A femoral neck fracture is an injury sustained to the weakest part of the femur bone, the neck. These injuries are usually seen in active young individuals after serious trauma and in elderly populations from falling. That being said, the elderly population is more prone to this injury due to the lack of density and the loss of minerals overtime within their bones.
Femoral Neck Fractures can be devastating and can cause many obstacles in a person’s life. Treatment is a crucial part of rehabilitation of this type of injury. The main goal of treatment is to prevent complications, prevent further progression of the injury, and to have the patient successfully return back to his/her premorbid function. Throughout the patient's treatment there
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is specific short term care and specific long term care that must be done to keep the rehabilitation on the right track. Short term care includes multiple different practices that must be done. It’s important for the patient to start with RICE; Rest, Icing, Compression, and Elevation. RICE helps with swelling and initial repair of the injury. Next the patient may want to use Hip abduction orthosis, which are hip braces, and orthotics to help with rehab. The hip braces will help with stability and replacement of the joint. Though orthotics are placed in shoes to help with foot problems, orthotics help prevent excessive pronation which increases stress on the femoral neck. Lastly, with short term care, if the patient wants to continue physical activity, their training/exercises must be modified. As for long term care surgery may be performed. Types of surgery include restructuring of the hip joint and femoral neck or also hip replacements. With long term care, physical therapy may be needed before and/or after the surgery has been performed. There are three stages of rehabilitation for a femoral neck fracture.
The first two weeks is the acute stage. This is the stage where it is important to control pain and inflammation using RICE and NSAIDS. Improving ambulation skills such as walking, standing, and any movements while using any assistance is also important because it will improve blood circulation and help to prevent any blood clotting. If surgery was performed, the gastrointestinal and urinary tract system is slowed down, so moving around will help improve those systems after surgery. Modes of exercise during this stage includes passive stretching, ankle pumps, passive and active range of motion, and progressing walking with weight bearing using assistance. The subacute stage is two to six weeks. Goals of this phase is to begin to increase mobility, neuromuscular control, functional skills, and continue progressing walking distance with assistance. Using a stationary bike and practicing standing and sitting will help improve mobility. Other modes of exercise include knee lifts with a lateral raise and standing up and sitting down in a chair. The chronic stage is weeks six to twelve aiming to increase hip joint mobility, dynamic control, and ambulation without assistance. Increasing hip joint mobility is important because poor mobility weakens glutes and shortens hip flexors causing the lower back to take over, which could cause back problems. As rehabilitation progresses, the patient may use their discretion …show more content…
to increase weight, begin more difficult exercises, and return to normal activity. The main goals of a rehabilitation program are pretty much the same no matter what the surgical course of treatment is. One of the most important goals that a physical therapist may focus on initially is functional training. Functional training consists of re-educating the patient in activities they do everyday. For example, during the functional training portion of the program a therapist may evaluate and correct the patient's gait pattern as well as specific weight transfers the patient does on a daily basis like getting in and out of a car, or having to sit or stand for long periods of time at their job. It is important to focus on this first because it can alter the way your patient moves as well as it provides a basis for strength training. The best way to do this is to simulate the situation you are trying train and do a great number of repetitions. Another very important aspect to the rehabilitation program is the actual muscle strengthening exercises. Depending on how the hip was fixated or if it was replaced determines what precautions a therapist may have to consider when making an exercise program. To decide what exercises to use for a beneficial rehabilitation program a therapist needs to consider what muscles they need to strengthen. One of many approaches is to start proximally to the injury and work your way distally while grouping them into compartments. Therefore, a possible grouping would be hip/pelvis/core muscles, hip abductors/adductors, quadriceps/ hamstrings, lower leg muscles, then the ankle/foot. Some examples of exercises that strengthen these muscles are bridges, gluteal sets, windshield wipers, heel slides, quad sets, long arc quad, short arc quad, and ankle pumps. All of these exercises can be considered neuromuscular exercises due to the fact that in order to complete these exercises you have to activate neurotransmitters and proprioceptors. A way to enhance the neuromuscular training is by using a Neuromuscular Electrical Stimulation (NMES) to help activate the nerves and neurotransmitters. An alternate way to enhance neuromuscular training is by providing feedback to the patient whether it be tactile, visual, or vocal feedback. After exercising some modalities that a therapist could use would be ice, Premod, Transcutaneous Electrical Nerve Stimulation (TENS) and compression. While rehabbing for the Femoral Neck Fracture, in the hip joint, the athlete may maintain physical activity with other extremities to stay mobile as long as there is no sudden movements in the hip area. The performance of non-weight bearing activities to strengthen the injured hip area should not involve any excess strain or flexion of the hamstring. The patient's gait should be watched and studied to eliminate future complications. Also, to predispose any abnormalities which led to the injury. The athlete may need certain orthotics to render any excess pronation, which could lead to chronic pain in the injured hip area. Neck of the femur fractures are usually seen in the elderly with falls or in younger populations with severe traumas like car accidents.
For the elderly there are a few precautions one can take to reduce the chance of one of these injuries. Staying active and living a healthy lifestyle can go a long way in maintaining bone density and reducing the chances or severity of osteoporosis. Being active does not mean one will not be affected by osteoporosis which is why getting a bone mineral density test is a great idea for the elderly. This test will show how brittle one’s bones are and allow for the patient to plan accordingly. There are medications one can take to influence one’s bone density, calcium supplements help keep bone dense and reduce the chances of fracture of
injury. The femur is the biggest bone in the body and therefore one of the strongest and hardest bones to break. With the elderly at a certain age it might be safer to walk with a walker or a cane to reduce falling and receive help when walking on stairs or simply holding onto a railing. Common sense should be used on a daily basis for example, do not get into a car with a drunk driver. There are thousands of drunk driving accidents with teenagers and young adults get into crashes and are severely injured or killed due to drinking and driving. The phrase “one can never be too safe” comes to mind when thinking about NOF fractures. The rehabilitation is serious and the pain that goes with it is intense, be smart and reduce the chances of injury.
10. What parts of the skeleton are most vulnerable to the ravages of osteoporosis? Since the elderly are at risk of getting osteoporosis especially in older women. The most common are areas of the body to get this disease would be the spine, ribs, wrist, hip and in the arm. Which in this case was the reason Margaret obtained her hip fracture.
Graston instrument-assisted soft tissue mobilization (GITSM) is a tool used by therapist and chiropractors to help break up the scar tissue and replace it with fibroblast allowing for faster recoveries (Black 2010). A series of heat, GISTM, then strength and flexibility training are required (Black 2010). Numerous studies have been conducted, by certified therapist qualified in GISTM, to examine the styles and recovery periods after an injury. After going through the treatment, patients are measured by their range of motion (ROM) to see if the treatments were effective or not (Black 2010). ROM can vary depending on the region of the body that is being treated, but the overall goal of GISTM is to allow a person to get back to their regular routines they had before their injury. A study conducted by Logan College of Chiropractic shows that plantar fasciitis (foot) can be treated by GISTM on the first day of treatment (Daniels and Morrell 2012). Another study by Duke University shows that GISTM can be effective for patients after surgery that had an injury in the Patellar tendon (knee) (Black 2010). After several treatments, GISTM can, also, be used to treat a compression fracture in the lumbar (back) (Papa 2012). Each study shows the method of GISTM, the patient’s recovery period along with the methods of recovery.
A femoral head preserving operation having satisfactory results in long term follow up should be the treatment of choice in younger individuals and THR in elderly where femoral head is badly damaged and in younger patients with multisystem diseases and poor general health. Considering the life style of people of our country who needs squatting habit, decompression of femoral head and TFL muscle pedicle bone grafting is a good option both in early and even in advanced stages of the disease unless the femoral head is badly deformed or collapsed more than 5mm. Considering its technical simplicity compared to the use of other vascularised bone grafts like vascularised fibular or vascular pedicle iliac crest graft, the above method can be recommended in patients of developing countries like ours where osteonecrosis is common.
There are many identifiable risk factors that are both modifiable, and non-modifiable. The gender of the patient is a major risk factor, as women are more likely to develop osteoporosis. Of the almost 50 million Americans diagnosed with osteoporosis, 80% are women. Females at any age have less bone density than males, but in the mid-30's women experience bone loss at a rate of 1% each year (Berarducci, 2008). Walker (2010) adds to the previous statistics, citing around one out of three women over the age of fifty will have a fracture related to osteoporosis, compared to one in 12 men.
In the end, it is all based on preference and financials. Some people may suffice with only some rehabilitation while others would require surgery and it would be in their best interest. It is a decision that should be left to both the patient and doctor. Amanda determined the most efficient way, despite what her doctors said and now she is gearing up for yet another successful soccer season as a senior.
The hospital promised early ambulation following hernia surgery. The hospital facility was designed to encourage movement without unnecessarily causing discomfort. Postoperative regimen designed and communicated by the medical team to patients
Treatment for this condition depends on the type of ankle fracture. Stable fractures are treated with a cast or splint and then crutches to avoid putting weight on the injured ankle. This is followed by an ankle strengthening program. Unstable fractures require surgery to ensure the bones heal properly.
Elderly patients require far more resources medically than younger patients with the same mechanism of injury (Dinh, Roncal, Byrne, & Petchell, 2013), and it is likely due to the deterioration of the body’s systems that come with age. As seen in Fig. 1, the two major causes of death for both sexes from age 65 – 84 are road traffic collisions (RTC) or falls. Figure 1 - The. Major causes of death due to unintentional injury between 2000-2002 (Retrieved from http://www.moh.govt.nz/moh.nsf/pagesmh/5795/$File/older-peoples-health-chart-book-2006-new.pdf).
Osteoporosis is a disease in which the bones become so weak and brittle that even a cough can cause enough stress on the bone that it will cause the bone to facture. The most commonly broken bones are the hip, wrist, and the spine. Although it affects men and women of all races, post-menopausal Caucasian and Asian women are more commonly affected than those of other ethnicities and sexes. In fact, thirty percent of all post-menopausal women in the US and Europe will be diagnosed with Osteoporosis and at least 40 percent of those will suffer from a fracture in their lifetime.
Thus, the recommended treatment for a patient with osteoporosis would receive supplementary calcium (1,000 to 1,500 mg of calcium daily) as confirmed in the National Institutes of Health Consensus Development Conference on osteoporosis in 1984. But studies have shown that as humans age their ability to absorb calcium starts to diminish making this treatment almost ineffective in some elderly patients. Patients of this time, with little treatment options were forced to endure many fracture related injuries; most commonly fractures of the hip which is a very complicated fracture requiring hospitalisation and a surgical practice would be required. Even if the surgery had been successful the patient would not be able to return to the previous levels of activity they were once at; forcing the patient from self-care to supervised living situations/nursing
Type I of OI is the most common, comprising 70% of all cases. Bruising will occur very easily in this type. The bone fragility is considered mild to moderate, and osteoporosis will be present. In this case it is likely that multiple fractures will have occurred before the age of 5.
Osteoporosis was first mentioned by Sir Astley Paston Cooper. Other common symptoms include gum disease, tooth decay, premature graying of hair, arthritis, low back pain, leg cramps, and nail growth. Fragility fracture occurs when a person falls from a standing position or a low height and breaks a bone that would not break in a person with a healthy bone. Heritability of bone mass estimated to account for 60-90% of its variance (Kaczkowsi, 2013).
This Preusser (2008) case study involves a 75 year old female, S.P., who fell at home and is admitted to the orthopedic ward for an intracapsular fracture of the hip at the femoral neck (p. 183). Assessment data includes her height is 5’3”, weight is 118 lbs, blood pressure...
Fibular fractures may be complete or incomplete fractures. Fibula fractures may occur anywhere along the bone. The fracture we are trying to fixate is a complete fracture. Fractures occur when a force is placed on the bone that is greater than it can withstand, and when a fracture does occur in the fibula, it’s usually at the same time as the tibia. When only the fibula fractures, it is usually because of a direct blow to the side of the leg or an extreme sideways bend at the ankle or knee. Some other common causes of fibular fracture include, direct hit from doing contact sports such as hockey or lacrosse, stress fracture; weakening of the bone from repeated stress, or indirect injury, caused by twisting, turning quickly, or violent muscle contraction. Tripping, falling or impact during an accident are also major causes of fibular
Steps that you can take to reduce the chances of getting osteoporosis is consuming at least 3 portions of milk and dairy produce that have reduced fat content. You should also choose vegetables that are high in calcium such as broccoli and cabbage. Another recommendation is try to moderate the amount of alcohol you intake because alcohol can affect the liver which is important with using vitamin D in your body. You should also try to watch how much coffee and soft drinks that you consume a day because they can decrease the amount of calcium absorption which can cause bone loss. You should try to avoid eating lot of salty foods because they can cause your body to lose calcium from the sodium that is within it which can lead to bone loss. Other factors that can help you avoid getting osteoporosis is getting enough physical exercise such as sports and working out because that can improve strengthening your bones, eating fish such as salmon and at least once a week and eating vegetables and fruits at least five times daily because they help get the different nutrients that your body needs to keep it healthy. Smoking also can cause bones to become brittle because it affects your bone density but also affects your lungs which makes it harder to breath which can also can make them to do less physical activities and can also cause them to have poor