Hip fracture: we will survive this trouble

Older people are highly susceptible to injury, especially hip fracture, which is accompanied by pain in the hip joint and impaired weight-bearing function of the affected leg. There are horror stories about this injury, which, unfortunately, have a basis in reality. Indeed, often after a hip fracture, older people become disabled. Therefore, it is extremely important to understand how to recognize an injury, what should be done in such situations, and how to rationally assess the chances of full recovery.

From your height

“Reached for a jar on the top shelf,” “bent over for a stick,” “climbed out of the bathroom” - in old age, these simple everyday situations can result in injuries, the worst of which is a hip fracture.

It must be said that a femoral neck fracture occurs at 40 and 50 years of age, in both men and women. However, according to data from open sources, about 90% of those injured with a hip fracture are people over 60 years of age and, most often, women. The injury is particularly problematic due to the fact that in old age bones heal much less well.

The bones of the elderly are fragile, so most femoral neck fractures in the elderly occur as a result of falling from their own height while walking, running, carelessly moving on stairs, ice, etc.

At the same time, experts point out that the fracture itself is not as dangerous as the complications it can cause. As already mentioned, quite often this injury in the elderly is accompanied by an exacerbation of various diseases, which can put them to bed for a long time and even lead to death.

An accident happened to my grandmother’s sister on the eve of the new year 2021, on December 31 - she tripped and fell at home. An X-ray at the emergency room showed a femoral neck fracture. I had to refuse the operation: severe hypertension and age 84 years. Despite the care of a professional doctor (her niece), the injury literally broke the previously strong-willed woman - she became depressed, became very weak, stopped eating, and died just six months later.

Recovery time after a fracture

Recovery time cannot be accurately calculated, since everything depends on its severity, nature, age of the patient and other factors. But on average they are at least six months. Only after this time will a person be able to stand on the injured limb, completely transferring his body weight to it.

In most cases, the treatment stage is accompanied by the following terms:

On the third day after applying the plaster cast, the patient must begin to massage the lumbar region. Then you should move to the uninjured limb. After a week, you can begin to massage the hip that was injured. This should be done carefully, following the doctor's recommendations.
After two weeks, if the cast is removed, you can begin to move your knee. It is best to do this under the supervision of a doctor and only after his permission. Moreover, in the initial stages the patient will need outside help. After about a month, you can begin to perform flexions and extensions on your own. After 2 months, the patient can attempt to sit down. This must be done according to specialized instructions.
After 3 months, the patient will be allowed to stand up using crutches and begin to move independently. In this case, the support should be on the healthy limb; you can only step lightly on the sore leg.
Gradually, the load on the hip should be increased and after six months you can make attempts to return to a full life.

Neck or skewer?

The upper end of the long femur has a complex structure. The rounding at the end is the head of the bone, the narrower part connecting the head with the body of the bone is the neck, and on both sides of this neck there are bone protrusions - trochanters (the outer one is especially noticeable), muscles are attached to them. The neck is the most fragile part of the femur.

“A neck fracture is one of the fractures of the upper thigh in the elderly, but not the most common,” says Dmitry Khryapin, an orthopedic traumatologist at the traumatology department of the V.V. City Clinical Hospital. Veresaeva. — The most common fracture in older people is a pertrochanteric hip fracture: there were 250 such patients in our department last year. In 2016, 185 people were admitted to the department with hip fractures. Most people call all these fractures fractures of the femoral neck, although the difference between them is very big: a pertrochanteric fracture heals better - the bone always heals - both with and without surgery, but the neck does not always.”

Destruction of the acetabulum

According to statistics, pelvic bone fractures occur in people aged 21-40 years. Their main causes are car accidents and serious domestic injuries. Acetabular fractures account for about 15-20% of all traumatic injuries to the pelvis. They are accompanied by fractures and dislocations of the femoral head.

Comminuted fracture.

Uncomplicated acetabular fractures in young people are treated without surgery. Surgery is required for T-shaped fractures, interposition of fragments in the joint, unreduced fracture-dislocations and massive fractures of the posterior edge of the cavity.

We need to operate!

Geriatricians insist that an elderly person with a hip fracture should be operated on. “In the civilized world, almost 100 percent of older people with a hip fracture undergo surgery,” says Andrei Ilnitsky, head of the department of therapy, geriatrics and anti-aging medicine at the Institute for Advanced Studies of the Federal Medical and Biological Agency. — Risks, of course, exist, as with any other operation. But the risk from not performing the operation and from complications associated with limited mobility is disproportionately higher.”

According to Dmitry Khryapin, about 2/3 of injured patients undergo successful surgery.

“Of the older people admitted to the department with both types of fractures, approximately 70-80 percent were operated on,” says the practicing traumatologist. — The operations were different - this included osteosynthesis, when the bones are connected with screws, and endoprosthetics. Last year we had about two hundred quotas for them and all of them were chosen.” He explained that osteosynthesis operations for the remaining patients were financed from other sources, and for endoprosthetics, according to a planned procedure, patients were sent to other hospitals according to quotas.

Surgical treatment and prosthetics

Surgical intervention is possible only if there are no contraindications associated with age and chronic diseases. During the operation, punctures and fragments are fixed - this leads to faster rehabilitation and restoration of the damaged bone.

Main types of surgical operations:

Osteosynthesis is the fastening of damaged bone elements with special metal structures. Most often, this operation is performed on patients under 65-70 years of age.
Installation of a bipolar prosthesis is prescribed for patients in the age category from 70 to 80 years.
Unipolar hip replacement is considered the best option for elderly patients.

In the process of unipolar endoprosthetics, the femoral head is removed and replaced with an artificial implant. Surgical intervention takes a minimum of time and is considered the safest and most gentle for elderly patients.

For complex, labor-intensive and multi-level surgical procedures, special fixing screws, three-blade nails, and dynamic hip screws can be additionally used.

Grandmother fell: our actions

If the grandmother has fallen and complains of pain, but can walk, albeit with difficulty, complaints about girdling pain around the hip joint, severe pain in the groin, acute or, conversely, dull pain in the joint when walking should alert loved ones. A fracture of the femoral neck may also be indicated by symptoms such as increased pain when moving and tapping on the heel of the injured limb, a slight inversion of the injured leg to the outside, which is noticeable in the foot, the inability to hold the leg in a straightened position (with the ability to bend and straighten the leg) , shortening the leg by several centimeters.

Trouble has happened. An elderly man is in painful shock, then depressed, confused, scared that he will now die forever. What to do?

First of all, he needs to be morally supported and encouraged. In the 21st century, a hip fracture is not a death sentence. Director of the Medical Research Institute Kirill Proshchaev advises: “An elderly person must be told that medicine has changed in almost one generation, and now people with hip fractures undergo surgery and the operation can restore their mobility and their previous way of life.”

Immediately after the injury - before the doctors arrive - you need to provide first aid: place it on a flat surface, fix the leg with a splint so that both the hip and knee joints are captured at the same time. ATTENTION: Doctors prohibit trying to bring the injured leg into a normal position.

It is important to get an injured elderly person to the hospital as quickly as possible, because the faster the necessary medical care is provided, the more effective the treatment will be. For example, during a fracture, hemoglobin drops significantly, blood clots or fatty tissue enter the blood, which can cause complications in the first day or two.

Resolve the issue of surgery with doctors. Typically, they try to perform the operation in the first two weeks after the injury. Unfortunately, in district and regional centers the issue takes longer to resolve - we must try to do everything possible to speed up the day of the operation.

If there is no risk that an elderly person will simply die on the operating table from heart or kidney failure, a sharp drop and surge in pressure, etc., surgical intervention is necessary - fastening the joint or bones with screws (osteosynthesis) or installing a joint prosthesis (endoprosthetics).

“The issue of timing of the operation is decided in each case individually, but we try to operate in the coming days,” explains Dmitry Khryapin. - As I already said. operations are carried out free of charge, for Muscovites according to quotas.”

Symptoms

In older people, fractures are not always accompanied by acute pain and swelling. And even such a severe injury as damage to the femoral neck, in certain cases can occur as an exacerbation of arthrosis or other pathology of the hip joint, which is aggravated by the absence of visible reasons to suspect an injury. However, this delays the diagnosis and worsens the prognosis. Therefore, you should contact an orthopedist-traumatologist if the following symptoms appear:

Pain in the hip or groin area, which may occur at rest and intensify during physical activity, especially when resting on the heel. In some situations, when, as a result of a fracture, the nerve passing through the hip joint suffers due to irritation by bone fragments or compression by swollen soft tissues, the pain may radiate to the heel.
Impairment of the supporting function of the affected leg, up to the loss of the ability to move independently without support or support.
Turning the injured leg outward while calmly remaining in a horizontal position. In this case, the patient cannot turn it to its normal position.
Shortening of the leg is typical for displaced or impacted fractures. But this is usually accompanied by acute pain, which can only be reduced with strong painkillers.
Formation of a hematoma in the thigh or groin area, which results from damage to blood vessels and muscles during a fall or as a result of injury from displaced bone fragments. But in obese elderly people, the hematoma may not appear externally due to the large volume of subcutaneous fat.

In the absence of timely, adequate treatment, the likelihood of developing aseptic necrosis of the femoral head, i.e., its death and gradual resorption, increases sharply.

What happens after the operation

Treatment of a hip fracture is a long process; it makes sense to imagine in advance what and how you will need to plan:

After the operation, the patient is sent to the intensive care unit for some time.

He is given antibiotics and blood thinners for a week.

A pillow is placed between the legs to keep the legs apart.

Almost immediately after the operation, the patient is recommended to move: sit up in bed, do breathing exercises, and perform simple muscle exercises.

3-7 days after the operation, the patient is helped to get to his feet with the help of crutches and begin to move with the assistance of a specialist.

On days 10-12 after surgery, the sutures are removed and the patient is discharged home.

Rehabilitation - it’s important not to be lazy

After discharge, the elderly person and his relatives must continue rehabilitation procedures according to the recommendations of the attending physician. A person must learn to walk again and return his life to normal. You can recover at home under the supervision and care of relatives and caregivers, or in a boarding house for the elderly.

In any case, experts are convinced that an elderly person should become an active participant in rehabilitation.

“In addition to the maximum possible physical activity - breathing exercises, exercises for the arms with and without weights, and others, an elderly person should lead a lifestyle as close as possible to normal: watched the evening news - continue to watch it, used the Internet - continue to use it, studied a foreign language - continue to teach him, crafted, created with his hands - continue these studies. Our task is to create an environment around an elderly person during the period of restrictions on movement that maximally simulates his previous lifestyle,” advises Andrei Ilnitsky.

It happens that older people with similar fractures are lazy to do the exercises prescribed for them to straighten their legs, etc. It is not always possible to motivate and organize them. In this case, specialists will help. “In addition to active movements, you can use passive ones, when a rehabilitation specialist or a person performing his functions takes the limbs of an elderly person in his hands and performs the necessary movements with them,” says Ilnitsky.

Treatment of hip fracture in older people

After confirming a femoral neck fracture and establishing its type, as well as its severity, patients are prescribed conservative therapy or surgery. The choice of specific treatment tactics depends on many factors, including the characteristics of the fracture, the general condition of the patient and the nature of existing chronic diseases.

However, the preferred treatment for hip fractures is surgery. Thanks to the operation, it is possible to achieve faster regeneration of bone tissue and provide the highest possible chance of full recovery. But if the risks of its implementation are too high due to dysfunctions of the cardiovascular system, kidneys, and severe metabolic pathologies that are often found in older people, they stop at conservative therapy.

Also, hip surgery is not performed on persons over 80 years of age or in the presence of psychoneurological disorders. In other cases, the choice can be made in favor of conservative treatment provided that the femoral neck fracture has a horizontal fracture line or is localized directly at the base of the bone.

Because older people often have chronic illnesses, they are more likely to develop complications during recovery. Therefore, they will be advised to obtain consultation from specialized specialists, in particular a cardiologist and pulmonologist. Working with a nutritionist and psychologist will also have a positive impact on the rehabilitation process.

Conservative treatment

Conservative treatment of a hip fracture in the elderly is a long and complex process that requires great patience and courage from the patient and his loved ones.

It is always comprehensive and, depending on the situation, may involve:

Skeletal traction is a procedure that involves slow, smooth stretching of a limb by applying a certain system with weights of different weights to it. As a result, the patient remains bedridden for 2-8 weeks, which is very difficult for elderly patients to tolerate. Therefore, today skeletal traction is used less and less.
Application of a derotational boot, which is a plaster splint that covers the thigh, lower part of the leg, with fixation on the torso and the presence of a transverse bar limiting movement. It is applied to the leg set aside, which ensures the creation of favorable conditions for the alignment of bone fragments and their fusion. In addition, the method allows you to completely immobilize the affected limb, which speeds up the process of regeneration of the femoral neck.
Drug therapy, which consists of taking medications to reduce pain, eliminate the inflammatory process and reduce the likelihood of complications. It consists of prescribing NSAIDs in the form of injections, and then oral medications, diuretics, calcium supplements and chondroprotectors. And in the first days of treatment, novocaine blockades can be performed to relieve acute pain, but only if normal blood pressure levels are maintained. The same drug support is also required after surgery for a hip fracture in older people.
Therapeutic massage of a healthy leg and body, carried out to improve blood circulation and prevent the development of complications that are often found in older people when they remain in bed for a long time. After the formation of a bone callus and discharge from the hospital, it must be continued until complete recovery.
Exercise therapy is an obligatory component of conservative therapy, necessary for the prevention of atrophic changes in muscles and the development of complications in the cardiovascular and respiratory systems. The intensity of exercise increases gradually as the fracture heals. Initially, they begin with breathing exercises conducted under the guidance of an experienced exercise therapy instructor. This method is an effective prevention of the development of congestive pneumonia in bedridden patients. Gradually, the exercise therapy program includes exercises involving uninjured parts of the body, and after discharge from the hospital, the injured leg.

In general, older people who have suffered a hip fracture are forced to stay in the hospital for up to 2 months. But this period is very individual and largely depends on the general condition of the patient.

After removal of the cast or skeletal traction, patients are allowed to move independently, but only with the support of crutches. Such support must be maintained for 4 months and only after that, with the permission of the attending physician, you can try to give minor physical activity to the broken leg.

You can sit down only with the permission of a doctor. As a rule, this is allowed only after 2-4 months of treatment.

Nevertheless, all modern orthopedists and traumatologists agree that prolonged immobilization and bed rest are detrimental for many older people. Immobility leads to the development of various types of complications, including severe pneumonia, which in 15-25% of cases ends in death. Therefore, in order to avoid such disastrous consequences, recently they have been trying to mobilize older people as early as possible.

When choosing the early mobilization method, skeletal traction is applied for only 10 days. After their expiration, the patient is allowed to sit down and hang his legs out of bed, but not move. All this time he receives therapeutic massage sessions, is on medication therapy and does exercise therapy according to an individually designed program. Only after 11 days of observing this regime is the elderly person allowed to get out of bed, but without putting any strain on the injured leg. You can stand and then walk only with crutches.

Early mobilization, for all its advantages, does not ensure bone fusion and the formation of a callus at the fracture site. Therefore, when choosing this treatment method, complete restoration of the function of the affected limb in an elderly person does not occur. Therefore, in the future he will only be able to move around on crutches or in a wheelchair.

Surgery for hip fracture in elderly people

Today, for the surgical treatment of femoral neck fractures in elderly people, 2 methods are used: osteosynthesis and hip replacement. But both of them can be performed only in the absence of the contraindications described above. The most effective method, which gives the best prognosis for recovery, is hip replacement with complete or partial replacement of its components. Osteosynthesis for elderly patients increases the likelihood of bone resorption or the formation of a false joint, which will also cause disability. But it continues to be used in practice due to its lower cost and ease of transfer by patients.

The essence of osteosynthesis is to compare and fix bone fragments with special metal screws, three-bladed Smith-Petersen nails or dynamic femoral screws. They are passed through the base of the femur, neck and head, which ensures reliable fastening of bone fragments and creates favorable conditions for their fusion. They can subsequently be removed, although this step is often abandoned in the treatment of older patients, since it essentially involves another surgical intervention.

When choosing this tactic for treating a fracture of the femoral neck, patients can sit up and then get out of bed shortly after the operation. However, until the fragments are completely consolidated, you can only stand and walk with the support of crutches, and you can sit down no earlier than 1-2 months after the operation. At the same time, how long it will be necessary to adhere to bed rest, walk with support, and when the issue of removing metal fixing structures can be considered is determined strictly on an individual basis by the attending physician. The duration of these time periods directly depends on the patient’s age, the condition of his body as a whole and the speed of recovery.

Immediately after osteosynthesis, patients are prescribed the drug therapy described above, and after 3-5 days, therapeutic massage, exercise therapy, and physiotherapy.

A more modern method of surgical treatment of a femoral neck fracture is endoprosthetics. When it is carried out, there is a significantly better prognosis for the restoration of the supporting and motor function of the injured leg and a significantly lower risk of complications due to the early mobilization of patients, which is carried out 2-3 days after surgery. The essence of the method is to replace only the femoral neck along with the head or the entire hip joint, including the acetabulum, with artificial endoprostheses. But the most favorable prognosis is provided by total endoprosthetics, which implies a complete replacement of the hip joint.

Modern endoprostheses are made from durable, absolutely biocompatible materials that can last 15-25 years.

But an operation of this type cannot always be performed, even if the patient has the desire and ability to pay for it. They try to resort to its help in all cases where there are no contraindications to surgical intervention, including it is performed on all patients over 70 years of age who are able to undergo such a procedure. In general, endoprosthesis replacement is indicated for:

fractures accompanied by the formation of a fracture line under the head;
displaced femoral neck fracture;
aseptic necrosis of the femoral head;
multiple chips resulting from injury;
the presence of a false joint;
arthrosis of the hip joint 3rd degree;
the presence of tumors in the hip joint.

But if there are contraindications for surgical intervention, most often due to the severe course of existing chronic diseases, performing endoprosthetics, despite all its advantages, is too risky.

How to reduce complications

At home, for 6-8 months after surgery, an elderly person must adhere to several rules that reduce the risk of various complications:

do not allow full flexion (or more than a right angle) in the hip joint.
while sitting, place a pillow on the chair so that your knees are lower than your hips;
do not cross your legs - neither sitting nor lying down;
do not lean forward - always stand with a straight, even back;
sit on a chair with your legs slightly apart,
hold on to the railing when going up or down stairs;
Use shoes with non-slip soles and low heels.

When visiting any doctor, you need to inform him about the presence of an endoprosthesis. If you experience pain at the surgical site or fever, you should contact your surgeon immediately.

Do not forget that the endoprosthesis is a mechanism and is subject to wear and tear. It can be made of metal, plastic, ceramics. Depending on the material and load, the prosthesis can last up to 15 years. How to extend its “service life”? It is advisable not to gain weight and try not to lift heavy objects.

In addition, it is better not to engage in active sports (tennis, skiing, etc.), but swimming and walking will not harm an elderly person with an endoprosthesis.

Recovery Features

After treatment in one way or another and consolidation of bone fragments, patients enter a period of rehabilitation, which is carried out at home or in specialized centers. In the first case, older people and their loved ones will need to strictly follow the recommendations received from their attending physician and take prescribed medications. Also shown during this period:

exercise therapy;
massotherapy;
physiotherapy;
diet.

In general, this stage has much in common with conservative treatment for a femoral neck fracture, but does not require immobilization. The duration of recovery largely depends on the chosen method of treatment and the individual characteristics of the patient.

If rehabilitation takes place at home, the injured elderly person will need to purchase a specialized bed with an anti-decubitus mattress and a special frame. If material resources do not allow this, it is necessary to re-equip the existing bed and replace the usual mattress with a harder and higher one. A rope is installed at the foot of the bed, which will act as reins. With its help, the patient will be able to get up and out of bed independently.

Diet is also given a lot of attention. To fully restore the body, you will need to switch to the most balanced diet, which will contain all the necessary minerals, vitamins, amino acids, etc. in proper quantities. Therefore, it is important to provide the elderly person with a varied diet, which will include fresh fruits and vegetables, dairy products, meat and offal, cereals, fish and seafood. At the same time, you will need to avoid spicy, fried, fatty, smoked foods, as well as carbonated drinks, alcohol and coffee.

In order for recovery to proceed as successfully as possible and without complications, patients themselves need to avoid deep bending, sitting on low chairs, sleeping on an injured limb, crossing their legs and some other actions.

Since the rehabilitation period is quite difficult from a psychological point of view even for the most cheerful pensioner, it is important to support him and provide him with interesting leisure time.

The patient’s relatives will need to constantly help him even with basic hygiene procedures, make sure that he does not remain in one position for a long time to avoid the formation of bedsores, regularly change his underwear, etc. It is also important to follow the recommendations received from the doctor and help your elderly loved one perform breathing exercises, Exercise therapy.

To facilitate the patient’s movement, it is worth installing handrails or other supporting structures around the perimeter of the room in which he lives. It is also recommended to carry into it all the things that an elderly person may need and place them so that they are at hand.

A very common problem that many older people face when treating and recovering from a femoral neck fracture is constipation. To avoid its occurrence, it is recommended that the patient drink plenty of fluids and, if necessary, use mild laxatives. At the same time, the toilet should also be converted by installing a special lining on it to increase the height. This will protect the hip joint from excessive stress and re-injury.

It is impossible to operate, to treat

At the V. Veresaev City Clinical Hospital, as Dmitry Khryapin notes, hip replacement is contraindicated for patients who lead an inactive lifestyle and suffer from senile dementia. “We perform osteosynthesis for pertrochanteric fractures for almost everyone,” says the traumatologist. “The contraindications here are acute heart attacks or strokes that occurred simultaneously with the fracture.”

Treatment without surgery consists of caring for the patient - preventing bedsores, pneumonia, etc., as well as activating him - first in bed, and after some time - with the help of a walker.

The main difficulties in treating such fractures are that bone healing takes a very long time (six to eight months), very long bed rest leads to bedsores, varicose veins and other complications, which is why doctors try to reduce it as much as possible.

In the postoperative period and if surgery is not possible, the most effective care can be provided by specialists from boarding houses for the elderly and nurses with medical education.

Contact rehabilitation assistants

Care by relatives almost always loses to professional care, experts say.

At home, after being discharged from the hospital, elderly people often just lie there for a month or two, since relatives cannot care for them. This causes muscle atrophy in the elderly, which provokes a whole chain of problems: the foot may drop, people drag their leg, the load on the knee increases, and since the leg is not fixed, problems with the knee joints begin.

When an elderly person does not get out of bed at all, does not exercise, contracture begins - ossification of the joints, curled legs that cannot be straightened by anything.

If relatives have time to care, then without special knowledge and skills, they often understand their task only in feeding and hygiene procedures. “But an elderly person, first of all, needs not a nurse, but a tireless assistant in activation, who knows at least its simplest methods - physical exercises, intellectual training, methods of auxiliary and substitutive movement, and so on,” says Kirill Proshchaev. – We need to decide whether one of the relatives or a hired specialist will perform the role of such a specialist. And if it is decided that this will be a relative, make the same demands on him as on a hired specialist: he should not show his negative emotions, fatigue, should not be overly compassionate, lament, ooh and ah, and he should always be in front of the elderly person neat, cheerful and energetic. At the same time, the caring relative should have the right to leave and weekends - and the family should provide for these moments - because he has an increased risk of emotional burnout.”

Going again after surgery is realistic

The speed of rehabilitation, says Sergei Sadovsky, executive director of the “Care and Care” network of boarding houses for the elderly, depends on the condition of the elderly person preceding the injury - whether he was independent.

“Usually, if a person was fully self-sufficient before the injury, then lying down is not normal for him and he will try to get up faster. But even elderly people who are already walking can be greatly “slowed down” by the fear that the same thing will happen to the second leg, and they begin to subconsciously feel sorry for the healthy leg and avoid activity.”

As the expert said, at the beginning of summer, a grandmother was brought from the hospital to one of the network’s boarding houses for rehabilitation after surgery on the femoral neck. “A week later she started walking, but overall she stayed with us for less than a month and went home on her own two feet,” says Sadovsky. “And this is one example of many when patients in private boarding houses and nursing homes show more positive dynamics of recovery,” says Sadovsky.

According to him, this grandmother’s stay, along with all consumables, cost the relatives 55 thousand rubles. This is half the price of staying at any resort. “We start with a set of physical exercises, then we help the elderly person sit up, and after a week we put him on a walker, and at the same time a psychologist works with the elderly person,” explains Sadovsky. — Recovery can take from two weeks to 4 months. Early rehabilitation, in a certain sense, is the guarantee that an elderly person will quickly return to normal life, and its duration will be significantly reduced, which is the advantage of professional care in private boarding houses.”

Drug therapy

Drug therapy is prescribed to elderly patients after surgery and conservative treatment. Medications help relieve pain spasms, relieve inflammation and reduce hematoma, and speed up the recovery process.

To eliminate sharp pain, a Novacoin blockade is performed.

It is not prescribed during the period of deterioration in the patient’s well-being, when blood pressure decreases, or when the patient develops a state of shock.

3-4 days after the exacerbation period, injections with non-steroidal anti-inflammatory drugs - Diclofenac or Ibuprofen - are prescribed. After 3-4 days, the injections are replaced with oral medications.

Such medications not only effectively eliminate painful spasms in the area of the injured joint, but also inhibit the further development of the inflammatory process. For complete regeneration of damaged bone elements, drugs from the group of chondroprotectors are prescribed - Dona, Alflutop.

Complivit Calcium D3, Kalcemin, Calcium D3 and other complexes that contain calcium help strengthen bone tissue and stimulate recovery processes. Additionally, diuretics may be prescribed to relieve swelling - Furosemide, Mannitol.

To keep grandma from losing heart, we set small goals.

Sometimes rehabilitation and treatment do not go as quickly as the elderly would like and he loses heart. In this case, Kirill Proshchaev recommends setting the elderly person not the final goal - to walk the same way as before the fracture, but to clearly identify and talk through intermediate goals with him and achieve them.

“Don’t forget to praise for achievement and motivate to move on: for example, this week we managed to walk through a room or ward, let’s go out into the corridor or another room from the windows of which the sunset is visible next week,” explains the expert.

Another equally important question: what to do if for some reason the elderly person did not undergo surgery or he himself refused the operation and he developed apathy and lost the meaning of life and self-confidence.

As Andrey Ilnitsky says, a person who cannot walk on his own can move with the help of substitute means, for example, a stroller. “Many people have moved and are moving this way – from famous politicians, for example, US President Roosevelt, to Paralympians and ordinary people who are in every city,” the expert sums up. “The main thing is to provide an elderly person in a wheelchair with access to go for a walk, to the store, on excursions, to the garden, and so on.”

Reducing the risk of another fall: a safe home, a stick, a familiar route

During the rehabilitation process, it is important to protect the elderly person from another fall. It is believed that a person who has suffered a fracture is already at risk of repeated falls. Experts recommend using a wand and under no circumstances being ashamed of it, remembering the fashion for this accessory in the 19th century.

“The most important thing is to create safe conditions in the house where an elderly person who has undergone trauma and surgery lives, to eliminate risky moments,” Andrei Ilnitsky points out. “These are, for example, carpets with curved corners, poor lighting in the corridor or pantry, furniture on wheels without locks that can move at any time, thresholds between rooms, and so on, and make auxiliary devices - handrails in the bathroom and toilet.”

He also advises relatives to walk with the elderly person several times along the usual routes to the store, to the park, and so on, so that he is convinced that he can go the same way. But next to him, at first, until the person has adapted after the fracture and surgery, is his assistant, who will not let him fall.