Las fracturas de fémur: causas, tratamiento y postoperatorio
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The Importance of Preventing Femur Fractures
The hip is the joint formed by the femur and the acetabulum of the pelvis. Thus, when we talk about hip fractures, they are usually fractures of the proximal femur, since they are more frequent than acetabular fractures.
Causes of Hip Fractures
In young patients, they are severe fractures usually following high energy trauma. In contrast, patients older than 65 years are fractures related to osteoporosis and generally due to trauma of low energy or pathological fractures. Fractures of the proximal femur are divided into intracapsular fractures , including the neck and head, and extracapsular or pertrochanteric fractures .
Treatment of femur fracture
The treatment of femoral fractures varies according to the type of fracture:
Intracapsular fractures in young patients should always be attempted osteosynthesis, in order to save the femoral head even with the medium term risk of head necrosis or post-traumatic osteoarthritis. When treatment with osteosynthesis is not possible, total hip prosthesis is the best option. In patients over 65, the synthesis is attempted when the fracture is not displaced. If it is, the treatment of choice is the prosthetic replacement , either with a total prosthesis or with a hemiarthroplasty in which only the femoral part and the head but without acetabular component are replaced.
The extracapsular fractures are more frequent and the treatment of choice is the synthesis of the fracture either with a screw-plate or with an endomedullary nail. The decision between one or the other will depend on the stability of the fracture and the criteria of the surgeon. Treatment with endomedullary nail avoids approaching the fracture site and allows smaller incisions.
Postoperative surgery in femur
According to specialists in Traumatology , the postoperative is also different depending on the age of the patient: in younger patients it is more conservative in allowing the load of the affected limb, while in older patients, apart from being more complex to maintain restrictions should be allowed to regain the ability to walk as soon as possible.
Prevention of femur fracture
The incidence of proximal femoral fractures in Spain over 65 years of age is 511 cases / 100,000 inhabitants / year, while Catalonia is 623 cases / 100,000 inhabitants. The mortality rate in the first year ranges from 4-36%, 25% of patients require institutionalization in geriatric centers and 50% require post-fracture aids.
For these reasons, it is an important issue that requires the management of these patients by multidisciplinary teams that include geriatricians, anesthesiologists and physiotherapists as well as orthopedic surgeons so that the patients can be operated in a short time and in the best medical conditions and then can be mobilized in an early manner with a correct control of the pain to try to integrate to their habitual environment as quickly as possible.
The mechanisms of prevention of osteoporosis are not only pharmacological but that maintaining moderate physical activity, avoiding overweight and a balanced diet can reduce the risk of fracture in the elderly. However, the advice of a specialist for the control and treatment of osteoporosis is advisable.
