Treatment and rehabilitation after hip fracture in elderly people. Is disability issued for a hip fracture? What does a patient with a hip fracture look like? Photo

Despite a sufficient number of modern effective treatment methods, hip fractures often lead to complete or partial disability. The main cause of disability is complications after poorly prescribed therapy or medical staff errors during operations.

Is there any disability for a hip fracture?

Disability in the event of a hip fracture provides patients with the opportunity to replace their main activity with light labor and continue working in more suitable conditions. If the victim’s health condition does not allow him to perform even the simplest work, disability gives the right to refuse it. Temporary disability is often prescribed after a hip fracture. In this case, the disability group is removed after a certain period.

A conclusion on the assignment of disability is issued by a medical commission based on the epicrisis of the patient’s disease and the results of additional studies. It is necessary to visit such a commission annually. In case of complete restoration of motor activity and the ability to resume normal daily life, the group is removed. According to the decision of the medical commission, disability can be lifelong.

The group is most often assigned to elderly people. Disability provides the right to receive supplements to your pension, enjoy various social benefits and receive some medications and devices for free to ensure a normal life.

The victim has the right to be assigned a group based on the decision of the medical commission, even if after the operation he is not bedridden, but has the ability to move. The patient still lost his ability to work and cannot be considered a full-fledged worker.

Establishing a disability group for a fracture

Based on the degree of disability, experts distinguish 3 main groups of disability:

First group. It is considered the most severe by the standards of the patient’s physical condition. It is prescribed in cases where the normal functioning of the victim is significantly limited and he cannot care for himself.
Second group. Given with less significant disabilities. Such patients can care for themselves and do not require constant supervision. Disabled people in this group have the opportunity to continue working under special working conditions. They are given additional breaks, the length of the working day is reduced, the production rate is reduced, etc.
Third group. The basis for its appointment is moderate functional impairment and loss of ability to work. Such patients move freely without outside help and can take care of themselves.

The cause of disability is most often the development of complications. For a hip fracture, the group is assigned based on the specifics of the injury and the resulting consequences. The most common scenarios:

The cause of aseptic necrosis of the femoral head can be either radical or drug treatment. If the pathology develops slowly, the third group is assigned. Increased physical activity is contraindicated for patients, so working conditions require significant changes.
With the rapid development of necrosis, when the injured limb completely loses the ability to perform musculoskeletal functions, the patient is given the second group.
In non-impacted fractures, false joints are formed. They can form in patients who refuse surgery, or in cases of unsuccessful surgery. Even in youth, fragments of the false articulation take quite a long time to heal. The likelihood of long-term disability is quite high, and older people often completely lose the opportunity to return to their normal lives. With such a fracture of the femur, disability of the second group is assigned. Over time, the victim's condition may improve. In this case, the group is changed to a third or removed.
The first disability group is assigned to a non-united fracture of the femoral neck, when the patient remains bedridden for the rest of his life.

In the event of complications arising from a hip fracture, disability is due in most cases. The assigned group and duration of disability are determined by MSEC based on the general condition of the patient.

Disability registration procedure

The process of registering disability is quite lengthy. The law prohibits starting to collect documents for a medical commission immediately after receiving an injury. From the moment of injury, the patient must undergo a course of treatment and the necessary rehabilitation, try all possible methods of restoring the musculoskeletal functions of the limb.

Registration of disability begins no earlier than six months after the fracture and only if the prescribed therapy does not bring the expected results.

All treatment methods used are recorded by the doctor in the patient’s outpatient record. Upon completion of therapy and rehabilitation, the patient is issued a certificate, which is provided to the MSEC members for review.

In addition, the victim will need to collect the following package of documents:

referral of the attending physician to undergo an ITU commission;
statement of the results of final examinations after the end of treatment and the recovery period;
patient's outpatient card;
copy of the passport;
working people must provide a notarized copy of their work record book;
patient's application for consideration of the case by the commission.

The collected documents are transferred to MSEC members. The patient may be asked additional questions if representatives of the medical commission doubt the advisability of assigning a disability. In this case, the patient needs to describe his condition as accurately as possible in order to prove to members of the meeting that the injury has significantly affected the change in quality of life.

If the disability registration process is successful, the patient is issued a corresponding certificate and an additional individual rehabilitation program is drawn up. This certificate is provided to the pension fund at the place of residence and to the social protection authorities. Based on the documents provided, the above authorities will assign a pension and benefits.

Actions of the patient if the commission refuses

If, by decision of the MSEC, registration of disability is denied, the patient has the right to write an application for re-examination. A meeting of the commission is convened no later than one month after the application is submitted. The victim can conduct an additional independent examination from doctors who are not directly related to MSEC.

If in this case the registration of disability is refused, the patient has the right to file a claim. The decision of this authority cannot be challenged.

The assigned disability group for a hip fracture depends on the specifics and severity of the injury. The patient will have to undergo an annual examination at MSEC. If his health improves and his performance is restored, the group may be changed or removed altogether.

ITU FOR THE CONSEQUENCES OF INJURY TO THE LOWER LIMB

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 for 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.

Recognized as a fairly severe injury, recovery occurs in no less than 6 months, and some patients, especially people of retirement age, remain confined to walkers or have limited movements for several more years. In this case, people after a fracture are recommended to apply for disability.

From the time of immobilization until the period of complete recovery, the victim is considered incapacitated, and the employing organization must pay so-called sick leave. Only after complete recovery the patient becomes able to work and is ready to begin his usual activities. If we consider the case of heavy physical work, the employee after a fracture should be reassigned to light work.

Establishing a disability group for a fracture

As a result of the fracture, a false joint may form. With this diagnosis, additional surgery is recommended; accordingly, the time of incapacity will be longer. Such groups of victims in the ITU should be defined as people with disability group 2. Also, patients with an initial diagnosis of pseudarthrosis are assigned to group 2.

Disability for a hip fracture is also assigned to victims whose treatment did not require surgery. In case of a fracture of the trochanteric region of the femur, patients are assigned to group 3, and physical work is allowed to begin no sooner than after 8 months from the moment of injury. Over time, ITU may consider removing the disability status if full recovery is possible.

Contents of the article: classList.toggle()">toggle

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.

This
healthy
know!

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.

Disability due to 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 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 for 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.

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.

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.

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

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, 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

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 - 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

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 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.