Rehabilitation after a hip fracture

A hip fracture is a serious injury, typical mainly for the elderly. In older age, bone loss occurs, which increases bone fragility. This severe injury previously often had fatal consequences. Thanks to the significant development of science and medicine, today rehabilitation after a hip fracture can significantly reduce the duration of treatment and prevent the development of complications.

Short-term rehabilitation program

For primary treatment, a short-term recovery plan is established for a certain required time. It includes 2 phases.

Hospitalization

This is a comprehensive plan for the duration of the patient's stay in the hospital. Important at this stage:

• positioning;
• cryotherapy;
• exercise therapy;
• sitting, standing, walking on crutches;
• self-service training, personal hygiene;
• instructing the patient on the principles to be followed.

Ambulatory treatment

The outpatient treatment phase includes comprehensive care immediately after the patient is discharged from the hospital. Recovery can be carried out in a sanatorium or at home, subject to periodic visits to the rehabilitation department.

At this stage, the exercise therapy prescribed in the hospitalization phase continues.

Rehabilitation after a hip fracture (after surgery and scar healing) also includes classes in the pool - hydrocinesis therapy. In addition, various forms of physical therapy are carried out at this stage.

It is important to learn how to use compensation funds correctly. According to the doctor's recommendations, the patient gradually increases the load on the operated area, so it is important to pay attention to the correct training of walking and fixing the proper movement patterns.

Treatment and rehabilitation after a fracture in the elderly

Part of the rehabilitation of an elderly person is not only physical education, but also the so-called. "re-socialization" - a return to an active life through one of the psychological geriatric programs.

But there are conditions in which the patient, due to sclerotic disorders, cannot fully realize the need for active exercise. In this case, rehabilitation after a fracture of the femur depends on the doctor, his agreement with the patient's family; treatment should be carried out despite the resistance of the patient.

Some patients complain of pain in the second, intact limb. These pains are caused by overloading the healthy side due to the impossibility of straining the operated area. A gradual load on the operated limb returns the original balance, the pain disappears. This is often a slow healing process lasting several months.

Physiotherapy

Therapeutic physical culture (kinesitherapy, exercise therapy) after a hip fracture is one of the main and most used methods of rehabilitation treatment. It consists in using movement for therapeutic purposes. The goal is to achieve the correct execution of the movement, as a necessary condition for the implementation of physical activity in everyday life. In exercise therapy, scientifically based and empirically proven effective movements are used to maintain or restore the lost function of a body part.

Physical exercises after a hip fracture begin with positioning, respiratory and vascular gymnastics, isometry of the gluteal and femoral muscles. In addition, the range in the operated joint gradually increases. Then, as instructed by the doctor, the patient is verticalized to train sitting, standing and walking on crutches. Positioning is carried out immediately after the operation, exercise therapy sessions are carried out the next day.

Scheme of a standard recovery procedure

The standard rehabilitation plan after a fracture of the femur (after surgery) is divided into separate days. Every day, the exercise is usually repeated, gradually increasing the load and adding other exercises.

0 day

On the day of surgery, the patient is positioned only on the back with an abduction cushion between the lower extremities. He performs breathing exercises, active training of a healthy leg. On the operated limb, training of the fingers and ankle joint is carried out.

1 day

The patient lies on his back with an abduction cushion between the legs, does not rotate the feet outward (they are secured with anti-rotation shoes). Rehabilitation of a hip fracture begins with active exercises, which include:

• finger training;
• vascular gymnastics (bending and pulling up the feet);
• isometry of the femoral and gluteal muscles;
• flexion of the limbs (the operated leg is bent on the stand up to 30°);
• strengthening the abdominal muscles;
• sitting on the bed up to 45° with support;
• training of the cervical spine;
• raising the pelvis (with the support of a healthy limb);
• breathing exercises (both static and dynamic).

Rehabilitation exercises for a fractured femur are repeated several times a day. In accordance with the degree of surgical intervention and the recommendations of the doctor, positioning is carried out on the healthy side with an abduction pillow between the knees. It is necessary to pay attention to the correct position of the operated limb - the patient should not rotate the foot outward.

2 day

The exercises of the previous day are repeated with the addition of a sitting position in bed towards a healthy limb. The knees when sitting should always be lower than the hips (the hip angle is maximum 45-60°).

A short block of exercises in a sitting position is added:

• vascular gymnastics;
• knee extension;
• breathing exercises;
• cervical spine training.

If classes go smoothly, verticalization is possible. Positioning is done on the healthy side.

3 day

The exercises are similar to those of the 2nd day; the flexion angle in the operated femur increases to 60°. Walking training is carried out on axillary crutches with an emphasis on the correct walking stereotype.

Closed shoes are required for safe movement. Shoulder crutches must be of the correct height.

The correct stereotype of walking is important - the patient takes the same steps, the toes of the foot are directed forward, the operated limb does not turn outward.

Added training for self-care on and off the bed, going to the toilet, sitting on a chair at the table, personal hygiene. Positioning is on the healthy side. During the day, the patient can carry out rehabilitation after a hip fracture at home.

Day 4

The hip flexion angle is increased to 90°. After consultation with the attending physician, abduction of the operated limb is added (the heel is raised with the help of a stand, does not come off it).

Knee flexion exercises, isometrics, abdominal muscle strengthening are added, a healthy leg can simulate cycling.

Day 5 (+ until stitches are removed)

In case of a fracture of the femur, treatment and rehabilitation are carried out until the removal of sutures and control of bone fusion.

During this period, the exercises of the previous days are repeated. The patient should already be able to independently manage self-care activities on and off the bed (sitting on a high chair, walking to the toilet, bathroom, personal hygiene, etc.).

Physiotherapy

The most common complications after surgery are swelling and healing of the surgical wound. Therefore, the goal of recovery is not only to solve the question of how to develop a leg after a hip fracture, but also to prevent these negative consequences. Most often, this problem is solved with the help of physiotherapy.

Electrotherapy

Remote electrotherapy has a healing, decongestant and analgesic effect. Calculations and experiments show that the application of remote currents does not contradict the physical conditions of application. There is no excessive vibration or heating of the non-ferromagnetic material of the endoprosthesis (when it is installed). Therefore, the use of electrotherapy is not considered harmful.

Mechanotherapy

In order to recover from a hip fracture, acupressure is used to promote the resorption of scars. It starts 1 month after the operation. The alternation of ischemia and subsequent hyperemia around the scar improves healing.

Soft tissue techniques work on the skin, fascia, and muscles. When the scar heals, they can connect with the subcutaneous tissue, so the massage uses pressure directed towards the scar. This massage method is also applied 1 month after the operation.

Thanks to positioning, the formation of contractures, bedsores, and edema is prevented. On the advice of the doctor, the patient is placed immediately after the operation on the back, on the side (on the healthy side) or on the stomach. Abduction pads and anti-rotation shoes are used for positioning.

The decongestant effect is provided by manual or instrumental lymphatic drainage and vacuum compression therapy.

Thermotherapy

In the case of total arthroplasty for a hip fracture, rehabilitation after surgery excludes positive thermotherapy. Therefore, only cryotherapy in the form of ice bags is used. The purpose of this method is to reduce swelling, bruising, and pain.

Magnetotherapy

Magnetotherapy uses the general biological effects of the magnetic component of the electromagnetic field. It supports soft tissue healing, suppresses inflammation and swelling. For therapeutic purposes, a low-frequency magnetic field with values ​​​​of 100-150 Hz is used.

Hydrotherapy

This method is recommended to be carried out after the scar has healed, i.e. at least 1 month after the operation. Hydrokinesiotherapy is the exercise of physical therapy in water, most often in the pool.

Hydrotherapy uses the increased resistance to movement provided by water while relaxing the body in the aquatic environment.

Results

The goal of long-term care after fractures is to motivate the patient to continue treatment and rehabilitation. An important part of the restorative approach is the perception of psychosocial consequences, monitoring of bone quality, regular contact with the doctor. The cessation of treatment or exercise is usually associated with the loss of all the positive effects of the procedures performed.