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Abstract: The patient was old and frail, walked unsteadily, and experienced hip pain and deformity after a fall. Radiographs were taken to confirm the femoral neck fracture, and sparse femoral neck trabeculae were also found, indicating osteoporosis of the femoral neck, suggesting that the patient had severe bone strength loss. In order to restore the weight-bearing activities of the hip joint and restore the ability to take care of herself, artificial hip joint replacement surgery was performed, after which the patient gradually resumed weight-bearing walking.
Basic information】Female, 80 years old
Disease Type】Femoral neck fracture
Hospital】Harbin First Hospital
Consultation time】February 2022
Treatment plan】Artificial hip arthroplasty + indwelling drainage tube + rehabilitation training
Treatment Period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】Hip pain was relieved, and the range of motion of the lower limbs was restored.
I. Initial consultation
The patient is an elderly female with severe osteoporosis and reduced bone mass, which constitutes the pathological basis of femoral neck fracture. The weakened muscle strength of the lower extremity prevented stabilization of the hip joint, and a twisting action of the hip joint occurred during a fall, which led to a femoral neck fracture. Radiographs were taken to confirm a subtrochanteric fracture of the femoral neck, and also showed osteoporosis of the femoral neck, suggesting the presence of severe bone strength loss. Since the patient had a subtrochanteric fracture, most of the blood supply to the femoral head was cut off and there was a high chance of ischemic necrosis of the femoral head. In order to restore the hip joint movement as soon as possible, surgical replacement of the artificial hip joint was required. Since the patient is old and frail, she should enhance nutrition and correct her general condition before surgery to prepare for the surgery.
II. Treatment history
After the patient and her family fully understood the type of subtrochanteric fracture, they chose the artificial hip joint replacement. After the risk assessment and physical condition adjustment before surgery, the patient met the surgical criteria. Postoperatively, the postoperative position should be positioned in such a way that the lower limbs are not crossed to avoid dislocation of the hip joint. After the operation, the rehabilitation training was started after the pain symptoms were relieved, and the range of motion of the hip joint was restored as well as the weight-bearing walking of the affected limb with the assistance of a walker.
III. Treatment effect
After the artificial hip joint replacement surgery, the patient’s hip pain was relieved, the shortening deformity and external rotation deformity of the lower limb were completely corrected, and the hip joint could be flexed and extended at the same time. The patient was able to gradually complete the walking function with the help of a walker, and was discharged from the hospital at 7 days. After strict rehabilitation, the patient’s basic living ability was restored. After a 3-month postoperative review, the patient’s hip function recovered well, no significant atrophy of the muscles around the hip joint was observed, the length of the lower limbs was symmetrical bilaterally, and no limping symptoms occurred.
IV. Notes
We are glad that the patient’s surgical treatment achieved good results, but the follow-up rehabilitation training needs to be continued. After discharge from the hospital, it is necessary to continue the muscle strength training around the hip joint and hip joint range of motion restoration training according to the guidance of the rehabilitation physician to ensure complete recovery of the hip joint function. Due to the patient’s advanced age and relatively slow blood circulation, regular review of vascular ultrasound is required to confirm the occurrence of lower extremity deep vein thrombosis. The risk period of lower extremity DVT is usually 4-6 weeks after surgery, and the hip function will usually recover completely after 3 months. It is more important to increase nutrition appropriately for patients’ postoperative recovery, and attention should be paid to preventing accidents such as falls and protecting the hip joint to avoid traumatic dislocation of the hip joint.
V. Personal insight
Due to osteoporosis and the weakening of the muscles around the hip joint, the patient lost the protective effect on the hip joint and suffered a femoral neck fracture after a fall. In life, attention should be paid to preventing falls, strengthening bone strength and enhancing muscle strength. Family members should pay attention to strengthen the care of elderly patients in general, avoid walking alone with weight or going to the bathroom, and after many efforts, the hip joint of elderly patients can be fully protected. In addition, this patient should try to avoid being bedridden for a long time to enhance his health.