Fractura de sold reprezinta in general o patologie grava cu sechele si complicatii importante ce reduc independenta si autonomia pacientilor care sufera de aceasta boala.
Fractura de sold apare prin pierderea echilibrului dintre rezistenta mecanica a osului si stresul aplicat acestuia. Este in general o patologie a varstnicului la care apare in urma unui traumatism banal favorizata fiind de terenul osteoporotic. La tineri survine mai rar, rezistenta mecanica a osului nefiind afectata de osteoporoza, iar pentru producerea ei sunt necesare traumatisme de intensitate mare care se intalnesc in special in accidentele rutiere.
Femurul este un os lung, pereche care alcatuieste singur scheletul coapsei. Este cel mai lung si mai rezistent os al scheletului uman. Ca orice os lung este alcatuit din doua extremitati, epifize, si o diafiza. Este legat de pelvis prin articulatia coxofemurala prin intermediul careia preia si sustine greutatea intregului corp. In pozitie anatomica nu este vertical ci este orientat oblic de sus in jos si latero-medial. Capul femural reprezinta aproximativ 2/3 dintr-o sfera cu diametrul de 4- 5, 5 centimetri. In cadranul postero-inferior prezinta o mica depresiune unde se insera ligamentul capului femural.
Santul subcapital reprezinta limita dintre cap si col.
La acest nivel se pot evidentia mici orificii ce dau trecere arterelor epifizare laterale. Prezinta suprafata neteda fara depresiuni, cu exceptia foveei capitis femoris si este acoperit de cartilaj.
Colul femural este elementul de legatura dintre cap si diafiza, cu care formeaza in plan frontal un unghi cu deschidere spre medial. Acest unghi este larg deschis in copilarie, diminua in timp, la adult ajunge in jur de 130. Valoarea unghiului de inclinatie variaza invers proportional cu statura si dimensiunile pelvisului, astfel ca la femei se apropie de 90. In plan transversal intre cap, col si planul tangent la fata posterioara a condililor femurali se formeaza un unghi de declinatie cu valoarea de 10 -15 colul fiind in declinatie. Variatiile unghiului de inclinatie pozitioneaza membrul inferior in coxa vara sau coxa valga. Variatiile unghiului de declinatie pun membrul inferior in rotatie mediala sau laterala.
Marele trohanter este o eminenta mare, neregulata patrulatera ce continua in sus diafiza femurala. Varful trohanterului mare este situat la nivelul capului femural.
Pe trohanterul mare se insera muschii pelvitrohanterieni.
Micul trohanter este o proeminenta mamelonata, situata postero-inferior de col si care da insertie muschiului iliopsoas.
2. 2. Structura femurului proximal Structura extremitatii proximale a femurului este adaptata functiei acestuia. Substanta osoasa propriu-zisa se prezinta sub doua aspecte: compacta si spongioasa. Substanta compacta dura, omogena este alcatuita din lamele osoase alaturate alipite intre ele fara a delimita cavitati intermediare. Substanta spongioasa este formata tot din lame sau trabecule osoase care insa sunt orientate in sensuri ...
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