Surgery for femoral neck fracture in the elderly

The lower limbs of a person are connected to the body at the location of the acetabulum of the pelvic bones. This is possible due to the anatomical structure of the hip. In its upper part, it has a thinning - the neck, which passes into a rounded head, which is inserted into the acetabulum of the pelvis and forms a movable hip joint. The most vulnerable part of the femur is the neck. When elderly people fall, fractures most often occur in this place due to its thinner diameter and age-related fragility of the bones. Since they heal poorly in people over 60, surgery can help with injuries. [ 1 ]

Indications for the procedure

Geriatricians say that every elderly person who has suffered a hip fracture should undergo surgery. Other indications for surgery may include:

• deformation of the hip joint (coxarthrosis stages 3 and 4);
• aseptic necrosis of the femoral head (bone death);
• complete immobility of the joint;
• pseudoarthrosis of the neck (dangling);
• tumor processes.

Preparation

In case of a hip fracture, surgery should not be delayed, as it can lead to dangerous complications. It is usually performed within the first 2 days after the incident.

Preparation for surgery consists mainly of determining the patient's condition and identifying factors that complicate its implementation. The choice of the most optimal treatment method depends on this.

The cardiovascular, respiratory, endocrine and nervous systems are examined, the functionality of the liver and kidneys and the presence of inflammatory foci are determined.

All preparatory measures are aimed at stabilizing systems and organs: blood pressure, blood sugar levels, and blood counts are normalized, heart failure is treated, and respiratory infections and blood clots are prevented.

Before the operation, an assessment of the results of preoperative preparation is mandatory using laboratory and instrumental methods; there should be an improvement in the controlled indicators.

Technique femoral neck fracture surgery

Surgery for a hip fracture at a younger age may involve osteosynthesis – fixing the bone with screws or titanium plates. For older people, there is no alternative to endoprosthetics. It is performed under partial or general anesthesia. [ 2 ]

The essence of the surgical operation is that the damaged bone and cartilage are removed and an artificial prosthesis made of durable high-quality metal is installed in their place. It is strengthened depending on the strength of the bones with or without special bone cement.

Contraindications to the procedure

All existing contraindications are divided into absolute and relative. The former include:

• severe chronic diseases associated with failure of the heart, respiratory organs, kidneys, liver;
• diabetes mellitus and other endocrine pathologies that cannot be corrected;
• HIV infection;
• severe osteoporosis;
• partial paralysis of muscles on the side where the operation is performed;
• mental illness;
• inflammatory process at the site of manipulation;
• technical impossibility of surgical intervention.

Relative factors that prevent surgery include grade III obesity, progressive osteoporosis, and varicose veins.

Consequences after the procedure

Some published studies show that the majority (about 93%) of surgeries were successful, without negative consequences, which means no complications, restoration of joint motor function within a month, and normalization of gait after six months. 4% of cases of endoprosthetics received a "satisfactory" rating (mild consequences), and only 3% ended in either severe complications or death. [ 3 ]

Complications after the procedure

Possible complications after surgery largely depend on the patient's age, health condition, quality of the prosthesis, the doctor's experience, the correctness of postoperative care, the depth and accuracy of the examination before surgery. They can occur both immediately after surgery and over the next few years. Among the complications are:

• dislocation of the implant head, i.e. its falling out of the acetabulum (according to statistics, 15 cases per 1000 operations);
• prosthesis rejection (1.4%);
• thromboembolism (0.3%);
• fractures and cracks of the femur.

Care after the procedure

After the operation, the patient is sent to intensive care, where he is given antibiotics and blood thinners for a week. During this time, the legs should be at some distance from each other, so a pillow is placed between them.

Almost immediately, you need to start moving, sitting on the bed and doing simple physical exercises. After 4-7 days, patients are already on crutches, and after 2 weeks, the stitches are removed and they are discharged home, where they will have to undergo a long period of rehabilitation under the supervision of relatives or a nurse. [ 4 ]

Sometimes it takes up to a year to return to your normal lifestyle. It is necessary to follow some rules to reduce the risk of complications:

• sit with your knees below hip level;
• do not cross your legs;
• when going up or down stairs, hold onto the railing;
• do not lean forward;
• sit with your legs apart;
• stand up with a straight back;
• do not lift heavy objects;
• If your temperature rises or you experience pain, consult a doctor immediately.

It is also important to create safe conditions for movement in the home to eliminate the risk of falls.

For the elderly, professional care is best suited, which can be provided by specialized rehabilitation centers. Here, not only rehabilitation specialists work with patients, but also psychologists who help restore faith in themselves.

Reviews

According to reviews from people who have undergone prosthetic surgery, despite all the risks, its high cost, and the difficult recovery period, this is the only way for elderly people to prolong their lives and get back on their feet.