Surgical treatment of femoral fractures Poland

The femur is the longest and heaviest bone in the human skeleton. It enables movement and proper weight bearing. It also serves as the attachment site for many muscles of the lower limb and the hip girdle. Comprising a shaft, distal end, and proximal end (which forms the hip joint), the femur’s neck connects the head to the shaft, forming two trochanters – lesser and greater. Despite being surrounded by numerous muscles and ligaments, the femur can still fracture due to the impact of significant forces, such as a fall.

Among the most commonly used classifications of femoral neck fractures are those by Garden and Pauwels, which encompass various degrees and types of hip joint injuries. Based on these classifications, the doctor determines the course of treatment.

• I stopień – złamanie z niecałkowitym przerwaniem i bez uszkodzenia warstwy korowej kości,
• II stopień – złamanie całkowite bez przemieszczenia z uszkodzeniem warstwy korowej kości,
• III stopień – złamanie całkowite z częściowym przemieszczeniem kości,
• IV stopień – złamanie z całkowitym przemieszczeniem odłamów kostnych.

The classification of fractures of the femoral neck according to Pauwels is as follows:

• I type – the fracture line along with the horizontal line forms an angle of 30⁰. This provides good treatment prognosis and a low risk of complications.
• II type – the angle ranges from 30-50⁰. Compression forces equal shear forces, resulting in poorer bone healing conditions and a higher likelihood of adverse effects.
• III type – the angle exceeds 50-70⁰. Shear forces significantly outweigh compression forces, posing a high risk of complications in bone union.

Learn more about fractures of the femoral neck here!

Hip fractures, commonly referred to as “hip fractures,” increase with age. They can result from trauma caused by falling on the joint or spontaneous fractures due to advanced degenerative changes. A significant predisposing factor to such injuries is decreased bone mineral density—osteoporosis. It is estimated that every fourth woman over 60 is at risk of developing the condition.

On the other hand, hip fractures are relatively rare in younger individuals. They may result from a traffic accident or participation in injury-prone sports. Other causes of hip fractures include:

• Congenital bone fragility and brittleness,
• Prolonged use of steroids,
• Advanced age and associated limitations (impaired coordination and balance, poor vision and hearing),
• Low estrogen levels,
• Calcium metabolism disorders,
• Neurological disorders,
• Bone tumors,
• Accumulation of microdamage to bone structure,
• Lack of physical activity.

Typical symptoms indicating a hip fracture include:

• Severe pain in the groin and hip region,
• Limited mobility of the limb during passive rotation,
• Deformation of the contours of the hip joint,
• Shortening of the lower limb and its characteristic external rotation position,
• Local tenderness around the hip joint,
• Swelling and bruising.

Persistent symptoms quickly lead to the inability to bear weight on the limb and walk.

Recovery after the procedure is an individual matter for each patient.

Diagnosis of a hip fracture is primarily based on imaging tests, including X-rays in anteroposterior projection. This allows for assessing the fracture gap and the extent of bone fragment displacement. In most cases, this is sufficient for diagnosis; however, sometimes additional diagnostic procedures such as magnetic resonance imaging (MRI) or computerized tomography (CT) may be necessary.

Therefore, based on this, the doctor determines the type of fracture and the extent of damage. They also plan the method for performing the surgical treatment. In addition to imaging diagnostics, the doctor conducts a thorough interview, including questions about the circumstances of the fracture and information about any concurrent medical conditions. The patient also undergoes a consultation with an anesthesiologist, during which they are asked to undergo a set of laboratory tests.

Learn more about the diagnosis

The aim of surgical treatment is to restore the anatomical relationships of the joint as best as possible and achieve stable union, thereby allowing the hip to regain its function. The method of surgical approach depends primarily on the patient’s age, overall health condition, the extent of degenerative processes, and the severity of the fracture. Among the methods of treatment, we distinguish surgical treatment with fracture stabilization and hip arthroplasty, which involves replacing part of the bone with an artificial element.

At Medi Horizon Clinic, hip fracture surgery is performed on most patients under general anesthesia. The duration of the procedure is approximately 2 hours. After the surgery, the patient remains in the clinic under the care of qualified medical staff who continuously monitor their health. In over 90% of patients, hip fracture surgery is performed without complications. The best results are achieved when surgical intervention is undertaken within 12-24 hours of the injury. Comprehensive rehabilitation is essential for returning to functionality.

The rehabilitation program following surgical treatment for a hip fracture must be fully individualized. It depends on various factors such as the patient’s age, accompanying conditions, or the extent of joint damage. Rehabilitation begins as early as the first day after surgery. It focuses on quickly mobilizing the patient to avoid complications associated with prolonged immobilization, such as thrombosis, pneumonia, or infection. Initial physiotherapy procedures include thrombosis prevention and teaching the patient proper crutch walking, stair climbing and descending, as well as educating them on daily activities.

Medi Horizon Clinic collaborates with qualified physiotherapists, ensuring that rehabilitation after hip fracture surgery yields very good results and helps in returning to full mobility. Rehabilitation should continue until the patient achieves normative values in clinical assessments. Full weight-bearing on the lower limb typically occurs around 12 weeks post-surgery. During this time, the goal of rehabilitation is to increase muscle strength and regain full range of motion in the operated joint.