Femoral neck, pertrochanteric or intertrochanteric region fracture
Femur is the biggest and strongest bone on the human body. At its proximal part it connects to the pelvis and forms the hip joint and at its distal part it forms the knee joint with lower leg bones. The femur consists of the head of the bone (caput femoris), neck of the bone and two big convexities (trochanter major and minor) at the proximal bone region. Then the body or trunk of the bone follows and at the distal part of the bone there are condylus femoris medialis and condylus femoris lateralis which connect to the tibia and form the knee joint.
Considering the stance of the human race, on two feet, and the fact that the femur connects two extremely important joints of the muscle-skeletal system, the femur takes on significantly big loads through every day activities, but the expansive musculature that surrounds it enables its stability and takes away some of the load from the bone itself. Fractures of the femur occurs when a bending or compressing force is put on the bone. That force is commonly of external nature and too excesive for the bone to handle because the femur is the strongest bone on the body which makes it extremely hard to break.
Femur fractures occur during difficult falls, in car crashes, skiing accidents, heavy objects falling on the leg, etc. Degenerative bone disease, eg. osteoporosis, which cause loss of bone strength and density can increase the risk of femur fractures.
Fractures can be divided according to:
1. PLACE OF THE FRACTURE: proximal part, trunk or distal part femur fracture
2. DIRECTION OF FRACTURE: transversal, diagonal or spiral fractures
3. OPEN OR CLOSED FRACTURES
4. SINGLE OR MULTIPLE FRACTURES
Femur fractures are a common occurrence with elderly who have possible sight problems, loss of muscle strength and balance and therefore loss of bone density and strength and who are more prone to falls leading to the femur bone being fractured.
Symptoms that occur are intense pain, inability to move the leg, stand up or walk, the injured leg could look shorter, damage to the surrounding muscle and tendon tissue as well as to near by blood vessels.
This injury is almost always treated surgically, by putting the bones in their place and using a rod to bind and fixate them together so that they could reconnect and heal properly. After the surgery the leg is put into a cast for a period of 6 weeks to help the healing process. After the immobilisation is removed a progressive functional therapy should be implemented, aimed at regaining of hip and knee range of motion, upper leg muscle strength and knee stability. It is extremely important that the loads are progressively increased, following the doctors instructions regarding them, that the phases of the therapy are not skipped and that the patient is not returning to full activities too early because this can cause the injury to repeat itself.
Prevention: regular physical activity of the elderly population in order to decrease and slow down muscle strength, balance and bone density loss, proper and timely treatment of degenerative bone disease, eg. osteoporosis, etc.
Umer Butt, MD, MRCS (UK), FRCS T&O (UK), Senior Consultant Orthopaedic Surgeon
Rehabilitation program author
Dr Butt is a full time Senior Consultant Orthopaedic Surgeon Specialist in Knee/Shoulder Sports Injury, Arthroscopy and Arthroplasty Circle Bath Hospital UK AO Clinic Centre for Orthopaedic, Trauma and Sports Injury KarachiGo to profile
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