How long does it take for an intertrochanteric fracture of the femur to go to the ground

Intertrochanteric fractures of the femur, mostly in older people. It is mostly caused by the sudden twisting and falling of the lower limbs, or the large bulge landing on the ground, and being directly affected by violent impact. Occasionally, it can be caused by violent contraction of the gluteus medius and gluteus minimus.

The types of fractures are divided into: transtrochanteric type, transtrochanteric comminuted type, and antitrochanteric type. The main symptoms are local pain, refusal to move the affected limb, external rotation and adduction deformity of the affected limb, severe hip swelling, and shortening of the limb.

There are often signs of ascending of the greater tuberosity, and the apex of the greater tuberosity exceeds the iliac line. The point of tenderness is not lateral to the inferior inguinal ligament and the circumflex, but at the greater tuberosity, which is the key point to distinguish it from femoral neck fracture. Mild displacement does not need to be repaired, and the injured limb can be fixed in the outer booth for 4-6 weeks.

If the displacement is large, the steel needle is pulled and reduced, and the affected limb is pulled and pulled in an abduction position of 30-40°, with a traction weight of 6-8 kg. After one week, when the swelling of the high hips such as the bilateral greater tuberosity subsides, it is fixed with an abduction splint to prevent hip varus, 6 weeks to remove traction, 8 weeks to help the crutches to the ground, gradual weight-bearing activities, and 10 weeks to walk without crutches. If the joint stiffness after plaster fixation causes difficulty in extension and flexion, and the difficulty in joint extension and flexion after surgery, apply bone grafting medicine externally to help recovery.

X-rays should be repeated at 45-50 days, and if the cortical bone is connected and callus is formed, it should be put on crutches. Gravity and pressure can facilitate fracture repair.

Analysis:

Hello, how long it will take depends on the recovery situation. In the early stage of fracture, it is advisable to eat more vegetables containing more fiber, and eat some bananas, honey and other foods that promote bowel movements.

Guidance: Bedridden patients are prone to urinary tract infections and urinary tract stones, and it is advisable to drink more water and diuresis. In this period, it is mainly based on relieving pain, removing stasis and renewing, and connecting bones and tendons.

The auxiliary examination methods of this disease are mainly imaging examinations, including X-ray examination, CT examination, and MRI examination

1. X-ray examination

X-rays are routinely used for the examination of this disease, and fractures can generally be detected, but in some special fracture types, such as incomplete fractures and fatigue fractures, because the fracture is not displaced, there are only irregular fractures, which cannot be shown on X-rays. In addition, X-ray images overlap the femur macrotrochanter, small trochanteric line, intertrochanteric line, crest and other bony fold shadows, as well as soft tissue shadows, and fractures are easily missed.

2. CT examination

CT significantly reduced the missed diagnosis rate of femoral neck basal or trochanteric and intertrochanteric fissure fractures, and could show the continuity of the bone cortex and the internal structure of the bone tomography level, but it also caused certain difficulties in diagnosis due to factors such as irregular bone at the femoral neck base or trochanter and intertrochanteric bone, trophic vascular shadow interference, and missed scanning.

3. MRI examination

MRI scans are significantly better than X-rays and CT scans. MRI has obvious advantages for incomplete fractures and fatigue fractures that cannot be shown on X-ray, such as incomplete fractures and fatigue fractures in the basal or trochanteric fissure fractures of the femoral neck. Minor fractures that cannot be shown on x-rays, and bone marrow changes that are shown on MRI.

High sensitivity. However, it is important to note that minor injuries can cause local effusions that resemble fracture shadows. T1 and T2 fracture lines are hypointense, and fat inhibition can improve the diagnosis rate.

However, be aware of volumetric effect artifacts, which can be avoided with thin-slice scanning, and do not use the epiphyseal line as a fracture line.

After the elderly fall, if they fall to the hip joint (commonly known as the large span), they are prone to intertrochanteric fractures, also known as intertrochanteric fractures. There are greater trochanteric (also called greater trochanter) and minor trochanter (also called lesser trochanter) at the proximal end of the femur, and the fracture occurs in between, which is called an intertrochanteric femoral fracture or an intertrochanteric fracture.

The diagnosis of intertrochanteric femoral fracture is as follows: a history of trauma; The hip joint cannot step on the ground; shortened deformity of external rotation of the affected hip; The affected hip is usually bruised and tender; Usually, after the elderly fall, they cannot stand up and walk, and the pain is unbearable.

If the above situation occurs, it is highly recommended that you take the elderly to the hospital for X-ray to understand the condition of the hip joint and make a clear diagnosis.

The best principle of intertrochanteric femoral fracture is: if you can tolerate surgery, try to do surgery, fix the fracture, relieve pain, sit up early, move on the ground, and avoid complications of bed rest (many elderly people die because of fractures: complications of fractures - lung infection, urinary tract infection, bedsores, venous thrombosis of the lower limbs, etc.).

Closed reduction and internal fixation are the most common surgical options, with DHS fixation for stable fractures, intramedullary nail fixation for unstable fractures, and hip replacement for severe comminuted fractures**.

The progress of technology and industry has made the operation simple and fast for doctors, and the operation can be completed quickly and minimally invasive.

Intertrochanteric fractures are common in older people. Due to the abundance of blood vessels in the tuberosity, fractures rarely heal after nonunion, but hip varus is more likely to occur. Long-term bed rest in elderly patients causes more complications.

1.Guard**.

Conservative ** according to whether the patient ** has the possibility of walking on the ground after the patient ** can be classified into two types of methods. For patients who are unable to walk at all, wear "T" shoes or short-term leather traction, provide symptomatic analgesia**, and encourage early sitting. For patients who wish to walk on the ground, supracondylar or tibial tuberosity traction can generally be used, and x-rays can be taken at regular intervals to adjust the weight of reduction and traction as appropriate.

If x-rays show callus formation, change to skin traction or wear "T" shoes for 4 to 8 weeks. Indications for bone traction for intertrochanteric fractures are:

1) Have serious concomitant diseases or early complications, ineffective after 2 weeks of system, and cannot tolerate surgery;

2) The condition improved after the system**, the fracture time was more than 3 weeks, and the patient was unwilling to operate;

3) Patients with acute myocardial infarction, cerebral infarction and cerebral hemorrhage within 3 months, surgery** may induce recurrence;

4) Patients with acute myocardial infarction, cerebral infarction and cerebral hemorrhage within 6 months have a greater risk of surgery and are relative indications.

2.Surgery**.

There are several types of surgical methods for intertrochanteric fractures:

1) External fixation stent Single-arm external fixation stent is a semi-invasive needle external fixation method between surgery and non-surgery, which is suitable for elderly patients with multiple diseases who cannot tolerate surgery.

2) Multiple nails The fixation of multiple needles is the most in line with the biomechanical requirements of the hip, but due to its structural defects, it has shortcomings such as loosening, needle detachment, and no compression on the broken end of the fracture. In order to overcome the above drawbacks, multiple hollow screws are now used instead.

3) Side pegboards.

4) Intramedullary nail system gamma nail; Proximal femoral intramedullary nail (PFN); ③pfn-a。

5) Artificial prosthesis replacement For elderly cases with an estimated life span of less than 10 years for intertrochanteric femoral fractures, as long as their physical conditions can tolerate it, bone cement artificial prosthesis replacement surgery can be selected as a leading method.

1.Has a history of trauma.

2.The above clinical signs and symptoms: pain, tenderness, external rotation deformity, etc.

Fractures may be seen on radiograph.

The most important thing to distinguish this disease from bone and neck fractures is:

Generally speaking, intertrochanteric fractures are more serious than femoral neck fractures due to abundant local blood vessels, obvious ecchymosis, and more severe pain; In the former, the tender point is mostly in the greater tuberosity, and in the latter, the tender point is mostly lateral and inferior to the midpoint of the ventral femoral ligament, which can be identified by x-rays.