The femur of the thigh is shaped like a “cane”, with a round smooth femur “head” and a slightly thinner femur “neck” together forming the handle of the cane, with the femoral stem under the neck. The beginning of the femoral stem is raised medially and laterally, with the lateral part being larger, called the greater trochanter, which is higher, and the medial part being smaller, called the lesser trochanter, which is lower. The so-called intertrochanteric fracture refers to the fracture between the base of the femoral neck and the level of the lesser trochanter. Wang Bo, Department of Rehabilitation, Songwon Chinese Hospital
Intertrochanteric fracture of the femur is mostly seen in the elderly. After the injury fracture, local pain and swelling are obvious, subcutaneous petechial hemorrhagic spots are visible, the distal fracture segment is pulled by muscles and rotated outward, and the patient cannot get down to stand or walk, which can be diagnosed by x-ray photograph. Fortunately, because of the adequate blood supply to the ramus, it is relatively easy to heal and bone discontinuity rarely occurs. However, if it is not treated properly, it will easily heal malformed and form hip entropion.
The principle of treatment for intertrochanteric fracture is repositioning and fixation. With early surgery and strong internal fixation, the patient can leave the bed and move around to avoid serious complications caused by long-term bed rest. The older the patient is and the more he/she cannot tolerate long-term bed rest, the more important it is to operate as much as possible. Non-operative treatment is mainly traction therapy, which is most suitable for stable fractures without displacement or combined with other diseases, and for those who are weak and cannot tolerate surgery. Regardless of the method of treatment, the patient will have to live in bed for a long or short period of time. Long-term bed rest can cause complications such as bed sores, urinary tract stones, cerebral thrombosis, and pneumonia, which can seriously affect the health of the elderly and even threaten their lives. Therefore, life care and nursing care are especially important.
When traction is performed, it is best for the patient to sleep on a special traction bed with an adjustable bed board and attached pulleys and levers for easy operation and adjustment. For general rest, use a hard bed or taut brown bed with a medium thickness mat. Elevate the injured limb appropriately to promote blood flow back and reduce swelling. During traction, pay attention to prevent hip joint inversion or foot rotation. Do x-ray fluoroscopy frequently to understand the alignment situation and prevent insufficient traction weight or excessive traction. Generally, the joint should be moved only after 8 weeks of traction, and the fracture should heal solidly after 3 months before walking on the ground with the help of crutches.
It is important to turn the patient frequently to prevent long-term pressure on the skeletal prominence from becoming red and erosion and forming decubitus ulcers. If necessary, place air cushions or cotton rings on the sacrococcygeal area and heels. Move the unfixed part of the body as much as possible as long as the injury permits and does not affect the traction or fixation of the injured limb. The amount and manner of exercise should be as directed by the physician.
The patient’s appetite may be affected for a short period of time after injury or surgery, and may be more pronounced in elderly patients, those with weaker constitution or poor mental capacity. Thus, diet should focus on color, aroma and taste to stimulate appetite. In order to enhance overall nutrition, it is appropriate to eat more vegetables rich in vitamin C such as pepper, tomato, amaranth, bok choy, cabbage, radish, etc. to promote fiber scab growth and wound healing.
Patients should learn to use the urinal to defecate in bed. Early fracture due to qi stagnation, the inability to push the transport, often have constipation. It is advisable to eat more vegetables containing fiber, bananas, honey and other foods that promote defecation. If necessary, take laxative drugs, such as marijuana pills, liquid paraffin or senna. Long-term bed rest is prone to urinary tract infection and urinary tract stones, so drink more water as appropriate to diuretic. To prevent pneumonic pneumonia, practice deep breathing and coughing hard. When sputum cannot be released, pat the back for assistance.
When you are bedridden, in addition to washing your face and brushing your teeth daily, you should wash your hair regularly to keep your body clean and comfortable. If bathing is inconvenient, you can take a bath instead. Shirt and pants should be changed frequently to keep the skin clean. The injured limb is inconvenient to wear pants, the blood supply to the toes is poor, and the cold season can be protected by sewing a cotton foot cover.