Hip femoral fracture

　　Hip femoral fracture is mainly caused by transmission, shearing, and compressive force. Fractures occur at locations far from the site of force application, rather than at the site where the force is directly applied. The fracture is caused by the force transmitted through conduction, lever, or rotation.

　　When falling, the hip joint is in a flexed and adducted position, the knee lands, and the external force is transmitted along the femoral shaft to the femoral head, which can break through the posterior joint capsule and posterior dislocation. If the hip joint is flexed only 60° or less during impact, the femoral head collides more with the strong bone above the acetabulum, which may cause acetabular fracture or femoral head fracture. The above-mentioned head fracture is caused by shearing and compressive force, and it may also be a patellar ligament avulsion fracture. If the femur is in an abducted and externally rotated position when the knee lands, the upper end of the femur acts like a lever, pushing the femoral head out of the acetabulum, and it may also cause acetabular anterior edge or femoral head fracture. Due to different mechanisms of injury, the difference in fracture type is very large, and it may be accompanied by femoral neck fracture, even hip joint acetabular fracture at the same time.

　　After the complications of hip femoral fracture occur,对症 treatment can be given. If there is significant pain or functional impairment, total hip arthroplasty should be considered. For young osteoarthritis patients, surface replacement surgery can be considered first.

　　1, Ischemic necrosis of the femoral head or fracture fragments.

　　2, Secondary osteoarthritis.

　　Hip femoral fracture patients have swelling and severe pain in the affected hip joint, and the function of the affected hip joint is severely restricted due to pain. This fracture often has hip joint injury, so hip joint posterior dislocation signs may occur, such as lower limb flexion, adduction, external rotation deformity, elastic fixation, limb shortening, or signs of hip joint anterior dislocation may occur.

　　Hip femoral fracture is mainly caused by traumatic factors. The fracture is caused by the transmission, lever, or rotation action of force. Therefore, preventive work should start from daily life, and safety should be paid attention to in daily life.

　　Hip femoral fracture diagnosis, in addition to relying on its clinical manifestations, also needs to rely on auxiliary examination. The anteroposterior X-ray film examination of the femoral head fracture can show the fracture, and CT and three-dimensional image reconstruction can clearly show the displacement of the fracture fragments.

　　Femoral head fracture patients should consume more high-fiber foods as well as fresh vegetables and fruits; a balanced diet, including proteins, sugars, fats, vitamins, trace elements, and dietary fibers, etc., is necessary. Avoid smoking, alcohol, coffee, and cocoa; avoid spicy, hot, and blood-moving foods; avoid moldy, fried, and greasy foods.

　　There are two types of treatment for femoral head fractures: non-surgical and surgical.

　　1. Non-surgical Treatment:For patients with fractures without hip dislocation, if the fracture block does not have obvious displacement or compression, non-surgical treatment can be performed. After the patient has rested in bed for 3 weeks, they can walk with crutches, without bearing weight on the injured limb. Giebel believes that long-term traction should be avoided, otherwise, it is easy to lead to ischemic necrosis of articular cartilage and joint stiffness. For fractures with dislocation, immediate reduction should be performed. During reduction, adequate anesthesia should be used to avoid the use of force, and strive for a successful reduction in one attempt. If two consecutive failures occur, surgery should be considered. After reduction, take X-rays to understand the reduction situation, and perform CT examination to clarify the position, size, and displacement of the fracture block.

　　2. Surgical Treatment:If the fracture block is obviously collapsed, displaced, inserted into the joint space, accompanied by dislocation and failure of manual reduction or associated with nerve injury, immediate open reduction should be performed.

　　Choose the anterolateral or posterolateral approach according to the position of the fracture block, expose the hip joint, and make the femoral head dislocate from the acetabulum. If the bone fragments are small, they can be excised. If the fracture block is large, it should be reduced and fixed with screws. If the fracture block is large and thick, it can be retrograde placed through the extracapsular part of the femoral head with cancellous bone tensile screws. If there are difficulties, only absorbable screws can be inserted in a forward direction, and the screw head should be below the cartilage surface. If the fractured part collapses, it should be lifted and padded with cancellous bone. If the collapsed area exceeds half of the joint load surface, it is difficult to perform internal fixation in comminuted fractures or when there is associated femoral neck fracture, joint replacement surgery should be considered. Before suture, the wound should be flushed repeatedly to avoid leaving cartilage or bone fragments, and a negative pressure drain should be left for 24 to 48 hours.