First aid for hip fracture should be provided as soon as possible after the detection of the characteristic signs of damage in the victim. This will help to avoid serious complications in the future, as well as to ease the current state of health of the patient until “ambulance” help reaches the scene of the incident.
Experts call the submitted injury format one of the most serious. At the same time, the medical care that should be given to the patient before the arrival of the doctors is a little different from the standard algorithm for fracture of the extremities.
The main problem of such a deviation is considered a high percentage probability of significant blood loss. And it does not matter at all whether it will be a closed fracture or its open alternative. In any case, blood loss leads to a steady deterioration in the overall clinical picture.
If you do not help the victim in time, then the blood loss can be up to one and a half liters. Such a large volume ensures the onset of traumatic shock in the first 10-15 minutes after injury.
To figure out how to best provide first aid, you first need to establish a clear localization of the lesion. During the initial brief examination, even a person far from medicine will be able to "by eye" determine the severity of the pathology, which in the future will allow more qualified help to turn out.
According to statistics, about 6% of all fractures fall on the deformation of the femur, which leads to a violation of the integrity of the femoral neck. Doctors call this part of the skeletal system something of a weak link. Especially often its injuries are diagnosed in older people who have experienced a fall.
During the initial on-site diagnosis, which makes it possible to draw up a subsequent program of emergency measures, it is extremely important to pay attention to several characteristic signs of deviation.
If a person has become a victim of a femoral fracture, then he will not be able to step on the injured leg, and his knee and foot will be turned in the direction of a healthy limb. Also, the condition will be accompanied by a pronounced pain syndrome, which will intensify each time you try to make even a slight movement.
If no external breaks were found, as it happens with an open lesion, then it is worthwhile to additionally conduct an auxiliary test. To do this, you have to gently press on the heel area with a little pressure, or knock on the ankle.
At fracture, the patient will experience a new tide of discomfort, which will confirm the nascent suspicions. Among other items typical symptoms distinguish:
- pain not only in the femur, but also in the joints;
- limited movement;
- a visible change in the shape of the thigh, which is often accompanied by shortening it;
- unnatural mobility in the area of the alleged lesion;
- partial or complete loss of sensation in the peripheral parts of the lower limbs.
If you identify at least one of these dangerous signs, you should immediately call an ambulance. And before her arrival, others will have to try on their own to make the victim feel better.
Regardless of the type of fracture and its severity with the number of affected healthy surrounding tissues, the general scheme of rendering pre-medical measures remains identical.
It provides four main steps:
- prevention of panic;
The first point is especially important, despite the complexity of its implementation. Only to achieve the desired effect can not use local sedatives or alcoholic beverages, issued "for courage." Such variants of development of events will not only aggravate the general condition of the patient, but also prove to be the foundation for smearing the clinical picture. It will become much more difficult for specialists to come to the scene of an accident to diagnose the extent and severity of the damage.
Particular attention should be paid to the behavior of the victim. In this case, crying or swearing - the preferred response of the body, rather than indifference. The latter almost always indicates that a person begins to fall into the stage of traumatic shock, which is almost impossible to overcome with improvised means without doctors.
To prevent the spread of pain shock, it is worth referring to the methods of anesthesia. It is best to use intramuscular injections of anesthetic spectrum. But they are allowed to use only after prior consultation with the doctor on duty in a telephone mode. It is forbidden to prescribe any medication on your own because of the risks of anaphylactic shock or other atypical complications.
The third point of the plan provides for the complete immobilization of the affected part, followed by fixation of the bone structure of the femoral system. This approach is designed to reduce the painful manifestations that make themselves felt even at the slightest movement.
Also correctly performed immobilization can prevent a number of complications that cause bone fragments. The latter is suitable for open fracture with a wound surface and bleeding. Immobilization will help prevent additional breaks:
- major vascular highways;
- nerve roots;
- healthy tissues, involving them in destructive processes.
But here it is categorically forbidden to try to correct the bones independently, or to pull out fragments from the wound, foreign bodies. Often, it is precisely the stuck parts of the skeleton and the fragments caught in the gaping wound that play the role of blocking massive bleeding. It will be more efficient to simply impose a splint in order to fix the skeletal system without a chance for its unintentional movement.
The final point of the strategy should be performed by professionals who take care of the most reliable immobilization without consequences for the patient's health. As soon as the doctors reach the scene, they should be briefed on the circumstances that led to the tragedy, the victim’s current state of health and the measures taken.
The detailed information gathered during the provision of a set of pre-medical measures will allow experts to quickly navigate the situation, as well as build a further plan of action.
Features of immobilization
In order to deliver the victim to the nearest hospital, since the ambulance team cannot reach the destination, it will be necessary to take care of creating the ideal conditions for proper transportation.
Best for immobilization of the victim of a femoral fracture of any format will be the tire of Diterichs, fitted to the human anatomical features. But this version will only work if you have the appropriate medical equipment, so only the arriving doctors on the ambulance often work with specialized tires.
And in the inpatient department of the hospital, the bus should be supplemented with plaster rings. They are imposed on three zones:
In addition, each ring must consist of at least seven layers of bandage together with a plaster solution. In total, five rings are applied to the injured, three of which are fixed on an unhealthy, sore limb, and two go for mounting in the trunk region.
In traveling conditions, such assistants are unlikely to be obtained, which makes immobilization with ladder tires to the forefront of relevance. For first aid, four such tires will fit, the length of each of which should be about 120 cm. In extreme cases, three ladder tools will do.
First, the suitable material will have to wrap with cotton with bandages to make the base softer. If there was no such thing at hand, then even a clean rag or clothes will do.
The first tire is curved strictly at the office of the three main parts of the body:
- femoral surface;
- lower leg
Next, you will need to form a recess for the muscular part of the lower leg and heel area. Separately, it is necessary to ensure that the flexure in the popliteal area occurs taking into account the obligatory adoption of the posture of a slightly bent knee. And the lower end is folded in the shape of the letter "G".
Such a well-thought-out approach will allow the foot to be securely fixed when the ankle is bent, which is strictly at right angles for the convenience of the injured. To complete the work with the first tire, it is necessary to completely cover the entire foot with its lower end. Approximately two centimeters of material should protrude beyond the tip of the toes.
After you are allowed to start laying two other tires. They are tied along the length of each other, while the lower end should repeat the curves of the letter "G" at a distance of about 20 cm from the lower boundary.
An elongated splint should be carried out strictly along the outer surface of the body, starting from the armpit, and ending with the lower limb all the way to the foot. To avoid foot sagging, you need to pre-install the lower curved edge so that it completely covers the foot at the top of the rear tire.
If others are lucky to have on hand the fourth professional stair tire, then it is mounted according to the vector of the internal femoral plane. Lay the material is from the crotch, bringing to the foot. The lower edge also needs to be folded in the shape of the letter “G” to further secure the foot, preventing its anatomical sagging. The edge is wound over the foot at the top of the lower bent border of the outer elongated tire for greater stability. At the final stage, you will need to strengthen everything with gauze bandages.
But sometimes even stair tire elements cannot be found. In such situations, it will be more productive to make a similar construction independently from scrap materials, waiting for the ambulance brigade. As the base used:
- long stick;
- disinfected metal strip that does not bend;
- construction board.
Before starting the manipulation, it is recommended to wrap the found tire substitute with cloth or cotton with bandages to avoid direct contact of the material with bare skin.
On the outer side of the board should be applied, ranging from the armpits and right up to the ankle. On the inner plane, the material is laid first in the groin, and then lead to the end of the lower limb. All parts are systematically fastened to the leg and the body itself.
The presented tactics will allow for more or less stable immobilization to the nearest hospital site. In addition to the goal of neutralizing pain, imposing the tire also works as a guarantee that there is no possible displacement of the bone structures.
Femoral neck fracture
In addition to the traditional femoral fracture, such injuries are often accompanied by impacted integrity of the femoral neck. The principle of first aid here is almost identical. Here it is also forbidden to try to set the bones on our own, as this is the prerogative of an experienced orthopedic surgeon.
Doctors say that hip fracture is more likely to cause more harm with concomitant traumatic shock than with a fracture of the bone structure. In this case, all such fractures will be sorted according to localization into the following types:
- proximal end of the femur;
- distal end of the femur.
The first point includes the deformation not only of the neck itself, but also of the head, or the spit area. In diaphysis, the emphasis is on the destructive effect in the region of the subversive zone, as well as the upper, middle, lower third of the diaphysis itself.
In the case of a diagnosed distal format, epistemmic and interstitial lobes deserve special attention. At the same time, in medical practice, the proximal end fractures are most often revealed.
In professional terminology, there is a separate classification that provides for the division of fractures into basal, transcervical and subcapital. Also, physicians distinguish adduction and abduction versions of damage. The latter are often impacted in nature, which complicates further treatment.
But often, victims are diagnosed with exactly adduction versions of the deformation caused by household injuries like falls during ice.
After the initial examination has been carried out, anamnesis is taken into account. Here it is worth paying attention to how severe the pain is. With impacted injuries soreness may be relatively weak, aggravated only with active actions when changing the position of the joint. In some types of damage, even return to the knee joint is possible, but this is not a mandatory characteristic.
Of the other points, the external rotation and shortening of the unhealthy limb by about 3 cm are noted, and with the impacted variation - 1 cm. But if there is an abduction format, then the problematic limb remains almost the same length as the healthy one, sometimes even stretching a few centimeters. .
To check the condition of the victim, laid in a horizontal position, ask to slightly raise the leg to tear it away from the supporting surface. So it turns out to detect "stuck heel syndrome", if it is the place to be. But even if the victim after a hard mechanical impact on the thigh can walk, it does not mean his normal state of health. Some patients with injected fractures at first can also be active.
Separately are protrocterlone and intertrophilon fractures, which are localized along the length from the base of the neck up to the turning line. They occur because of the fall on the big spit. Against the background of concomitant osteoporosis, which is often diagnosed in older people, the injury takes a more serious turn.
Such breaks in the integrity of bones, skin, and subcutaneous tissue almost never occur without massive blood loss, extensive swelling.
Immobilization in a similar situation is performed using the same Diterichs bus, which is available in the ambulance car, if you inform the dispatcher of suspicions regarding the type of fracture when you call the medics.
After the victim is taken to the inpatient unit of the hospital, the medical staff will immediately begin treatment on the principle of stable functional osteosynthesis. It is considered that the optimal time for carrying out surgical intervention with preservation of a high probability of a successful outcome is the first day. Otherwise, one can tolerate the launch of the mechanism of secondary changes and vascular thrombosis. The latter will clog the supply of nutrients to the femoral head.
This is evidenced by statistics, because only in 22% of all patients with a diagnosed fracture of the femoral neck and subsequent mixing of fragments, the head continues to receive the necessary substances with blood. Cases of ischemia occur in a third of the victims. A large part, which is over 45%, is struggling with avascularity.
In order to prevent the most serious development of events, it is important to be able to provide assistance to the victim immediately, and to guarantee his hospitalization in a short time.