Knowledge about intertrochanteric fracture of the femur in advanced age.
Femoral intertrochanteric fracture is a common orthopedic disease, with the arrival of aging in China, so that senior femoral intertrochanteric fracture is often encountered in clinical work, in order to make elderly friends understand the knowledge related to senior femoral intertrochanteric fracture and the prevention and treatment strategy, now from six aspects of the knowledge related to senior femoral intertrochanteric fracture, hope that elderly friends can benefit from it.
I. Treatment strategy of intertrochanteric fracture of the femur in advanced age
Since the intertrochanteric localization is dominated by cancellous bone, the elderly have obvious osteoporosis and are prone to unstable comminuted fractures after injury. At the same time, elderly patients are often accompanied by various medical diseases before the injury, which is risky for elderly patients regardless of the treatment modality. Conservative bone traction and internal fixation surgery cannot achieve the purpose of early bed activity, and their weight-bearing bed activities are predicated on good bony healing of the fracture, while long-term bed rest is prone to serious complications such as pneumonic pneumonia, pressure sores, urinary tract infection, and deep vein thrombosis. The use of artificial joint replacement is an active, effective, and most direct treatment for these fractures, providing early joint movement, and in general, patients can be on the floor within 1 week after surgery (4-6 weeks for patients with internal fixation), reducing the time spent in bed and decreasing the incidence of complications due to prolonged bed rest. The artificial femoral head replacement procedure is the most attractive to orthopedic surgeons and patients because it does not involve bone healing and therefore does not require long-term braking and quicker recovery of hip function after surgery.
Prevention and treatment strategies for complications of high-grade intertrochanteric fractures
In the case of senior femoral intertrochanteric fracture, conservative bone traction and internal fixation surgery cannot achieve the goal of early bed mobility, and long-term bed rest is prone to serious complications such as pneumonia, decubitus ulcer (pressure sore), urinary tract infection and deep vein thrombosis. Therefore, the prevention of perioperative complications of high-grade intertrochanteric fractures is very important, and the main preventive elements include.
1. Prevention of pulmonary infection: When the patient’s condition permits, encourage the patient to expand the chest more, breathe deeply, cough, try to expel sputum, pat the back regularly, do abdominal deep breathing, which helps to expel sputum, and also train to blow balloons, blow blisters, drink more water, and do nebulized inhalation when necessary to prevent pulmonary infection. For patients with pre-existing respiratory diseases, ultrasonic nebulized inhalation should be used to reduce or control the pre-existing diseases by applying preventive measures such as drugs. And to maintain oral hygiene, if necessary, good oral care.
2. Prevention of deep vein thrombosis of lower limbs: Strengthen postoperative observation, listen to the patient’s complaints, and pay attention to the color, temperature and swelling of the skin at the extremity for any abnormalities. Use long elastic stockings for the lower extremities, elevate the foot of the bed, and encourage patients to perform early bed activities of the affected extremities, such as muscle contraction and active forceful flexion and extension of the ankle and toe joints. For those who cannot get out of bed, the patient should be encouraged to actively flex and extend the lower extremity in bed and perform toe flexion and dorsiflexion exercises. For those who are unable to move, the nurse or family members should passively massage the calf muscles to promote blood return. Change the position regularly during bed rest (every 1-2 hours is appropriate). Advise the patient to abstain from smoking to avoid nicotine stimulation of the blood vessels, which can cause venoconstriction. Use anticoagulants according to medical advice.
3. Prevention of decubitus ulcers: Because of poor blood circulation and long postoperative bed rest, decubitus ulcers can easily occur in the sacrococcygeal region, heel, scapula, posterior occipital region and other bony protrusions, so basic care should be strengthened to keep the bed soft, clean, dry and flat. Change the position regularly, massage the pressurized parts, wipe the body with warm water frequently, and clean the perineum after defecation. Enhance nutrition and take nutritious meals that are easy to digest, high in calories, multi-fiber and high in protein. For thin elderly people, use an air ring or use a mattress to prevent bedsores.
4. Prevention of urinary tract infection: Encourage and help patients to be more active, drink more water, and keep the perineum clean. When urinary catheters are placed in postoperative patients, change the urine bag once a day regularly and take care of the urethra orifice once a day, keep the urinary catheter in the correct position, and perform urine routine and urine culture examination regularly. The urinary catheter should be removed on the first postoperative day.
5. Prevention of constipation: Reasonable diet structure, more fresh vegetables and fruits. Postoperative patients resume eating and drinking as soon as possible. The elderly should maintain a daily water intake (including water intake from food) of about 2000 ml, and balance the daily three meals with coarse and fine grains. Reasonable use of sedatives and laxatives.
6. Prevention of potential postoperative complication “dislocation”: explain to the patient and nursing staff the serious consequences of dislocation, raise awareness from the ideological point of view, and obtain the patient’s cooperation. Instruct the patient on the position of the postoperative limb and the method of moving it during bed rest to avoid dislocation. Keep the affected limb in an abducted 30° neutral position with the toe upward, and place a soft pillow or triangular thick cushion between the legs to prevent external rotation of the affected limb and inversion. After the operation, place the potty from the healthy side, pay attention to protect the affected hip joint and avoid external rotation and internal rotation of the replaced hip joint.
7, prevention of accidents: carefully inquire about the history and extent of previous diseases, and cooperate with the doctor to set out the care plan. In addition to orthopedic care for the elderly, we should pay attention to the observation and care of the whole body and be alert to the occurrence of critical lesions. Record the nursing history in a timely manner and take protective care measures in a targeted manner.
Third, fall prevention strategy for the elderly
The 21st century is the era of population aging, and the health and quality of life of the elderly are receiving more and more attention. Falls mark the beginning of the aging process and are an increasingly serious public health event among the elderly population. A fall is a sudden, involuntary change in body position that causes any part of the body (excluding the feet) to “touch the ground” unexpectedly, but does not include falls caused by paralysis, seizures or external violence. Fall prevention aims to objectively assess potential risk factors and develop interventions and exercise programs to reduce the risk of falls without disrupting life. Fall prevention measures for the elderly should include strengthening fall health education, multi-factor fall risk assessment, strengthening exercise and balance function training, improving joint function, overcoming fear of falling, close medication monitoring and active treatment of related diseases, etc.
Fourth, rescue and treatment strategies for the elderly after a fall
After an elderly person falls, the first step is to understand whether the elderly person is injured or not. If moving without assessment, it is easy to cause secondary injuries. In the absence of major injuries, it is advisable for family members to pick up their elders by half-kneeling; direct bending can easily lead to back muscle strain. Along the ground, help the elder to stable furniture, such as closet, dining table, chairs, etc., and rest against the furniture for a few minutes. In addition, the balance of the helper should be sufficient, otherwise there is a risk that even they will fall to the ground. If the fall is extremely painful or feels like a bone bruise, swelling, deformation, bleeding or bleeding, it may be a fracture. In this case, immediate help and emergency medical attention is required.
After a fall, many elderly people are more afraid of activities and gradually reduce their activities, and so on in a vicious circle, gradually losing their activities. Therefore, after the acute treatment of falls in the elderly, family members need to strengthen preventive measures to help the elderly overcome psychological barriers and maintain the function of daily activities.
V. Rehabilitation strategies after artificial femoral head replacement in elderly patients with intertrochanteric fracture
1. Pre-operative psychological rehabilitation education
Elderly patients, with poor psychological tolerance, are afraid to move for fear of postoperative joint dislocation, or are impatient in nature and cannot exercise step by step. If patients are informed of the specific postoperative rehabilitation treatment plan, it will not only make them realize the importance and necessity of postoperative rehabilitation treatment, but also enable them to establish rehabilitation confidence and cooperate with various rehabilitation training correctly and happily.
2.Early postoperative training
Methods.
(1) lying in a flat position with a large pillow placed between the legs, keeping the legs apart and abducted by 30°.
(2) Dorsiflexion and plantarflexion of the ankle joint can be performed 6 hours after surgery, 10 times/min, 10-20 min/time, 6 times/d, to promote blood return to the lower limbs and reduce the chance of deep vein thrombosis, and to instruct patients to practice deep breathing.
(3) To start training bedside sitting up on the second day after surgery, the affected hip should be avoided to be flexed more than 90 degrees, while the affected limb should be kept in an external booth, with both feet placed flat on a small stool at the bedside without weight.
(4) After patients can sit up in bed, encourage self-care activities within their ability, such as washing face, combing hair, changing clothes, eating, etc., in order to increase appetite, improve self-care quality, enhance self-confidence and promote recovery.
3. Post-discharge training
Two weeks after surgery, most patients have been discharged from the hospital. Post-discharge rehabilitation training includes.
(1) Weight-bearing exercises: start partial weight-bearing of the affected limb with the help of abduction, and gradually overtake to full weight-bearing.
(2) Do not cross your legs, do not lie on the affected side, do not sit on sofas or low chairs, do not lean forward when sitting or standing, do not bend over to pick up things, and do not sit on the bed with your knees bent. Carry out functional exercises for abduction, external rotation and internal retraction of the affected hip, so that the strength of the tissues and muscles of the hip joint can be restored as soon as possible.
(3) Up and down stairs exercises: only go up and down one level of stairs at a time, with the healthy limb going up first, followed by the crutches and the affected limb; when going down stairs, the crutches go down first, followed by the affected limb, with the healthy limb following last; both “the healthy limb goes up first and the affected limb goes down first”.
(4) Lifelong follow-up.
VI. Bone health strategy
To prevent osteoporosis, we need to establish a scientific lifestyle: eat a balanced diet, and eat more calcium-rich foods, such as milk, cheese, shrimp, etc.; get proper sunlight, as vitamin D is a key substance that effectively promotes calcium absorption, and sunlight can help the body synthesize vitamin D. In summer, you can let your calves, arms and back get about 20 minutes of sunlight in the early morning and late afternoon; exercise in moderation to increase the body’s balance and coordination, and prevent falls. The body’s balance and coordination ability to prevent falls; annual bone density check.