case, dysfunction of the leg can be expressed to varying degrees. Often they are minor and the patient can move freely. Treatment is surgical.


3. Vein thrombosis. When lying in bed for a long time, venous blood stagnates, which results in the formation of blood clots. In order to prevent thrombosis, they try to restore the patient’s motor activity as early as possible.


4. Congestive pneumonia. When the patient is weakened and bedridden, the function of his respiratory system is impaired.
   Mucus stagnates in the lungs. Pneumonia develops. Often it is very severe and leads to the death of the patient. Prevention is carried out using breathing exercises.


5. Early complications after surgery: insertion of screws at the wrong angle, insufficient or too deep insertion of screws into the bone, damage to the acetabulum, vessel or nerve.


6. Late complications after surgery: loosening of the metal structure, failure of the prosthesis.


7. Joint infection after surgery, development of arthritis.


8. Arthrosis– degenerative disease of the hip joint. Leads to disruption of its function. Requires long-term conservative treatment.

How to prevent hip fracture?

• Full physical activity, sports and gymnastics at any age.
• Adequate nutrition, the presence in the diet of a sufficient amount of foods high in calcium.
• The use of multivitamin complexes and dietary supplements with calcium is especially important in old age, during menopause in women, and during illness.
• Fighting excess body weight.
• Timely treatment of diseases of bones, joints, endocrine organs.

How to provide first aid for a hip fracture?

How to recognize that a victim has a femoral neck fracture:

• moderate or slight pain in the groin;
• turning the foot outward;
• inability to lift the heel of an extended leg from the surface;
• shortening or lengthening of the injured limb;
• the victim cannot get up on his own. The exception is for victims with impacted fractures.

What does the ambulance crew do?

• Painkillers are injected - 30-50 ml of 1% novocaine solution into the fracture site.
• Antishock drugs are administered if necessary.
• The leg is fixed with a transport splint: pneumatic or Dieterichs splint.
• Apply a sterile bandage and administer blood substitutes for open fractures and significant blood loss.

What is the connection between hip fracture and osteoporosis?

Osteoporosis makes bones brittle. On the one hand, old bone tissue is quickly destroyed (resorption is actively occurring), and on the other hand, new bone tissue is formed very slowly. This leads to the fact that the bone acquires a spongy structure, becomes less dense and prone to fractures.

Due to the fragility of bones in osteoporosis, 70% of femoral neck fractures are comminuted or multi-comminuted. This complicates the treatment, requiring the surgeon to use special techniques. For example, an angularly stable bone plate, which is secured with screws to hold the bone fragments in the required position. These patients are more likely than others to have a joint prosthesis installed.

Patients with osteoporosis have a difficult time recovering from a fracture. Their callus formation is worse, and bone fusion occurs more slowly. The Stavropol State Medical Academy studied rules for the treatment of patients with osteoporosis who have suffered a hip fracture:

• Operation in all cases, except for those patients who have serious contraindications.
• Low-traumatic operations: The operation is performed through 2 small incisions – a bridge osteosynthesis technique. This allows for less trauma to the periosteum and a shorter postoperative period.
• Application of Angular Stable Inserts for fixation of bone fragments.
• Exclusion of external fixation after surgery. Doctors recommend avoiding plaster and other rigid dressings.
• Early activation after surgery. The patient begins active movements earlier, which improves bone nutrition and avoids contracture (decreased mobility) of the joints. Patients are recommended to move the knee joint and put early weight-bearing on the operated leg.
• Drug treatment of osteoporosis promotes bone fusion.

How to develop a leg after a hip fracture?

Early initiation of rehabilitation allows one to maintain the viability of the blood vessels supplying the femoral head and thereby avoid the development of avascular necrosis. Taking these factors into account, development begins from the first day of treatment.

Recovery without surgery

In order to develop a leg after a hip fracture, the patient’s positive attitude and his belief in recovery are very important. Therefore, if a person is depressed or depressed, psychological help is necessary, especially in old age, when a hip fracture can provoke

Disability due to injuries to the lower extremities accounts for 30 to 40% of total disability due to damage to the bones and joints of the extremities; the first place among them is occupied by disabled people with consequences of lower leg injuries. When conducting a medical and social examination of patients with injuries to the lower extremities, it is necessary to clarify the condition of the uninjured limb, pelvis and lumbar spine, where degenerative-dystrophic processes occur when statics are disturbed. The latter are often observed in cases of irrational employment, which results in failure of compensation and aggravation of disability. At the same time, one of the disadvantages of MSE for injuries of the lower extremities is the overestimation of the severity of the injury and the underestimation of compensation mechanisms.

Disability due to fractures and dislocations of the femur

Fractures of the femoral neck are impacted, often valgus, abduction, and non-impacted - varus, adduction.
Impaction of a femoral neck fracture creates the most favorable conditions for healing with any treatment method. The healing time for fractures is 4-5 months, and restoration of the musculoskeletal function of the limb occurs after 6-8 months.
After a period of temporary incapacity for work, persons engaged in mental, light and moderate physical labor begin to work.
Persons working in professions of heavy physical labor, after completion of treatment, on the recommendation of the Internal Affairs Committee of treatment and preventive institutions, should be temporarily transferred to light work.

Non-impacted femoral neck fractures are subject to surgical treatment. The operation of choice is osteosynthesis with a three-bladed rod. If the operation is effective and there are no complications in the postoperative period, consolidation of the fracture occurs within a period of 6-8 to 10-12 months. The clinical prognosis in such cases is favorable, and patients are considered temporarily disabled during the consolidation period.

Extension of the period of temporary disability beyond 4 months is also indicated for patients who have undergone a second operation 3-4 months after the first due to the identification of such early complications as migration of the rod, secondary displacement of fragments.

When consolidation occurs during a period of temporary incapacity for work, persons engaged in mental work, as well as light and moderate physical labor, are recognized as able to work.

Persons with moderate physical labor require a temporary transfer to light work upon the conclusion of the Inspectorate Commission of medical institutions. Persons with heavy physical labor need rational employment.
If, when transferring to another profession that is not contraindicated for health reasons, a decrease in qualifications occurs, ITU assigns them disability group III.

Complications of a femoral neck fracture are pseudarthrosis and aseptic necrosis of the head.

False joints of the femoral neck are usually formed with non-impacted fractures in patients treated conservatively or ineffectively operated on. Treatment of false joints of the femoral neck is surgical. The fusion of fragments of false joints occurs over a long period of time, and therefore for such patients, during the initial examination at the ITU, it is advisable to determine disability group II.

If, during re-examination, fusion of fragments is established, then the patients’ ability to work is assessed in the same way as with a healed “fresh” fracture.

If the pseudarthrosis is not eliminated and there is a moderate impairment of the SDF (static-dynamic function), the patient is assigned disability group III.

Aseptic necrosis of the femoral head can be a complication with any method of treating a fracture.
In case of aseptic necrosis with slow progression, persons with heavy physical labor are assigned disability group III for rational employment.

With rapid progression of aseptic necrosis, leading to complete loss of limb support, surgical intervention is indicated.

In such cases, disability group II is established.

Fractures of the trochanteric region of the femur (pertrochanteric, intertrochanteric) are treated conservatively and surgically. The time frame for consolidation of fractures, regardless of the treatment method, is 3-5 months.

Restoration of working capacity occurs in persons engaged in mental and light physical labor after 5-6 months, and in heavy physical labor after 6-8 months.

When treating such fractures, especially with a conservative method, post-traumatic deformity in the form of riding breeches is sometimes observed. It does not have a significant effect on work ability, but with significant
loads can lead to deforming arthrosis of the hip joint, which, in turn, may be an indication for the establishment of disability group III.

Treatment of femoral shaft fractures is carried out by intraosseous osteosynthesis or skeletal traction. The average time for consolidation of fractures, regardless of the treatment method, is 4-6 months. The working capacity of persons in professions of mental and light physical labor with an uncomplicated course of the fracture is restored after 6-7 months, and for medium and heavy physical labor - after 8-10 months.

In this regard, during the initial examination at the ITU, patients are shown an extension of the period of temporary disability.
Complications of femoral shaft fractures include delayed consolidation, false joint, deformity with shortening of the limb, and contracture of the joints (mainly the knee).

Delayed consolidation is detected 4-5 months after the start of treatment and serves as an indication for surgery, most often - bone parietal auto- or homoplasty, sometimes with intraosseous or extraosseous osteosynthesis. The duration of treatment for such a complication is extended by approximately 1.5 times, but the prognosis is favorable, and therefore, during the initial examination at the ITU, it is advisable to extend the period of temporary disability.

False joints of the femoral diaphysis require long-term treatment, and their prognosis is often questionable.
Therefore, for patients operated on for pseudarthrosis of the femoral diaphysis, it is advisable to determine disability group II.
The methods of surgical treatment of false joints of the femoral diaphysis are the same as for delayed consolidation. For fibrous pseudarthrosis, extrafocal compression-distraction osteosynthesis is effective.
An unconsolidated pseudarthrosis of the femoral diaphysis with moderate impairment of SDF (stato-dynamic function) serves as an indication for establishing disability group III.

Fractures of the distal end of the femur, periarticular or intraarticular, are most often treated surgically.
Consolidation of fractures occurs within 4-5 months.

Restoration of ability to work in persons with mental work occurs after 5-6 months from the moment of injury, in persons with physical work - after 6-8 months.

With the development of stage III deforming arthrosis of the knee joint, arthrodesis or joint replacement may be performed.

Of the traumatic dislocations of the femur, the most common are posterior dislocations.

After reduction of the dislocation, a long-term, at least 4 weeks, immobilization is required and then a long-term, for 2-3 months, unloading of the limb to prevent aseptic necrosis of the femoral head.

The period of temporary disability for patients of all professions is about 4 months. However, after completion of treatment, persons with heavy physical labor must be transferred to work under lighter conditions for a period of 2-3 months, upon the conclusion of the Institutional Inspectorate of medical institutions.

Old hip dislocations can be reduced quickly. It should be borne in mind that the more time has passed since the injury, the more difficult it is to reduce the dislocation. Surgical reduction 1 month or more after injury is always associated with the risk of developing aseptic necrosis of the femoral head. With unreduced posterior (iliac) dislocation, the dysfunction of the limb is compensated relatively satisfactorily. The ability to work of patients working in professions of mental, light and moderate physical labor is not impaired.

Retraining is indicated for persons employed in professions of heavy physical labor. For the period of rational employment, he is assigned disability group III.

Disability due to internal injuries of the knee joint

In non-operated patients working in professions associated with long walking, forced body positioning, staying at heights, significant physical stress, etc., with repeated joint blockades, there may be indications for determination of disability group III for the period of rational employment.

Treatment of patients with injuries to the cruciate ligaments of the knee joint is surgical. Restoration of joint function occurs after 4-6 months, and therefore patients are advised to extend the period of temporary disability.

With the development of extension-flexion contracture of the knee joint, pathological mobility in it or arthrosis in persons working in contraindicated types and working conditions, disability group III is determined.

Disability due to fractures of the leg bones

The consequences of fractures of the tibial condyles depend mainly on the degree of restoration of the anatomical relationships of their articular surface.

Treatment times, complications, and functional outcomes, as well as assessment of patients' ability to work, are similar to those for fractures of the femoral condyles.

Fractures of the diaphysis of the tibia include isolated fractures of the tibia or fibula and fractures of both bones.

Fractures of the fibula are consolidated in a relatively short time with complete restoration of limb function. Oblique, helical and comminuted fractures of the tibia are treated with skeletal traction or extrafocal osteosynthesis, transverse ones - with a plaster cast. Indications for immersion osteosynthesis may arise in the absence of reposition effect using the indicated methods for oblique, helical and transverse fractures.

The time period for consolidation of tibial fractures ranges from 4 to 6-7 months. Temporary disability for uncomplicated fractures lasts about 5 months for people with mental work and 8-10 months for people with physical work.
The most common and serious complications of tibia fractures are delayed consolidation and the formation of false joints.

If delayed consolidation is observed in a fracture with a satisfactory relationship of fragments, union can be achieved through long-term immobilization with a plaster cast or the use of compression osteosynthesis. Despite the long time required for fracture healing with delayed consolidation, with timely recognition and adequate treatment, the clinical prognosis is favorable.

In such cases, patients should have their periods of temporary disability extended.

If delayed consolidation is due to unsatisfactory alignment of the fragments and open reduction and immersion osteosynthesis with bone grafting are indicated, which is usually performed 4-5 months after the injury and later, it is advisable for patients to be assigned disability group II.

False joints of the tibia in closed and open non-gunshot fractures are more often formed in the form of fibrous and neoarthrosis. When treating fibrous pseudarthrosis, the method of choice is compression-distraction extrafocal osteosynthesis. Consolidation with this method of treatment often occurs within 4-5 months, however, if necessary, patients can have their temporary disability extended.

Due to the uncertainty of the clinical and work prognosis and the length of the rehabilitation period during operations of submersible osteosynthesis and bone grafting, patients are assigned disability group II.

Unrepaired pseudarthrosis of the tibia causes static-functional disorders of varying severity. In most cases, the ability to work of patients with fibrous pseudarthrosis or neoarthrosis of the tibia, especially when patients use fixation devices, is preserved. However, persons working in professions associated with heavy physical stress, long walking and standing, need rational employment and, if necessary, the establishment of disability group III.

Fractures of the distal metaepiphysis of the tibia include complex, usually comminuted, fractures of the tibia metaepiphysis and ankle fractures in various forms.

The treatment period for fractures of this group varies from 4-5 weeks for an isolated fracture of the lateral malleolus to 5-6 months for combined ankle fractures and complex comminuted fractures of the metaepiphysis of the tibia.

In an uncomplicated course, these fractures result in the complete restoration of the patient’s ability to work within 6-7 months, regardless of profession. The most common complications are malunion of intra-articular fractures with disruption of the congruence of the articular surface of the tibia and unresolved subluxations in the ankle joint. These complications lead to the development of deforming arthrosis of the ankle joint, accompanied by static-functional disorders and severe pain, which can serve as the basis for determining disability group III for persons working in professions involving prolonged walking and standing.

In case of early secondary displacement of fragments and subluxations requiring surgical intervention, patients are recognized as temporarily disabled for the period of treatment.

In severe stages of deforming arthrosis of the ankle joint, indications for arthrodesis may arise. This operation, if successful, relieves pain, but does not eliminate static-functional disorders of the limb. Efficiently employed patients retain their ability to work.

Disability due to fractures of the foot bones

During the period of treatment and rehabilitation, patients are recognized as temporarily disabled. Fractures of the same bones with displacement of fragments often require surgical intervention and an increase in treatment time to approximately 4-5 months.

Such injuries are often complicated by deforming arthrosis of the ankle or subtalar joint, which can limit the ability of patients to work in a number of professions, in particular those associated with physical stress, long walking and standing.
For arthrosis of the subtalar joint, subtalar arthrodesis surgery is highly effective, which completely restores the patient’s ability to work.

Severe combined foot injuries, accompanied by dislocations in the joints and loss of skin, usually require long-term and complex treatment, and therefore there are indications for determining disability group II for 1 year. With the consequences of injury in the form of foot deformation, extensive scars on supporting surfaces, patients working in professions associated with heavy physical stress, long walking and standing are recognized as having limited ability to work (disabled group III) for the period of rational employment.

The consequences of complex fractures of the bones of the extremities often require restorative surgical treatment, which, despite the wide possibilities opened up by the use of modern surgical and technical means and bone grafting, does not always achieve the goal.
As measures to ensure improvement of both the supporting and motor functions of the limb, one should point out the advisability of using prosthetic and orthopedic products in the form of splints, fixation devices, orthopedic shoes, which are indicated for delayed consolidation, false joints, shortenings, pathological joint laxity and injuries peripheral nerves.

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A femoral neck fracture (HFF) is a serious injury to the skeletal system, which in many cases leads to disability. Injury is more common in women aged 65-75 years, men are injured less often.

Even minor impact loads on the bone can cause a fracture. Treatment of PSB is a long and complex process that requires complex work of specialists from various fields.

Causes and mechanism of hip fracture in older people

Fractures of the femoral neck in old age are usually pathological in nature and are caused by age-related changes.

Over the years, the level of calcium in the human body, the main building material of bone, giving it strength, decreases. After 40 years, the bone apparatus ceases to renew itself as intensively as at a young age.

The number of developing structural elements of bone (osteons) decreases, and destructive processes accelerate. All this leads to thinning of the bones and increased fragility. The risk of injury increases.

Factors associated with damage to the femoral neck are:

Fractures in older people can occur due to falls from their own height, weak shocks and impacts on surrounding objects. In some cases, the bone can be damaged even with excessive strain on the skeletal muscles.

Symptoms of fractures by type

Symptoms of a femoral neck fracture in the elderly directly depend on the type of fracture. Types of femoral neck fractures:

• Valgus type (the head is displaced upward and outward);
• Varus type (the head is displaced downward and inward);
• Embedded type (a fragment is inside another).

Valgus type

Valgus fractures Femoral necks in older people (in which the angle between the neck and the body of the femur is increased) are characterized by the following clinical signs:

• Dysfunction of the injured limb;
• Pain in the groin (pain syndrome is not always pronounced);
• In a horizontal position, the leg is turned outward;
• The patient cannot turn the leg in the pronal (internal) direction;
• Pressure on the heel of the sore leg or tapping on it leads to an exacerbation of the pain syndrome;
• Subcutaneous hematoma. The symptom occurs several days after the injury. Initially, blood from damaged vessels flows into deep tissues, which cannot be noticed during external examination.

Varus type

For fractures varus type(the angle between the main part of the bone and its body decreases) shortening of the injured leg is added to the above-described set of symptoms. The difference in the length of the limbs does not exceed a few millimeters, so it can only be noticed with careful diagnosis.

Involved fracture

A characteristic sign of an impacted femoral neck fracture in older people, in which the head is immersed in the body of the bone, is the almost complete absence of symptoms. The victim can walk, leg function is not impaired.

In this case, there is minor pain in the groin area. A set of clinical symptoms arises only after a few days, when the injury breaks down and the cervix moves out of the position it occupied after the injury.

A separate type of injury to the femur is a femoral neck fracture in older people. As a rule, the ability to walk is preserved. However, the process of movement may be accompanied by pain of varying intensity. Pain also occurs when trying to palpate the damaged area.

Depending on the location, femoral neck fractures can be: basicervical (in the picture on the left), cervical (middle) and subcapital (right).

Conservative treatment of hip fracture in old age

Conservative treatment is used mainly for horizontal impacted fractures, as well as in young patients. Skeletal traction is not applied to young people. Therapy for a hip fracture involves immobilizing the joint with a cast reaching to the middle of the knee. The period of its use is 3-4 months. The patient retains mobility, but moves on crutches, avoiding stress on the injured limb.

The process of treating such fractures in elderly patients is more long-term and complex.. There is a need for skeletal traction, which is applied for a period of 2 (for non-displaced femoral neck fractures) to 6 months (for displaced femoral neck fractures). In the first case, the weight of the cargo does not exceed 2-3 kg, in the second – 8 kg.

A prerequisite for conservative treatment of femoral neck fractures in the elderly is gymnastics, which must be started within a few days after the injury, adequate care, adequate nutrition, and monitoring the psycho-emotional state of the victim.

Surgery

Surgical treatment of femoral neck fractures is the main method of therapy. Indications for surgery are the following factors:

• Old age of the patient;
• Subcapital fractures (the fracture line passes under the head of the bone);
• A large number of fragments;
• Strong displacement of fragments;
• Aseptic necrosis.

Specialists use 2 tactics of surgical treatment: osteosynthesis and joint replacement.

Osteosynthesis is the mechanical fastening of bone fragments using metal screws or Smith-Petersen nail. In this case, the fixing elements are introduced from the side of the bone body, pass through the fracture line and are screwed into the head.

Osteosynthesis for a hip fracture is suitable for relatively young patients with good bone tissue and adequate regenerative potential.

Surgery for a hip fracture in old age: the endoprosthesis replacement method is more often used, when the damaged joint is completely or partially replaced with a mechanical analogue.

There are unipolar (the femoral head and neck are replaced), bipolar (the head, neck and acetabulum are replaced), and total prosthetics.

Today, bipolar type endoprosthetics is considered optimal, since when using this method there is no increased wear of the articular cartilage.

First aid for a hip fracture

Properly provided first aid for fractures of the femoral neck can significantly shorten the period of subsequent treatment and reduce the likelihood of complications. If you suspect an injury to the thigh and hip joint, you should lay the victim on a flat, hard surface, ensure that the leg is immobile (cover it with bolsters), and apply a splint.

The splint is applied to 2 joints: knee and hip. It is fixed with soft strips of fabric, bandages, and a wide belt. You can additionally fix the leg below the knee. Some care must be taken not to allow the patient's injured limb to move to the side or twist.

In the presence of severe pain, oral (by mouth) administration of non-steroidal anti-inflammatory drugs (ketorol, analgin) is allowed. You should not carry out more complete medical treatment yourself.

A prerequisite for first aid is to call an ambulance and transport the victim to a hospital for further examination and treatment.

Caring for older people with a hip fracture

Treatment of a hip fracture at home necessarily includes daily care for the patient. When caring for elderly patients with a hip fracture, one must adhere to the general rules for working with bedridden patients. If possible, regularly change the position of the patient's body (every 2 hours). When the patient is in skeletal traction, it is recommended to use anti-decubitus mattresses and circles. Particular attention should be paid to hygiene.

The patient is washed daily, the body is treated with dermatoprotective compounds, massaged, the bed is changed and straightened. Camphor alcohol, zinc cream, and specialized oils can be used as a dermatoprotector.

Nutrition for a hip fracture in old age should be high in calories, but easy to digest.

It should be remembered that a bedridden patient with a hip fracture does not experience significant physical exertion, and therefore does not spend a lot of energy. Therefore, you should not abuse the amount of food.

Unused nutrients are stored in the form of fat, which makes recovery difficult.

In the absence of contraindications, the patient should be given up to 2 liters of liquid per day (liquid consumed as part of first courses is also taken into account).

Rehabilitation after a hip fracture in old age

Already from the first days of the postoperative period, rehabilitation measures should be carried out for the patient. This allows you to reduce the risk of complications, speed up recovery, avoid joint contractures, and return the victim’s performance to the level it had before the injury. Rehabilitation is carried out using methods such as:

Exercise therapy for a hip fracture in older people must be carried out under the supervision of a specialist, since too early activity can lead to aggravation of the situation. The exercise is stopped if the patient complains of a sharp increase in pain and deterioration in well-being.

How to develop a leg after an injury

They begin to work on the injured leg while still in bed. To do this, the patient needs to bend and straighten the limb at the hip and knee joint, alternately raise both legs, spread them apart, rotate clockwise and counterclockwise. The load should increase gradually. Impact forces must be avoided. The use of simulators is allowed, but their use must be discussed with the attending physician.

Once the patient is allowed to stand, he should actively take advantage of this opportunity. Initially, the patient walks with a walker, then with crutches.

The duration of walking is gradually increased from a few meters to a kilometer per day or more.

At the last stage of recovery, you can leave only 1 crutch, and then completely abandon it, returning to the normal method of movement. Next, the muscle strength of the leg is restored. The patient can go to the gym or exercise at home.

Consequences and disability of a hip fracture in the elderly

During the treatment of femoral neck fractures, victims often experience complications associated with both a violation of the trophism (supply of nutrients and oxygen) of the bone and a prolonged lying position:

• Aseptic necrosis. Joint tissues die due to insufficient blood supply;
• False joint in a femoral neck fracture - the appearance of a movable connection between the fragments;
• Venous thrombosis and congestive pneumonia - occur as a result of the patient’s low physical activity;
• Arthrosis of the joint is a post-traumatic process of a degenerative nature;
• Postoperative complications: wound infection, failure of the prosthesis, results of medical errors.

Patients who have suffered a fracture of the femoral neck are assigned disability group 2 or 3. This depends on the long-term consequences and the level of decline in the patient's physical capabilities. Elderly people who, due to a fracture, have completely lost the ability to move independently, are assigned disability group 1.

MSE and disability in lower limb fractures
MSE and disability in lower limb fractures
MSE and disability in femoral fractures
MSE and disability in fractures of the lower leg bones
MSE and disability in femoral neck fractures
MSE and disability in hip fracture
MSE and disability in knee joint injuries
MSE and disability in hip dislocations
MSE and disability in pseudarthrosis
MSE and disability in foot fractures

Disability due to injuries to the lower extremities accounts for 30 to 40% of total disability due to damage to the bones and joints of the extremities; the first place among them is occupied by disabled people with consequences of lower leg injuries. When conducting a medical and social examination of patients with injuries to the lower extremities, it is necessary to clarify the condition of the uninjured limb, pelvis and lumbar spine, where degenerative-dystrophic processes occur when statics are disturbed. The latter are often observed in cases of irrational employment, which results in failure of compensation and aggravation of disability. At the same time, one of the disadvantages of MSE for injuries of the lower extremities is the overestimation of the severity of the injury and the underestimation of compensation mechanisms.

Fractures and dislocations of the femur.
There are fractures of the proximal end (femoral neck and trochanteric region), the diaphysis of the femur and the distal end of the femur (supracondylar, transcondylar and condylar fractures). The most common (up to 60%) fractures are the proximal and the least common are the distal (15%) end of the femur.
Fractures of the femoral neck are impacted, often valgus, abduction, and non-impacted - varus, adduction.
Impaction of a femoral neck fracture creates the most favorable conditions for healing with any treatment method. The healing time for fractures is 4-5 months, and restoration of the musculoskeletal function of the limb occurs after 6-8 months.
After a period of temporary incapacity for work, persons engaged in mental, light and moderate physical labor begin to work.
Persons working in professions of heavy physical labor, after completion of treatment, on the recommendation of the Internal Affairs Committee of treatment and preventive institutions, should be temporarily transferred to light work.
Non-impacted femoral neck fractures are subject to surgical treatment. The operation of choice is osteosynthesis with a three-bladed rod. If the operation is effective and there are no complications in the postoperative period, consolidation of the fracture occurs within a period of 6-8 to 10-12 months. The clinical prognosis in such cases is favorable, and patients are considered temporarily disabled during the consolidation period.
Extension of the period of temporary disability beyond 4 months is also indicated for patients who have undergone a second operation 3-4 months after the first due to the identification of such early complications as migration of the rod, secondary displacement of fragments.

When consolidation occurs during a period of temporary disability of a person with mental, as well as light and moderate physical labor are recognized as able to work.
Persons with moderate physical labor require a temporary transfer to light work upon the conclusion of the Inspectorate Commission of medical institutions. Persons with heavy physical labor need rational employment.
If, when transferring to work in another profession that is not contraindicated for health reasons, a decrease in qualifications occurs, ITU sets them III disability group.

Complications of a femoral neck fracture are pseudarthrosis and aseptic necrosis of the head.
False joints of the femoral neck are usually formed with non-impacted fractures in patients treated conservatively or ineffectively operated on. Treatment of false joints of the femoral neck is surgical. Fusion of fragments of false joints occurs over a long period of time, and therefore for such patients, during the initial examination in the ITU, it is advisable to determine Disability group II.
If, during re-examination, fusion of fragments is established, then the patients’ ability to work is assessed in the same way as with a healed “fresh” fracture.
In case of unresolved pseudarthrosis and moderate impairment of SDF (static-dynamic function), the patient is assigned III disability group.

Aseptic necrosis of the femoral head can be a complication with any method of treating a fracture.
In case of aseptic necrosis with slow progression, persons with heavy physical labor are determined III disability group for rational employment.
With rapid progression of aseptic necrosis, leading to complete loss of limb support, surgical intervention is indicated.
In such cases it is established II disability group.

Fractures of the trochanteric region of the femur (pertrochanteric, intertrochanteric) are treated conservatively and surgically. The time frame for consolidation of fractures, regardless of the treatment method, is 3-5 months.
Restoration of working capacity occurs in persons engaged in mental and light physical labor after 5-6 months, and in heavy physical labor - after 6-8 months.
When treating such fractures, especially with a conservative method, post-traumatic deformity in the form of riding breeches is sometimes observed. It does not have a significant effect on work ability, but with significant
loads can lead to deforming arthrosis of the hip joint, which, in turn, can be an indication for establishment of disability group III.

Treatment of femoral shaft fractures is carried out by intraosseous osteosynthesis or skeletal traction. The average time for consolidation of fractures, regardless of the treatment method, is 4-6 months. The working capacity of persons in professions of mental and light physical labor with an uncomplicated course of the fracture is restored after 6-7 months, and for medium and heavy physical labor - after 8-10 months.
In this regard, during the initial examination at the ITU, patients are shown an extension of the period of temporary disability.
Complications of femoral shaft fractures include delayed consolidation, false joint, deformity with shortening of the limb, and contracture of the joints (mainly the knee).

Slow consolidation is detected 4-5 months after the start of treatment and serves as an indication for surgery, most often - bone parietal auto- or homoplasty, sometimes with intraosseous or extraosseous osteosynthesis. The duration of treatment for such a complication is extended by approximately 1.5 times, but the prognosis is favorable, and therefore, during the initial examination at the ITU, it is advisable to extend the period of temporary disability.
False joints of the femoral shaft require long-term treatment, their prognosis is often questionable.
Therefore, for patients operated on for pseudarthrosis of the femoral diaphysis, it is advisable to determine Disability group II.
The methods of surgical treatment of false joints of the femoral diaphysis are the same as for delayed consolidation. For fibrous pseudarthrosis, extrafocal compression-distraction osteosynthesis is effective.
An unconsolidated pseudarthrosis of the femoral diaphysis with moderate impairment of SDF (stato-dynamic function) serves as an indication for establishing III disability group.

Fractures of the distal end of the femur, periarticular or intraarticular, are most often treated surgically.
Consolidation of fractures occurs within 4-5 months.
Restoration of working capacity in persons with mental work occurs after 5-6 months from the moment of injury, in persons with physical work - after 6-8 months.
With the development of stage III deforming arthrosis of the knee joint, arthrodesis or joint replacement may be performed.

From traumatic dislocation of the femur Posterior dislocations are the most common.
After reduction of the dislocation, long-term immobilization, at least 4 weeks, and then long-term, for 2-3 months, unloading of the limb are necessary to prevent aseptic necrosis of the femoral head.
The period of temporary disability for patients of all professions is about 4 months. However, after completion of treatment, persons with heavy physical labor must be transferred to work under easier conditions for a period of 2-3 months, based on the conclusion of the Institutional Inspectorate of medical institutions.

Old hip dislocations are adjusted promptly. It should be borne in mind that the more time has passed since the injury, the more difficult it is to reduce the dislocation. Surgical reduction 1 month or more after injury is always associated with the risk of developing aseptic necrosis of the femoral head. With unreduced posterior (iliac) dislocation, the dysfunction of the limb is compensated relatively satisfactorily. The ability to work of patients working in professions of mental, light and moderate physical labor is not impaired.
Retraining is indicated for persons employed in professions of heavy physical labor. For the period of rational employment, he is assigned disability group III.

Internal injuries of the knee joint.
Internal injuries to the knee include injuries to the menisci and cruciate ligaments.
If the meniscus is damaged, patients are advised to undergo surgery - meniscectomy. Postoperative treatment lasts about 1.5-2 months, and during this period the function of the knee joint usually returns to normal. The working capacity of patients is restored within 2.5-3 months from the moment of injury, but sometimes due to persistent stiffness in the knee joint, the period of temporary disability is extended. Disability does not occur in patients after a timely and uncomplicated meniscectomy.
In non-operated patients working in professions associated with long walking, forced body positioning, staying at heights, significant physical stress, etc., with repeated joint blockades, indications for determining III disability group for the period of rational employment.
Treatment of patients with injuries to the cruciate ligaments of the knee joint is surgical. Restoration of joint function occurs after 4-6 months, and therefore patients are advised to extend the period of temporary disability.
With the development of extension-flexion contracture of the knee joint, pathological mobility in it or arthrosis in persons working in contraindicated types and working conditions, it is determined III disability group.

Fractures of the leg bones.
Fractures of the tibia bones are divided into fractures of the proximal end, which include compression or comminuted fractures of the tibial condyles, the diaphyses of the tibia bones and the distal metaepiphysis of the tibia bones. Among the latter, comminuted compression fractures of the metaepiphysis of the tibia and ankle fractures are of primary importance. The most common fractures are ankle fractures, followed by fractures of the diaphysis of the tibia, and the least common are fractures of the metaepiphyses of the tibia.
The consequences of fractures of the tibial condyles depend mainly on the degree of restoration of the anatomical relationships of their articular surface.
Treatment times, complications, and functional outcomes, as well as assessment of patients' ability to work, are similar to those for fractures of the femoral condyles.
Fractures of the diaphysis of the tibia include isolated fractures of the tibia or fibula and fractures of both bones.
Fractures of the fibula are consolidated in a relatively short time with complete restoration of limb function. Oblique, helical and comminuted fractures of the tibia are treated with skeletal traction or extrafocal osteosynthesis, transverse ones are treated with a plaster cast. Indications for immersion osteosynthesis may arise in the absence of reposition effect using the indicated methods for oblique, helical and transverse fractures.
The time period for consolidation of tibial fractures ranges from 4 to 6-7 months. Temporary disability for uncomplicated fractures lasts about 5 months for people with mental work and 8-10 months for people with physical work.
The most common and serious complications of tibia fractures are delayed consolidation and the formation of false joints.
If delayed consolidation is observed in a fracture with a satisfactory relationship of fragments, union can be achieved through long-term immobilization with a plaster cast or the use of compression osteosynthesis. Despite the long time required for fracture healing with delayed consolidation, with timely recognition and adequate treatment, the clinical prognosis is favorable.
In such cases, patients should have their periods of temporary disability extended.
If delayed consolidation is due to unsatisfactory alignment of the fragments and open reduction and immersion osteosynthesis with bone grafting are indicated, which is usually performed 4-5 months after injury and later, it is advisable for patients to have Disability group II.
False joints of the tibia with closed and open non-gunshot fractures, they form more often in the form of fibrous and neoarthrosis. When treating fibrous pseudarthrosis, the method of choice is compression-distraction extrafocal osteosynthesis. Consolidation with this method of treatment often occurs within 4-5 months, however, if necessary, patients can have their periods of temporary disability extended.
Due to the uncertainty of the clinical and labor prognosis, the duration of the rehabilitation period during operations of submersible osteosynthesis and bone grafting is determined for patients Disability group II.
Unrepaired pseudarthrosis of the tibia causes static-functional disorders of varying severity. In most cases, the ability to work of patients with fibrous pseudarthrosis or neoarthrosis of the tibia, especially when patients use fixation devices, is preserved. However, persons working in professions associated with heavy physical stress, long walking and standing, need rational employment and, if necessary, establishment of disability group III.

Fractures of the distal metaepiphysis of the tibia include complex, usually comminuted, fractures of the tibia metaepiphysis and ankle fractures in various forms.
The duration of treatment for fractures of this group varies from 4-5 weeks for an isolated fracture of the lateral malleolus to 5-6 months for combined ankle fractures and complex comminuted fractures of the metaepiphysis of the tibia.
In an uncomplicated course, these fractures result in the complete restoration of the patient’s ability to work within 6-7 months, regardless of profession. The most common complications are malunion of intra-articular fractures with disruption of the congruence of the articular surface of the tibia and unresolved subluxations in the ankle joint. These complications lead to the development of deforming arthrosis of the ankle joint, accompanied by static-functional disorders and pronounced pain, which can serve as a basis to determine disability group III persons working in professions involving prolonged walking and standing.
In case of early secondary displacement of fragments and subluxations requiring surgical intervention, patients are recognized as temporarily disabled for the period of treatment.
In severe stages of deforming arthrosis of the ankle joint, indications for arthrodesis may arise. This operation, if successful, relieves pain, but does not eliminate static-functional disorders of the limb. Rationally employed patients remain able to work.

Fractures of the bones of the foot.
Among the fractures of the bones of the foot, fractures of the talus and calcaneus or severe combined injuries of the foot have independent expert significance. Fractures of the talus and calcaneus without displacement of fragments heal within 3-4 months; Complete restoration of the musculoskeletal function of the foot occurs after 4-5 months.
During the period of treatment and rehabilitation, patients are recognized as temporarily disabled. Fractures of the same bones with displacement of fragments often require surgical intervention and an increase in treatment time to approximately 4-5 months.
Such injuries are often complicated by deforming arthrosis of the ankle or subtalar joint, which can limit the ability of patients to work in a number of professions, in particular those associated with physical stress, long walking and standing.
For arthrosis of the subtalar joint, subtalar arthrodesis surgery is highly effective, which completely restores the patient’s ability to work.

Severe combined foot injuries, accompanied by dislocations in the joints and loss of skin, usually require long-term and complex treatment, and therefore there are indications for determining II disability group for 1 year. With the consequences of injury in the form of foot deformation, extensive scars on supporting surfaces, patients working in professions associated with heavy physical stress, long walking and standing, are recognized as having limited ability to work for the period of rational employment (disabled group III).

The consequences of complex fractures of the bones of the extremities often require restorative surgical treatment, which, despite the wide possibilities opened up by the use of modern surgical and technical means and bone grafting, does not always achieve the goal.
As measures to ensure improvement of both the supporting and motor functions of the limb, one should point out the advisability of using prosthetic and orthopedic products in the form of splints, fixation devices, orthopedic shoes, which are indicated for delayed consolidation, false joints, shortenings, pathological joint laxity and injuries peripheral nerves.