Diaphyseal fractures of hip

immobilization by Ilizarov
Fig. 29. Immobilization device G. A. Ilizarov

Fractures of the diaphysis hip occur in the upper, middle and lower third of the direct (injury, compression) and indirect (bend, twist) injury. The treatment is carried out by three methods: skeletal traction, surgery (knocking together with a nail or bond to the metal plate) and fixing device, A. Ilizarov (Fig. 29). When applying skeletal traction in the first period of medical physical culture appointed on the 2nd day after the injury. On the background of General developmental and breathing exercises the following exercises: the stretching and bending of the fingers, static tension of the muscles of the hips, lifting the basin, building on foot bent at the knee and hip joints healthy feet and hands. Allowed to sit in bed (at the direction of a physician) using a stair-rod. Special attention is paid to the ability maximum relaxation of the muscles of the thigh. After 5-7 days, when reached the comparison of the fragments (reduced thrust load, the patient is taught to strain the muscles of the thigh, to raise straight leg, which is a sign to the fracture consolidation. I the period of medical physical culture lasts from the moment of fracture until the seam, when you shoot skeletal traction (1,5-2 months). Duration physiotherapy sessions 25-30 min, 4-6 times a day.
The second period starts with the date of withdrawal skeletal traction and continues to fully strengthen bone spur and restore movement of joints (1-1 .5 months). In this period the patient is put on a pair of crutches (the first few days of not stepping on broken leg), learns to walk with crutches on a level surface and the stairs, and then with one crutch or a stick, and later without support. The objectives of physiotherapy II period are: restoring damaged limbs in all joints, muscle tone and proper support to his feet. To solve these tasks are carried out exercises in the different starting positions (lying on the back, sitting, standing at the gymnasium wall, in the foot and therapeutic swimming. Duration 40-50 minutes the Number of repetitions of each exercise 6-10 times; the classes are held 3-4 times a day.
The third period starts from the time when the patient could walk without support, and continues to the full restoration of movements of joints and a normal gait. In the studies included running, jumping, jumps, pereshagivaniya or jumping over obstacles, exercises on coordination, balance, outdoor games, swimming in the pool. The elderly perform these exercises on choice, taking into account their capabilities. Final rehabilitation occurs within 4.5 to 6 months.
In the treatment of diaphyseal fractures of hip operational method in the medullar channel enter a metal rod, the length of which is equal to the length of the thigh. After surgery leg put in a splint of Bellera and appoint exercises: the stretching and bending of the fingers, all kinds of motion foot. On day 2, Methodist, fixing her thigh and the lower leg of the operated leg, helps the patient to bend and straighten her in the knee and hip joints. Yourself sick performs voltage of the thigh muscles. On the 3-4th day he straightened leg lifts within the Methodist supports the thigh and the lower leg), 4-6-I day sits up in bed. On 8-10 th day after the stitches have been removed, the patient raises and lowers straightened leg, bend and extends her in the knee and hip joints, sitting with his feet dangling off the bed, stand, walk on crutches, getting slightly on the operated leg. 3 weeks is allowed to fully move. Some patients in the postoperative period are determined by the curvature of the nail and delayed Union (especially when strictly transverse fractures) as a consequence of early rising and walking. At this time when you walk, you must step on the leg and thereby create vzaimovliyaniya bone fragments, the need for consolidation of a fracture. Conducting exercises in therapeutic swimming pool recommended on 9-10-th day after the removal of the stitches. The final seam fracture, restoration of function and disability come in 4 to 6 months after surgery. The nail is removed after 8-10 months. Terms of renewal of athletic training is prescribed by the doctor individually, but not earlier than one year after the transverse fracture.