Fracture of neck of femur (intracapsular)

Pathoanatomy-

These are displaced with external rotation of distal fragments and proximal migration.

Mechanism-

Depending upon age of patient-

Classification-

2. Pauwel’s classification-

It is based on angle of inclination

3. Garden’s classification-

It is based on degree of displacement and severity of fracture

Stage 1- Trabecular bending only no displacement
Stage 2- All segments aligned, trabecular broken between head and neck and undisplaced
Stage 3- All segments are out of alignment, complete fracture and incomplete displaced.
Stage 4- completely displaced

Diagnosis-

Patient complaints of little complain in growing while walking
Inability of weight-bearing following injury like deploying on floor missed step etc.
Can be missed for several days or weeks as there is almost no swelling.
Physical examination-

Complication-

Management-

Conservative management-

Physiotherapy management-

Objective-

To restore Full or at least functional range of motion of hip joint.
To restore adequate strength, power and endurance of muscles around the hip and knee.
To obtain self-sufficiency in performing all the ambulatory activities with walking aids or suitable orthosis whenever necessary.

During immobilization-

Immobilisation can be given by traction, hip spica for pseudoarthrosis.
Proper relaxation positioning by the help of pillows to avoid rotation of limb which can lead to contractures.
Adequate chest PT to avoid respiratory complications
Resistive movements to ankle and toes of affected limb and all joints of unaffected limb.
Strong isometrics of quadriceps, hamstrings, hip extensors and hip abductors for 10-10 seconds to avoid post immobilisation atrophy.
Early knee mobilisation.
Initiate sitting on bed.
Pre gait training exercises on the edge of the bed in supine lying.
Perform quadricep drills in a high sitting.

Mobilization-

Weight bearing and a brief period of full weight bearing on the affected leg alone are very important to balance the whole body weight on the affected leg during standing and walking.
Strengthening of quadriceps and gluteal muscles by progressively resistive exercises
Passive stretching to increase range of motion
Wall supported squatting and cross leg sitting with back supported against wall.

Post operative management-

Week 1-

Assistive side turning in bed by use of pillow between legs to prevent pressure sores
Proper relaxation positioning
Resistive isometrics to gluteus Maximus and quadriceps by pressing down whole leg on the bed
Resistive ankle toe movement and full range of motion of opposite limb.

Week 2 and 3-

Stitches are removed by this time
Begin small range relaxed passive movements.
Self assisted heel drag and range of motion by the help of CPM, knee ratchet, roller skates.

Week 4 to 8-

After 8 weeks-

Increase exercise intensity and reach maximum contractions.
Weight bearing and weight transfer done according to the condition of the patient.
Gait training and limp correction once the pain subsides.

Reference-