Fracture of the Femur
The femur is the longest, most voluminous and resistant bone of the human skeleton. Numerous muscles fundamental for the movement of the lower limbs are inserted on it. Articulating at its proximal end with the hip bone, it gives rise to the joint of the same name ( better known as coxofemoral), while its distal epiphysis articulates with the patella and tibia giving rise to the knee joint.
The treatment of a fracture of the femur almost always requires surgical synthesis. Only in the presence of contraindications to this approach can conservative treatment be suggested. In the vast majority of cases, surgery is however essential for survival and functional recovery of the The type of surgery chosen depends, in each case, on the type of fracture.
Fractures of the femur in the elderly
Fractures of the femur in young people and sportsmen
In the "elder
Aftermath
In the elderly, the fracture of the femur is typically localized to the upper extremity (head or neck of the femur), severely limiting the mobility of the limb, which is already compromised by old age. For this reason, the fracture of the femur represents a very serious event; Suffice it to say that about 15-20% of patients with proximal extremity fracture die within one year of the traumatic event. The data are even more alarming if we consider that about 50% of patients partially or totally lose self-sufficiency after suffering this type of injury.
About 75% of hip fractures affect women, for whom the risk of dying from complications is equal to that of passing away from breast cancer.
Unfortunately, the incidence of the disease is increasing and it is expected that by 2030 in Europe there will be about 750,000 new cases a year.
Causes
In the elderly, hip fractures are often caused by a fall or seemingly insignificant trauma. Osteoporosis, tumors or infections can in fact undermine the strength of the bone making it more susceptible to fractures.
For an elderly person, the main risk factors are therefore linked to falls and osteoporosis.
OSTEOPOROSIS AND FRACTURES
"Osteoporosis is a systemic disease (affects all bones) of the skeleton characterized by reduced bone mass and deterioration of the microarchitecture of the bone tissue, with a consequent increase in fragility and predisposition to fractures"
When the fracture of the femur is displaced, that is when the two bone heads lose their natural alignment, it is accompanied by intense pain (which can radiate to the groin) and the inability to move the thigh. The affected limb is adducted (approached to the other), extra-rotated (the foot tends to touch the ground with its external edge) and slightly shorter than the healthy one. Conversely, when the fracture is composed, the patient may experience minor pain in the groin and may even be able to walk.
Diagnosis
The diagnosis of the fracture is entrusted to the observation of the aforementioned clinical signs which will then be confirmed by the radiographic examination. This examination, performed in different projections, allows you to easily identify displaced fractures, while for meshed ones a more careful reading of the radiograms is essential.
Treatment
The therapy of these fractures is essentially surgical, since in its absence the disease would have a "high probability of worsening with localized complications at the fracture site (difficult welding of the fractured heads; necrosis of the femoral head), or generalized, mainly due to to the long period of immobility (bedsores, pulmonary and bladder infections, infections of the veins of the lower limbs).
The surgery is aimed at obtaining an early functional recovery. The technique used depends on the type of fracture and the age of the patient. Generally, if the fracture is located medially, it is displaced and the patient is over 60 years old, we proceed with the application of a total joint prosthesis or of the distal femoral extremity only (endoprosthesis, recommended for patients over 70 years of age).
If the patient is younger, or when the fracture is lateral, osteosynthesis is used, ie a surgical intervention aimed at joining the bone fragments with metal means, such as nails and plates. After the operation it is essential to adopt adequate rehabilitation protocols.
Prevention
Preventing osteoporosis in the elderly and with it fractures of the femur means:
- regularly engage in physical activity;
- get the right amount of calcium with your diet;
- moderate alcohol consumption;
- avoid smoking;
- early diagnosis of the disease.
Falls, on the other hand, are related to the organic deterioration typical of old age. The decrease in balance, muscle strength, reflexes and mental clarity, associated with diseases such as visual disturbances and orthostatic hypotension, is a very important predisposing factor for injury.
In the young and in the sportsman
Thanks to improved bone health, fracture of the femur in young people and sportsmen is a rather rare occurrence.In most cases it is the consequence of a violent traumatic event (road accident); more rarely it can arise from trivial trauma (often in these cases the bone mass and elasticity are undermined by congenital diseases, malnutrition or anorexia) or as a consequence of prolonged and repeated loads. This type of injury is therefore more common among cross-country athletes , especially if female and affected by the so-called triad (a condition characterized by osteoporosis, amenorrhea and eating disorders).
Also in these cases, the fracture of the femur is generally treated with the surgical insertion of screws and plates, in order to promote healing and prevent complications.
