Hip Fracture Rehabilitation and Physiotherapy
Hip fractures are an extremely common occurrence in elderly populations and have significant negative consequences for the individual and the society looking after them. Younger people do fracture the neck of the femur but it is in elderly people with a degree of osteoporosis that the overwhelming number of these injuries occur. If the fracture is impacted (pushed together) or lower down on the femur and there is little likelihood of loss of blood supply to the upper femur so the fracture can be fixed in situ or left conservatively to heal. If the fracture is through the neck of the femur with its risk of loss of blood supply to the head then the head may be replaced by a half hip joint or hemiarthroplasty.
Once the operation has been performed the physiotherapist will assess the patient the day after, checking their mental state, monitoring their respiratory status and their ability to move both the unaffected and operated leg. If the operative instructions indicate so, the physio will start to get the patient up with an assistant. The patient will be moved towards the edge of the bed and sat there for a while to assess their status. Patients often feel dizzy, have pain or are anxious about getting up so the physio may just work on some sitting balance to encourage a feeling of security, sitting the patient in a chair for a while.
Progression from this point involves walking with a frame, the best walking aid to choose if the patient is going to have difficulty in getting going. A typical gait pattern is to move the frame forward, put the operated leg up to the frame and then bring the other leg up whilst taking some weight on the frame. Regular practice, sitting out and participating in normal activities such as going to the bathroom and getting dressed will move the patient towards normality. Getting an elderly person re-orientated towards the normal activities of daily living is vital as they can be badly disrupted by the fracture and hospital admission.
The physio will continue to monitor the patient''s status and encourage increased mobility until the patient is discharged. Many patients have little input once they are back home again but could likely benefit from rehabilitation classes to improve their muscle power, balance, coordination, gait pattern and endurance under the supervision of a physiotherapist.
Author Jonathan Blood-Smyth