The structure of the femur. Pain syndrome of the greater trochanter Features of the structure of the femur

The longest and most massive in the human body is the femur. She is directly involved in the implementation of movements when walking, running. Any injury or deviation from the normal structure will inevitably affect its functions.

Form and structure

In the anatomical atlas, the human skeleton contains two such bones, located to the right and left of the spine. In its natural position, the femur is at an angle to the vertical.

Anatomy describes the following elements that have a different structure:

diaphysis - the middle part of the body of the bone, containing the medullary cavity;
proximal and distal epiphyses (upper and lower, respectively), with well-defined condyles - thickening of the epiphysis;
two apophyses - protrusions, each of which has its own ossification nucleus in the process of osteosynthesis;
metaphyses - areas located between the diaphysis and the epiphysis, providing lengthening of the thigh in childhood and adolescence.

The relatively complex structure is due to the purpose of the human femur and the features of the fastening of the leg muscles. The proximal epiphysis ends with a head, and near its top there is a small rough depression to which the ligament is attached. The articular surface of the head is connected to the acetabulum of the pelvis.

The head crowns the neck, which makes an angle of about 114-153o to the longitudinal axis of the diaphysis (the smaller the angle, the wider the pelvis).

The top of the improvised angle on its outer side is headed by a large trochanter - a prominent tubercle of the femur, which has a hole on the inner surface.

The intertrochanteric line on one side and the intertrochanteric crest on the other connect the lesser and greater trochanters of the femur. The marked formations serve to attach the muscles.

Near the inferior, the lateral and medial lips separate to form the popliteal surface. Approaching the greater trochanter, the lateral lip gradually transforms into the gluteal tuberosity, to which the gluteus maximus is attached.

The medial lip near the superior epiphysis leaves in the direction of the lesser trochanter.

The distal epiphysis widens downwards; two rounded condyles are formed on it, somewhat protruding in the posterior direction. In front between the condyles lies a saddle-shaped deflection, to which, when the knee joint is extended, the patella is adjacent. The rear view allows to distinguish the intercondylar fossa.

Development

X-ray studies are one of the methods for studying the anatomy of the skeleton. Osteogenesis of the femur is a long process, ending by the age of 16-20. The primary point is formed in the diaphysis on the 2nd month of embryo development. Secondary points - at different times.

So, one of them in the distal epiphysis is born in the final weeks of intrauterine development. Between the first and second years of a child's life, the ossification point of the upper epiphysis appears. The greater trochanter begins ossification at the age of 3, and the lesser trochanter begins at the age of 8. Fracture resistance, for which the quality of bone tissue is responsible, is formed at a young age.

fractures

As we age, bones become more fragile.

If it is easier for most young people to avoid serious injury, then the elderly should take care of themselves: the most common fall or abrupt standing on one leg in an attempt to maintain balance can lead to a hip fracture.

Osteoporosis, characterized by low bone density, weakened muscle tone, partial loss of control over the body by the brain, are additional factors that increase the risk of fractures.

The cause of injury in a middle-aged or young person may be a strong blow, a fall from a height, or a car accident.

The development of a bone cyst, the causes of which are difficult to establish today, inevitably weakens the section of the bone.

Symptoms of this phenomenon:

the hip joint hurts a lot when trying to move the leg;
the victim is unable to tear the limb off the floor;
the foot is turned outward.

In some cases, a person may experience pain shock, and with an open fracture, significant blood loss.

Depending on the location of the injury, intraarticular fractures are distinguished (the neck or head of the femur suffers), intertrochanteric and diaphyseal. Pain in these areas, in combination with other symptoms characteristic of each case, may also indicate the presence of:

diseases of bones and joints (osteoporosis, arthrosis, etc.);
neurological disorders;
allergic diseases, gout, tuberculosis.

Fracture diagnosis

Visual assessment will immediately reveal a violation of the integrity of the body of the femur. Hip deformity is obvious if the victim was not lucky enough to be limited to a crack. An open fracture, accompanied by a rupture of soft tissues, establishes an unambiguous prohibition for the patient on any attempts to move the leg.

In cases where the greater trochanter is injured, a swelling is found at the upper epiphysis of the femur.

The main way to identify the clinical picture is research using an X-ray machine.

In addition to determining the type and severity of the fracture, such a study will determine the presence of a crack that is not diagnosed during an external examination, as well as identify how soft tissues have been damaged.

Fracture treatment

The type of treatment given depends on the type of injury.

The crack requires the imposition of a plaster cast, the complete exclusion of physical activity and strict adherence to bed rest. The duration of treatment is regulated by the attending physician;
A fracture in which the head or neck of the femur is affected without displacement is treated with a plaster cast and a pelvic girdle or Beller splint, in order to limit the mobility of the limb as much as possible;
The damping tire is also prescribed for fractures with displacement. The shape of the bone is restored, a pin is inserted into the limb. If attempts to splice fragments were unsuccessful, surgical intervention is necessary;
The treatment of an open fracture differs from that of a closed fracture by measures to prevent infection. Small fragments are eliminated, the rest are put together.

Important! Beller's splint is a device designed for skeletal traction and connection of bone fragments with associated damping (oscillation damping) to ensure limb immobility. The design of the tire is a frame device, weighed down by a load, on which the foot rests.

Healing lasts at least a month. In the process of treatment, periodic, with an interval of about 7 days, X-ray control of the fracture condition is carried out.

Possible complications during treatment

For various reasons, whether it is a genetic predisposition, medical error or the inability to carry out high-quality treatment, abnormal bone fusion may develop from the norm. The patient may be assigned a disability of group II or III.

Improper splicing of fragments can lead to pathology: a false joint or pseudoarthrosis of the femur is formed. This condition is characterized by abnormal mobility in the area of pathology, changes in muscle strength, visible and palpable shortening of the leg. In this case, treatment takes a significant amount of time. Pathology is corrected surgically;
Aseptic necrosis (pathology of blood flow in the artery of the femoral head) is a possible complication of unsuccessful treatment of the femoral neck. It is characterized by pain in the hip joint, which can be projected onto the front surface of the thigh, into the groin area, into the gluteal muscle. If the pain does not subside when taking anti-inflammatory drugs or analgesics, then a hip replacement is prescribed.

In order to prevent possible complications, such as false joint and necrosis, or their timely elimination, it is important to monitor the condition of the injured limb and immediately take the necessary measures.

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Source: https://TravmaOff.ru/kosti/bedrennaya.html

The structure and types of injuries of the human femur

The femur is the thickest and largest component of the skeleton when compared with all other tubular bones located in the human body. All tubular bones affect human movement, so the femoral bone element can also be called a long lever of movement. Based on development, it has apophyses, epiphyses, metaphyses and diaphyses.

Taking X-rays in accordance with the further development of the child, you can see that the ossification point of the femoral head, that is, the epiphysis, appears first. This happens in the first year of development. In the third and fourth years, the apophysis is determined, and in the 9-14th year, the ossification point appears in the lesser trochanter of the bone.

Fusion occurs in reverse order at an older age, from 17 to 19 years.

Anatomy

The head of the femur is connected to the rest of the femur with the help of the neck. The neck is located to the axis of the bone body at an obtuse angle, which ranges from 114 to 153 degrees. In women, a lot depends on how wide their anatomical pelvis is.

If the width is large, the angle approaches a straight line.

There is also a small spit, which is placed at the lower edge of the neck. It occurs on the medial side and slightly behind. The greater and lesser trochanters are connected to each other by a ridge that runs obliquely on the posterior side of the bone.

They are connected on the front surface.

Studying the anatomy of the femur, you can see that her body is slightly arched anteriorly. It is located in a triangular-rounded shape.

The back side of the body has a trace from the muscular attachment of the thigh and consists of a lateral and medial lip. These lips also have traces of attachment of the corresponding muscles, this is noticeable in the proximal part.

At the bottom, the lips diverge. In this place, a smooth triangular platform is formed on the posterior femoral surface.

This is due to the fact that the femoral bone fragment in its natural position is oblique, and its lower end is closer to the midline compared to the upper end. The articular condylar surfaces from the anterior side pass into each other, therefore, a slight concavity is formed in the sagittal direction.

The condyles are separated from each other by a deep intercondylar fossa on the lower and posterior sides. Each condyle on the side has a rough tubercle located above the articular surface.

Damage

The femoral bone element plays an important function in human locomotion. As mentioned above, it is the longest element of all tubular bones.

The length of the femur in adult men is about 45 centimeters, which is about one-fourth of the height. Therefore, its damage significantly affects human activity.

Hip injuries are quite common. The most common of them are fractures, when there is a violation of the anatomical integrity. There are many reasons for this - a fall on a hard object, a direct blow, and so on. Trauma to the femur is almost always severe. It can be accompanied by pain shock and severe blood loss.

Depending on the location, there are three types of femoral fracture:

Trauma to the upper end of the bone;
Damage to the diaphysis;
Fracture of the distal metaepiphysis of the bone, damage to the proximal metaepiphysis may occur.

The clinical picture depends on the specific form of the fracture. In most cases, the victim is unable to lift his heel off the floor.

He feels pain in the hip joint, which becomes especially strong when trying to make not only active, but even passive movements. The leg is slightly rotated outward, adducted.

If a displaced fracture occurs, the greater trochanter is located above the line, which is called Roser-Nelaton. With the help of x-rays, the degree of displacement and the nature of the fracture are specified.

A cervical fracture or medial bone injury is referred to as an intra-articular injury.
A lateral fracture is considered a periarticular injury, however, sometimes the plane of the fracture can penetrate into the joint cavity.

Treatment of hip injuries depends on the nature of the fracture.

If a fracture of the neck of the bone occurs or the head of the femur is damaged without displacement, treatment is based on prolonged immobilization of the limb.

To do this, use the Beller abduction splint or a plaster cast and a pelvic girdle. The immobilization period is from two to three months, and then unloading is done for several weeks.

If a fracture occurs with displacement of fragments, skeletal traction is prescribed, based on the use of the functional Beller splint, provided that the leg is maximally abducted.

A Kirschner wire is passed through the distal metaphysis of the bone. A complication may occur - aseptic necrosis, in which the head of the femur and the bone body are affected.

If conservative treatment fails, fragments are compared surgically.

Fractures of the trochanters may occur.

Types of trochanter fractures

Isolated fracture of the main trochanter. The reason for this is usually a blow or direct injury, in which it is the femur that suffers. In this case, separation occurs along the apophyseal line. The victim feels limited pain during movement and palpation.

There is swelling at the site of the injury. Limb function suffers little. Treatment is based on immobilization in the mid-physiological position. Immobilization can be carried out using a functional Beller splint, or in a plaster splint.

Its duration is about three weeks.

Isolated fracture of the lesser trochanter. This fracture is considered avulsion. Its cause is a sharp and short-term tension of the iliopsoas muscle. This often happens when jumping over a sports equipment that is performed with legs apart. There is pain at the site of injury. The victim cannot bend the leg at the hip joint. Treatment is based on immobilization with a functional splint, which is applied for several weeks.

The most frequent damage occurs to the bone diaphysis. Mostly the middle third suffers. Such injuries occur due to direct and indirect injuries, most often during active games and when falling from a height. The level of the fracture determines its type.

Types of diaphyseal fractures High diaphyseal fractures. In this case, the central fragment is located in the position of abduction, external rotation and flexion, as the iliopsoas and gluteal muscles are reduced. Abduction is more pronounced depending on the proximal level of the fracture. The distal fragment is displaced inwards, backwards and upwards.
Injuries of the middle third. The central fragment is displaced medially due to the adductor muscles of the thigh. The peripheral fragment is displaced upward and backward due to contractions of the gastrocnemius muscle. Clinical signs are pain, abnormal mobility, crepitus, and dysfunction of the limb.
Low damage.

If the femur breaks, it is treated with traction. Tires and plaster bandages are not able to ensure the correct position of bone fragments. If a transverse fracture occurs, skeletal traction is applied, which is performed with a Kirschner wire.

In order for the treatment to be successful, it is important to apply traction and reposition the fragments as early as possible. If you are late with these activities, it is difficult to correct the incorrect position of the fragments. Sometimes this is not possible.

Rarely, there are cases when one-stage reposition is done using general anesthesia.

Usually, this is indicated for transverse fractures, in which there is a large displacement of fragments, and for damage to the lower third of the bone, if the distal fragment is rotated and shifted upward and anteriorly. In this case, the leg is bent at the knee joint and fixed with a plaster cast after reposition.

There is no specific time frame for fracture consolidation. It all depends on the age of the patient, the degree of displacement and the nature of the damage. The average fusion period ranges from 35 to 42 days.

Skeletal traction in hip fracture

If these factors are present, it can be concluded that the fracture has healed, however, the final decision is made only after the load is removed and the patient's reaction is controlled. For example, if the corn is not quite strong, the patient will complain of pain, so the load will have to be applied again.

If there is no such need, the traction period does not increase, even if complete fusion has not occurred. After the needles are removed, the leg is left with a splint and traction on the lower leg for several days.

So, the femoral bone element plays an important role in human motor activity. Its fracture causes the victim to temporarily stop various activities. In order for the hospital term to be not very long, it is important to follow all medical recommendations.

Source: http://bezperelomov.com/nogi/bedrennaya-kost.html

Anatomy (structure) of the human femur: large den, bones, muscles

Considering the tubular bones that are present in the human body, the femur can be called the largest of them. Since all bone tissues with a tubular structure are involved in the work of the motor apparatus, the femoral element of the skeletal column is the lever of human motor activity.

In cumulative work with muscles, ligaments, the vascular system, nerve fibers and other tissues, the resulting structural unit - the thigh, has a rather complex structure. Having thoroughly studied it, you can identify the causes of joint and bone pain.

Bone Anatomy

The femur is the largest tubular bone tissue in the human skeleton.

She, like other tubular bones, has a body and two ends. The upper proximal section ends with the head, which serves as a connecting link with the pelvic bone.

At the point of transition of the neck into the bone body, there are two massive tubercles called apophyses or skewers. The large trochanter of the femur ends the bone body. On its medial surface there is a depression.

At the lower edge of the neck there is a small trochanter located medially behind. The greater trochanter is connected to the lesser trochanter by an intertrochanteric crest running obliquely along the posterior side of the bone.

They are also connected on the anterior surface by an intertrochanteric line.

Considering in detail the anatomical structure of the femur, its anterior curvature is visualized, which has a trihedral-rounded or cylindrical shape.

The posterior part of the bony body consists of the lateral and medial lips, which are defined by a rough line of muscle attachment. These lips also show traces of attachment of the femoral muscle tissue. This is noticeably closer to the center of the bony body.

In the lower part of the bone, the lips diverge in different directions, forming a smooth triangular area.

The distal epiphysis expands to form two large rounded condyles. The condyles differ in size and degree of curvature of the articular surfaces. The medial condyle stands out more inferiorly than the lateral one, although both of them are located on the same level.

This is explained by the fact that in a calm natural position, the bone fragment is inclined, its lower end is close to the midline, and the upper one is slightly deviated. On the lower and posterior side of the bone, both condyles are separated by a deep intercondylar fossa.

On the lateral part of each condyle there is a rough tubercle located above the surface of the joint.

Femur

Where is the bone and its structure

The lower limb contains a musculo-ligamentous apparatus, a vascular system, nerve fibers, and other tissues. This skeletal element forms the thigh.

The upper anterior part of the thigh ends with the inguinal ligament, the posterior part with the gluteal fold, the lower part of the thigh is limited to a distance of approximately 5 cm to the patella.

The femur has a different outline: from above it is connected to the hip joint, from below it forms the knee joint, articulating with the common tibia and patella.

The outer part of the femur is a connective tissue (periosteum). It is necessary for normal development, growth of bone tissue in children, restoration of the functional features of the bone after severe injuries of the femur. Since it has a tubular structure, it contains several elements.

upper and lower epiphyses (limbs);
the diaphysis of the femur (body);
bone areas located between the epiphyses and the diaphysis (metaphyses);
junction of muscle fibers (apophysis).

Based on the upper epiphysis, the head is located, which, together with the pelvis, participates in the formation of the joint.

In the acetabulum, with the help of cartilaginous tissue, three bones are articulated - the pubic, ischial and iliac. This characteristic feature of the body manifests itself before reaching the age of 15 years.

Over the years, these bone tissues are interconnected, forming a strong frame.

The hip joint combines all the bones into a single whole. On the surface of the condyles is cartilaginous tissue, inside - loose connective tissue. If the joint space is displaced, this may indicate pathological changes in the cartilage tissue. Most often, this indicates the development of arthrosis, since at this stage the restriction of motor activity has not yet been observed.

femoral head

The upper proximal epiphysis is represented by the head of the femur, which is connected to the rest of the bone tissue with the help of a neck. The surface of the head directed upwards is located closer to the median longitudinal plane of the muscle structures.

In the middle of the head is the fossa of the femur. This is where her ligaments are located. With the help of the neck, the head is connected to the body of the femoral bone tissue, forming an obtuse angle ranging from 113 to 153 degrees. The anatomy of the femur of the female body is such that the angle depends on the width of the structure of the pelvis (with a large width, it is close to straight).

muscles

The human thigh is characterized by the presence of several muscle groups. Thanks to them, the motor activity of the hip and knee joints is carried out. This ensures the maintenance of the body in an upright position and the upright posture of a person.

The anterior muscle group consists of:

quadriceps femoris, which extends the lower leg at the knee joint, flexes the thigh at the hip joint;
sartorius muscle, which flexes the lower leg at the knee, turning it inward, flexing and turning the thigh outward.

The posterior extensor muscles are composed of:

semitendinosus muscle;
semi-transverse;
two-headed.

This group is involved in flexion of the lower leg at the knee, extension of the hip joint, turning the lower leg inward.

the popliteal muscle sets the knee joint in motion, turns the lower leg inward.

The medial muscle group consists of the pectineus, adductor longus, adductor short, adductor magnus, and gracilis muscles. This muscle group rotates the thigh outward by flexing the hip joint and lower leg at the knee joint.

Functional role

Being the largest bone of the skeleton, the human femur is characterized by a high functional ability. In addition to being a link between the trunk and lower limbs, other functional features are:

reliable support of the skeleton (due to the fastening of the main muscles and ligaments, it ensures the stability of the lower extremities on the surface);
motor (used as the main lever for movement, turns, braking);
hematopoietic (in bone tissue, stem cells mature to blood cells);
participation in metabolic processes that contribute to the mineralization of the body.

The last function is quite important for the body. The contractile work of the muscular system depends on the presence of calcium in the bone tissue.

It is necessary for both the heart muscle and the nervous system, the production of hormones. If the body contains an insufficient amount of calcium, the reserve supply of calcium in the bone tissue comes into play.

This ensures the mineralization of the body, the restoration of the necessary balance.

Possible causes of pain

During a serious injury, a violation of the integrity of the bone occurs, that is, a fracture. Such injuries resulting from a fall on a hard object, a strong blow, are accompanied by serious pain, a large loss of blood. Depending on the focus of mechanical action, there are:

injuries of the upper part of the bone tissue;
violation of the integrity of the diaphysis of the femur;
damage to the distal, proximal metaepiphysis.

Femoral injuries of the most powerful nature, in addition to delivering severe pain and blood loss, can be accompanied by pain shock, which can lead to death.

The femur is a fairly important component of the skeleton. Violation of its integrity provokes a long-term limitation of physical activity. In order to recover as soon as possible, it is necessary to follow all medical instructions.

Source: https://SkeletOpora.ru/anatomiya-kolena/bedrennaya-kost

Anatomy and structure of the human femur

The femur is the largest bone of the human skeleton, which is directly involved in the process of human movement when walking or running. It has a saber shape and normally withstands the mechanical impact of shocks, falls or compressions well. Damage to the hip bone is extremely dangerous and can lead to complete immobility in old age.

Fundamentals of the anatomy of the femur

The main purpose of this bone is to support the weight of the human body and fasten the muscles involved in the process of walking, running and maintaining the human body in a vertical position in the process of moving in space.

In this regard, it has its own unique anatomy. The structure of the femur is quite simple. It consists of a hollow cylindrical structure, expanding downwards, and the muscles of the leg are attached to its back surface, along a special rough line.

The head of the bone is located on the proximal epiphysis and has an articular surface that serves to articulate the bone with the acetabulum. Exactly in the middle of the head is a hole. It is connected to the body of the bone by a neck, which has an inclination of its axis of 130 ° in relation to the body.

At the point of transition of the neck into the body of the bone element, there are two tubercles. They are called large and small skewers. The first tubercle can be easily felt under the skin, as it protrudes laterally. His small brother is behind and from the inside.

The skewers are connected to each other in front by an intertrochanteric line, while at the back this function is performed by a pronounced intertrochanteric ridge. The trochanteric fossa is located near the greater trochanter in the region of the femoral neck.

Such a complex structure with a large number of depressions and protrusions is necessary for attaching the muscles of the leg to the bone element.

The lower end of the bone is wider than the upper, and it smoothly passes into two condyles, between which the intercondylar fossa is placed, which is easily viewed from the front. The function of the femoral condyles is articulation with the tibia and the patella.

It is worth knowing that this element of the femur has a surface radius decreasing posteriorly, having the shape of a spiral. The lateral surfaces of the bone element have protrusions in the form of epicondyles. Their purpose is to fasten ligaments. These parts of the body can also be felt quite easily through the skin, both from the inside and outside.

Classification of hip fractures

The hip bone, despite the fact that it can withstand significant loads, often breaks. This is due to the fact that it has the greatest length in the human body, therefore, with a direct blow or a fall on a hard object, it is almost 100% likely to fracture.

The anatomy of the femur is such that its fractures are usually always accompanied by a violation of its anatomical integrity, while the injury is always severe, accompanied by severe blood loss and pain shock. For sick or elderly people, such damage can be fatal.

The femur, depending on the location of the fracture, can have three types of injury:

diaphysis injury;
damage to the upper bone end;
injuries of the distal metaepiphysis of the bone.

Diagnosis of fractures is usually not difficult, as they are visible to the naked eye, although the full clinical picture depends solely on the specific form of a fracture. In most cases, the patient cannot raise the heel off the floor, while feeling pain in the hip joint.

The pain intensifies if the patient tries to make passive and active movements. It is especially aggravated when the fracture is open and the bone fragment comes out through the muscles and skin. In this case, any movement is strictly prohibited.

The X-ray machine allows you to install:

type and nature of the fracture;
its heaviness;
the degree of damage to the soft tissues surrounding the bone.

An accurate diagnosis of a fracture is possible only with the help of an X-ray machine, while the femur may not be completely broken, but has only a crack. Cracks in the bone are as dangerous as fractures, as they threaten to disrupt its shape and form bone calluses, which makes it difficult for a person to walk.

First aid and treatment tactics

The main treatment for fractures of this bone is its extension. In the case of transverse fractures, a Kirschner wire is used for skeletal traction. It is worth remembering that the imposition of a splint and a plaster cast in case of a fracture of the tibia will not give the desired effect, so you need to start the traction procedure as soon as possible.

The fact is that the sooner the reposition of bone fragments and bone traction begins, the better the effect can be achieved. If the incorrect position of bone fragments is established too late, it becomes difficult or even impossible in principle to carry out a full-fledged treatment.

Sometimes bone fragments are returned to their place at the same time under general anesthesia. Such an operation is performed when large debris has shifted. This usually refers to fractures of the lower third of the femur. After "straightening", her patient's leg is fixed in the knee and a plaster cast is applied to it.

Healing of fractures of the described types usually occurs by 35-42 days. At the same time, the duration of treatment can vary significantly depending on the nature of a particular fracture, the gender and age of the patient, and his condition. However, it is impossible to focus only on these terms, since the degree of recovery of the patient can only be established by a clinical study.

So it can establish how strong the callus formed at the fracture site is. In the event that it is not completely formed, the treatment can be continued, but the needle from the leg is removed in any case within a month.

The extraction procedure for a fracture of the femur must be monitored by x-rays, and “transmission” must be carried out at least once a week. If the bone grows together incorrectly, then it is worth making an adjustment with the help of special medical equipment.

Correctly performed treatment will allow you to get an almost perfect leg.

Moreover, if a shortening of the limb by more than two centimeters is recorded, then measures will have to be taken, since in this case the gait may not be restored, and the internal organs and spine will be infringed. Therefore, the patient should carefully monitor his condition and promptly inform the attending physician about his change.

After the treatment is over, the patient is allowed to load the sore leg no earlier than two to three weeks later. To reduce this period, physiotherapy exercises are used, as well as warm baths.

If conservative methods of treatment have not brought results, the patient may be shown surgery. This may be an incorrect bone fusion, the appearance of suppuration processes, serious deformities of the femur.

Management of the rehabilitation period

After the end of treatment, the rehabilitation period begins. During this time, the limb should fully restore all its functions and the patient should be completely cured. During rehabilitation, the patient must adhere to certain rules.

It is impossible to lie down for a long time, and at the end of the treatment period it is necessary to get out of bed as soon as possible. The earlier the patient gets up, the lower the risk of complications. In the event that the pain cannot be tolerated in any way, it is worth taking an anesthetic, but you should not abuse such a medicine, since it has a very bad effect on the heart and liver.

To speed up the recovery process, physiotherapy procedures are usually prescribed. In this case, the patient is allowed to use a cane, walker or crutches. It is worth taking care of yourself at this time and not loading an unnecessarily sore leg.

A special role in the rehabilitation period is played by diet. It should be balanced and contain fruits, vegetables and foods rich in calcium.

It is necessary to try to avoid constipation and other stomach disorders, as this can reduce the mobility of the patient and adversely affect his rehabilitation.

It is best not to leave him alone during this period, as relatives can prevent the occurrence of new injuries as a result of a fall of a person who has suffered a fracture of the femur.

Anatomically, the femoral head is held by the annular glenoid fossa. The femur is considered the largest in the body, it has a complex structure. It is not easy for a person who is far from medicine to understand this, but it is necessary to understand the causes of the onset and characteristics of the course of diseases of the femur.

Anatomy of the femur

If you look at the femur not from a scientific point of view, but from a philistine one, you can see that it consists of a cylindrical tube expanding towards the bottom. On the one hand, one round femoral head (proximal epiphysis) completes the bone, on the other hand, two rounded femoral heads or distal femoral epiphysis.

The surface of the bone in front is smooth to the touch, but behind it has a rough surface, as it is the place of muscle attachment.

Proximal epiphysis of the femur

This is the upper part of the bone (femoral head) that connects to the pelvis through the hip joint. The articular head of the proximal femur has a rounded shape and is connected to the body of the bone by the so-called femoral neck. In the area of the transition of the femoral neck to the tubular bone, there are two tubercles, which in medicine are called skewers. The spit that is located on top is larger than that located below and can be felt under the skin. The intertrochanteric line is in front between the greater and lesser trochanters, behind them is the intertrochanteric crest.

Distal epiphysis of the femur

This is the lower section of the bone, wider than the upper one, located in the area of the knee, it is represented by two rounded heads called condyles. They are easily palpable in front of the knee. Between them is the intercondylar fossa. The condyles serve to connect the femur to the tibia and patella.

epithesiolysis

The concept of epifesiolysis combines fractures of the growth plate of the bone. The disease affects children and adolescents, since at their age the growth zone of the bone has not yet closed. There is also the concept of osteoepiphyseolysis, in which the fracture affects the body of the bone.

Juvenile epithesiolysis of the femoral head

Juvenile epiphysiolysis of the femoral head occurs during the period of puberty in a child (in a girl it occurs from ten to eleven years, in boys - from thirteen to fourteen). It can affect one joint or both. Moreover, in the second joint, the disease manifests itself 10-12 months after the defeat of the first joint.

It is manifested by a displacement of the head of the epiphysis in the growth zone, the head, as it were, slides down, in the correct position, the head of the femur adjoins the articular bag.

If juvenile epiphyseolysis of the femoral head occurs as a result of an injury, it will manifest itself with the following characteristic symptoms:

Pain that worsens with exertion.
A hematoma may appear at the site of injury.
Edema.
Leg mobility is limited.

If the disease has arisen due to bone pathology, then it manifests itself with the following symptoms:

Periodic pain in the joint, can either occur or disappear within a month.
Lameness not related to injury.
The affected leg cannot support the weight of the body.
The leg is turned outward.
Shortening of the limb.

A doctor can make a diagnosis based on an x-ray.

Important! Undiagnosed and untreated epiphyseolysis leads to the early development of arthritis and osteoarthritis of the joint.

Once the diagnosis is confirmed, treatment should begin immediately. If an operation is required, it is scheduled for the next day.

The doctor selects the tactics of treatment based on the severity of the disease. This disease is treated by the following methods:

The femoral head was fixed surgically with 1 screw.
Fixing the head with a few screws.
The growth plate is removed and a pin is installed, which prevents further displacement.

The problem of this disease is that the child enters the hospital late, when the deformation is visible to the naked eye.

Distal epiphyseolis of the femur

Occurs in the knee joint in the growth zone as a result of the following actions:

sharp rotation in the knee;
sharp bending;
hyperextension in the knee joint.

Deformity of the knee joint.
Hemorrhage in the knee joint.
Restriction of movement of the leg in the knee joint.

If the epiphysiolysis is detected in time, it is possible to do with the reduction of the joint without opening. In advanced cases, surgery is required.

Important! Mothers of boys over the age of 7 should carefully monitor the child's gait, as the initial stage of this disease is manifested by lameness.

The prognosis of the disease depends on its severity. In the most severe cases, deformity of the joint occurs, and the growth of the limb slows down.

Decentration of the femoral heads

Decentration of the femoral head is a displacement, slippage of the articular heads of the bones from the acetabulum due to a discrepancy between the size of the cavity and the joint. Otherwise it is called hip dysplasia. This is a congenital disease that can cause hip dislocation. It manifests itself with the following symptoms:

Restriction when breeding the hips to the sides, while a kind of click is heard.
Asymmetry of the inguinal and gluteal folds.
Leg shortening.

When examining a child in the maternity hospital, the neuropathologist first of all checks the hip joints of the child. If dysplasia is suspected, the child is sent for an ultrasound. This type of diagnosis is preferred for children under 1 year old.

Treatment of dysplasia should begin from the very first days of diagnosis. Undiagnosed and untreated dysplasia leads to joint problems in adulthood, such as dysplastic coxarthrosis.

Cystic remodeling of the femoral head

Cystic restructuring is manifested by the growth of bone tissue around the edge of the articular cavity, which leads to displacement of the femur, as a result of this, subluxation of the hip occurs.

It manifests itself with the following symptoms:

joint pain;
movement restriction;
soft tissue atrophy;
limb shortening.

Diagnosed by x-ray, which usually clearly shows bone growths.

This disease has many subspecies, so an accurate diagnosis should be made by the attending physician. It can be recorded along with a list of further necessary treatment on a separate page, which is given to the patient in the hands.

The femur is a very important element in the human skeletal system. In order to prevent various diseases associated with it, it is necessary to strengthen the musculoskeletal system from childhood.

If we consider x-rays of the proximal end of the bone in a newborn, only the femoral shaft can be seen. The metaphysis, epiphysis and apophysis are located in the cartilaginous stage of development, so they are not visible as formed elements. Taking x-rays in accordance with the further development of the child, you can see that the head of the femur, that is, the epiphysis, appears first. This happens in the first year of development. In the third and fourth years, the apophysis is determined, and in the 9-14th year, the ossification point appears in the lesser trochanter of the bone. Fusion occurs in reverse order at an older age, from 17 to 19 years.

Anatomy

The proximal or upper end of the bone bears the articular head, which is round in shape. If you look at the head a little lower from its middle, then you can see a small rough hole in the structure. In this place is the attachment of the ligament of the head of the bone. The head of the femur is connected to the rest of the femur with the help of the neck. The neck is located to the axis of the bone body at an obtuse angle, which ranges from 114 to 153 degrees. In women, a lot depends on how wide their anatomical pelvis is. If the width is large, the angle approaches a straight line.

Where the neck passes into the bone body, there are two tubercles. They are called apophyses or skewers. The greater trochanter is the upper end of the body of the bone. Its medial surface, which faces the neck, has a fossa. There is also a small spit, which is placed at the lower edge of the neck. It occurs on the medial side and slightly behind. The greater and lesser trochanters are connected to each other by a ridge that runs obliquely on the posterior side of the bone. They are connected on the front surface.

Studying the anatomy of the femur, you can see that her body is slightly arched anteriorly. It is located in a triangular-rounded shape. The back side of the body has a trace from the muscular attachment of the thigh and consists of a lateral and medial lip. These lips also have traces of attachment of the corresponding muscles, this is noticeable in the proximal part. At the bottom, the lips diverge. In this place, a smooth triangular platform is formed on the posterior femoral surface.

The distal or lower end of the bone is thickened and forms two condyles, which are wrapped back and have a rounded shape. The medial condyle protrudes more downwards than the lateral one. However, despite this inequality, both condyles are located at the same level. This is due to the fact that the femoral bone fragment in its natural position is oblique, and its lower end is closer to the midline compared to the upper end. The articular condylar surfaces from the anterior side pass into each other, therefore, a slight concavity is formed in the sagittal direction. The condyles are separated from each other by a deep intercondylar fossa on the lower and posterior sides. Each condyle on the side has a rough tubercle located above the articular surface.

Damage

The femoral bone element plays an important function in human locomotion. As mentioned above, it is the longest element of all tubular bones.

The length of the femur in adult men is about 45 centimeters, which is about one-fourth of the height. Therefore, its damage significantly affects human activity.

Depending on the location, there are three types of femoral fracture:

Trauma to the upper end of the bone;
Damage to the diaphysis;
Fracture of the distal metaepiphysis of the bone, damage to the proximal metaepiphysis may occur.

The clinical picture depends on the specific form of the fracture. In most cases, the victim is unable to lift his heel off the floor. He feels pain in the hip joint, which becomes especially strong when trying to make not only active, but even passive movements. The leg is slightly rotated outward, adducted. If a displaced fracture occurs, the greater trochanter is located above the line, which is called. With the help of x-rays, the degree of displacement and the nature of the fracture are specified.

A cervical fracture or medial bone injury is referred to as an intra-articular injury.
A lateral fracture is considered a periarticular injury, however, sometimes the plane of the fracture can penetrate into the joint cavity.

Treatment of hip injuries depends on the nature of the fracture. If a fracture of the neck of the bone occurs or the head of the femur is damaged without displacement, treatment is based on prolonged immobilization of the limb. To do this, use the Beller abduction splint or a plaster cast and. The immobilization period is from two to three months, and then unloading is done for several weeks.

If a fracture occurs with displacement of fragments, it is prescribed based on the use of the functional Beller bus, subject to maximum abduction of the leg. A Kirschner wire is passed through the distal metaphysis of the bone. A complication may occur - aseptic necrosis, in which the head of the femur and the bone body are affected. If conservative treatment fails, fragments are compared surgically.

Fractures of the trochanters may occur.

If the femur breaks, it is treated. Tires and plaster bandages are not able to ensure the correct position of bone fragments. If a transverse fracture occurs, skeletal traction is applied, which is performed with a Kirschner wire. In order for the treatment to be successful, it is important to apply traction and reposition the fragments as early as possible. If you are late with these activities, it is difficult to correct the incorrect position of the fragments. Sometimes this is not possible. Rarely, there are cases when one-stage reposition is done using general anesthesia. Usually, this is indicated for transverse fractures, in which there is a large displacement of fragments, and for damage to the lower third of the bone, if the distal fragment is rotated and shifted upward and anteriorly. In this case, the leg is bent at the knee joint and fixed with a plaster cast after reposition.

There is no specific time frame for fracture consolidation. It all depends on the age of the patient, the degree of displacement and the nature of the damage. The average fusion period ranges from 35 to 42 days.

However, the issue of removing traction does not depend on these terms. Clinical examination can determine the disappearance of pain, the formation of callus and the elimination of pathological mobility. If these factors are present, it can be concluded that the fracture has healed, however, the final decision is made only after the load is removed and the patient's reaction is controlled. For example, if the corn is not quite strong, the patient will complain of pain, so the load will have to be applied again. If there is no such need, the traction period does not increase, even if complete fusion has not occurred. After the needles are removed, the leg is left with a splint and traction on the lower leg for several days.

So, the femoral bone element plays an important role in human motor activity. Its fracture causes the victim to temporarily stop various activities. In order for the hospital term to be not very long, it is important to follow all medical recommendations.

In the anatomical atlas, the human skeleton contains two such bones, located to the right and left of the spine. In its natural position, the femur is at an angle to the vertical.

Anatomy describes the following elements that have a different structure:

diaphysis - the middle part of the body of the bone, containing the medullary cavity;
proximal and distal epiphyses (upper and lower, respectively), with well-defined condyles - thickening of the epiphysis;
two apophyses - protrusions, each of which has its own ossification nucleus in the process of osteosynthesis;
metaphyses - areas located between the diaphysis and the epiphysis, providing lengthening of the thigh in childhood and adolescence.

The head crowns the neck, which makes an angle of about 114-153o to the longitudinal axis of the diaphysis (the smaller the angle, the wider the pelvis). The top of the improvised angle on its outer side is headed by a large trochanter - a prominent tubercle of the femur, which has a hole on the inner surface. The intertrochanteric line on one side and the intertrochanteric crest on the other connect the lesser and greater trochanters of the femur. The marked formations serve to attach the muscles.

The body of the bone is close to a cylindrical shape, trihedral in cross section, twists slightly around the axis and bends forward. The surface of the body is smooth, but the posterior section contains a rough line (the place of muscle attachment), which diverges into 2 lips near the epiphyses. Near the inferior, the lateral and medial lips separate to form the popliteal surface. Approaching the greater trochanter, the lateral lip gradually transforms into the gluteal tuberosity, to which the gluteus maximus is attached. The medial lip near the superior epiphysis leaves in the direction of the lesser trochanter.

Development

fractures

As we age, bones become more fragile. If it is easier for most young people to avoid serious injury, then the elderly should take care of themselves: the most common fall or abrupt standing on one leg in an attempt to maintain balance can lead to a hip fracture. Osteoporosis, characterized by low bone density, weakened muscle tone, partial loss of control over the body by the brain, are additional factors that increase the risk of fractures.

Older women are more likely to get injuries of this kind, which is explained by the structure of the female femur: a smaller angle between the neck and the diaphysis, a thinner neck, in comparison with the male. Osteoporosis in women is also more pronounced, and this exacerbates the situation. The cause of injury in a middle-aged or young person may be a strong blow, a fall from a height, or a car accident. The development of a bone cyst, the causes of which are difficult to establish today, inevitably weakens the section of the bone.

Symptoms of this phenomenon:

the hip joint hurts a lot when trying to move the leg;
the victim is unable to tear the limb off the floor;
the foot is turned outward.

In some cases, a person may experience pain shock, and with an open fracture, significant blood loss.

diseases of bones and joints (osteoporosis, arthrosis, etc.);
neurological disorders;
allergic diseases, gout, tuberculosis.

Fracture diagnosis

In cases where the greater trochanter is injured, a swelling is found at the upper epiphysis of the femur. The main way to identify the clinical picture is research using an X-ray machine. In addition to determining the type and severity of the fracture, such a study will determine the presence of a crack that is not diagnosed during an external examination, as well as identify how soft tissues have been damaged.

Fracture treatment

The type of treatment given depends on the type of injury.

The crack requires the imposition of a plaster cast, the complete exclusion of physical activity and strict adherence to bed rest. The duration of treatment is regulated by the attending physician;
A fracture in which the head or neck of the femur is affected without displacement is treated with a plaster cast and a pelvic girdle or Beller splint, in order to limit the mobility of the limb as much as possible;
The damping tire is also prescribed for fractures with displacement. The shape of the bone is restored, a pin is inserted into the limb. If attempts to splice fragments were unsuccessful, surgical intervention is necessary;
The treatment of an open fracture differs from that of a closed fracture by measures to prevent infection. Small fragments are eliminated, the rest are put together.

Important! Beller's splint is a device designed for skeletal traction and connection of bone fragments with associated damping (oscillation damping) to ensure limb immobility. The design of the tire is a frame device, weighed down by a load, on which the foot rests.

Healing lasts at least a month. In the process of treatment, periodic, with an interval of about 7 days, X-ray control of the fracture condition is carried out.

Possible complications during treatment

Improper splicing of fragments can lead to pathology: a false joint or pseudoarthrosis of the femur is formed. This condition is characterized by abnormal mobility in the area of pathology, changes in muscle strength, visible and palpable shortening of the leg. In this case, treatment takes a significant amount of time. Pathology is corrected surgically;
Aseptic necrosis (pathology of blood flow in the artery of the femoral head) is a possible complication of unsuccessful treatment of the femoral neck. It is characterized by pain in the hip joint, which can be projected onto the front surface of the thigh, into the groin area, into the gluteal muscle. If the pain does not subside when taking anti-inflammatory drugs or analgesics, then a hip replacement is prescribed.

The human body is the femur. Features of all tubular bones are the presence of a body and two ends.

The location of the head of this bone is based on the upper proximal end, it serves to connect with the pelvic bone. The direction of the medial and upward is characterized by the surface of the head, called the articular. In its middle is the fossa of the head of the body of the femur, which is the site of attachment of the ligament of the head of the bone. The neck of the bone connects the head and body, forming an angle of up to one hundred and thirty degrees with it.

On the border of the neck and body there are two large bone tubercles, which are called skewers. The location of the greater trochanter has on its medial surface, which faces the neck, a trochanteric fossa. He himself is above and laterally. The lesser trochanter is located medially and posteriorly, near the lower edge of the neck. These two skewers have an intertrochanteric line connecting them at the back, called the intertrochanteric crest.

The femur, or rather its body, is cylindrical in shape, which is curved anteriorly by a convex part, and around the longitudinal axis it looks as if twisted. The body of the bone has a smooth surface, behind there is a line that is slightly rough, and it is divided into two lips - medial and lateral. The middle of the femur connects these lips closely, and towards the lower and upper directions they begin to diverge. Both lips are directed to the skewers of the femur - large and small. The lateral lip enlarges and becomes much thicker, finally passing into the gluteal tuberosity, which is the place where the large tuberosity is attached. Sometimes this tuberosity has the appearance of a third trochanter. The medial lip passes into a rough line. Reaching the lower end of the femur, the two lips diverge from each other, forming a popliteal surface that has the shape of a triangle.

The distal end of the bone is slightly expanded, forming two large rounded condyles. These condyles differ in size and degree of curvature of the articular surface.

The medial condyle is larger, the lateral condyle is smaller. Both condyles are located at the same level, and behind they are separated from each other by a fossa, which is called the intercondylar. On top of the articular surface of the medial condyle there is a medial epicondyle, and also the lateral side of the condyle has a lateral epicondyle, which is much smaller than the medial one. Anteriorly, both condyles pass into each other with their articular surfaces. This forms a concave patella surface, to which the posterior side of the patella is attached.

Since the femur is the largest bone, it is most susceptible to various deformations. The most severe of these are fractures. When the anatomical integrity of the bone is broken, this is a fracture. The reasons for it can be different: a direct blow to the thigh, a fall on hard objects, and much more. If the femur is broken, then this injury is considered severe. In this case, there may be a significant loss of blood and, naturally, walking becomes impossible, and any load on the injured limb is also excluded. The deformed leg is shortened. The large vessels of this limb can be damaged as a result of the displacement of fragments, especially the lower third, when the fragment moving backwards damages, thereby causing profuse bleeding. The femur must be immobilized without delay. For this, a splint is applied, anesthesia is done, and then the victim is taken to the traumatology department.

The structure of the femur is extremely simple, however, it performs the main function - it keeps the load of the body and the body itself in balance, participates in complex motor manipulations, and is the basis for the articulation of the lower extremities with the pelvis. Such opportunities were given to her by nature itself, therefore, you need to treat your health with care.