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Hip ORIF Physical Therapy Protocol

This protocol provides guidelines for rehabilitation following open reduction and internal fixation (ORIF) surgery for a hip fracture. It outlines the post-operative precautions, exercise program, and progression criteria for different phases of rehabilitation, including early, intermediate, and advanced stages.

Introduction

A hip fracture, also known as a broken hip, is a common and serious injury, particularly among older adults. Open reduction and internal fixation (ORIF) is a surgical procedure used to stabilize and heal a fractured hip. This procedure involves surgically exposing the fracture site, realigning the bone fragments, and then securing them in place with plates, screws, or other implants. Physical therapy plays a crucial role in the recovery process after hip ORIF surgery, helping patients regain mobility, strength, and function. This protocol outlines a comprehensive physical therapy program designed to guide patients through the different phases of rehabilitation, from the initial post-operative period to return to activities of daily living and desired functional goals. The protocol emphasizes a patient-centered approach, tailoring the exercises and interventions to individual needs and abilities. This protocol provides evidence-based recommendations for physical therapy management of older adults with hip fracture across the episode of care. It covers examination, interventions, outcome measures, and interprofessional management for different settings and time periods.

Post-Operative Precautions

Following hip ORIF surgery, it is essential to follow specific post-operative precautions to promote healing and prevent complications. These precautions aim to protect the surgical site, minimize stress on the repaired bone, and prevent excessive movement that could disrupt the healing process. The following precautions are generally recommended in the initial weeks after surgery⁚

• Weight-bearing restrictions⁚ The surgeon will determine the appropriate weight-bearing restrictions based on the type of fracture, the surgical approach, and the individual patient’s healing progress. Partial weight-bearing, non-weight-bearing, or touch-down weight-bearing may be recommended initially.
• Hip flexion limitations⁚ Avoid bending the hip beyond 90 degrees, as this can stress the surgical site and hinder healing.
• Hip rotation limitations⁚ Avoid rotating the hip inward or outward excessively, as this can also place stress on the fracture site.
• Hip adduction limitations⁚ Avoid crossing the legs or bringing the operated leg across the midline of the body.
• Avoid prolonged standing or sitting⁚ Limit the duration of standing or sitting to prevent excessive strain on the hip joint.
• Use assistive devices⁚ Utilize assistive devices such as walkers, crutches, or canes as instructed by the physical therapist to aid in ambulation and maintain proper posture.

It is crucial to follow these precautions carefully and seek guidance from your surgeon or physical therapist for any questions or concerns.

Phase I⁚ Early Rehabilitation (Weeks 1-2)

Phase I of rehabilitation focuses on minimizing pain and inflammation, promoting wound healing, and restoring basic functional mobility. The emphasis is on gentle movements and exercises to gradually increase range of motion and strength while protecting the surgical site. Key objectives of this phase include⁚

• Pain management⁚ Pain is a common post-operative experience and should be addressed effectively. The physical therapist will assess pain levels, provide pain relief strategies, and educate the patient on pain management techniques.
• Swelling control⁚ Reducing post-operative swelling is essential for promoting healing and improving mobility. Techniques such as elevation, ice application, and gentle massage may be used to manage swelling.
• Range of motion exercises⁚ Gentle range of motion exercises for the hip, knee, and ankle are initiated to prevent stiffness and improve joint mobility. These exercises should be performed within the pain-free range of motion and within the weight-bearing restrictions prescribed by the surgeon.
• Muscle strengthening⁚ Light isometric exercises, such as quadriceps and gluteal muscle contractions, are introduced to maintain muscle strength and prevent atrophy.
• Gait training⁚ Once the patient can tolerate weight-bearing, gait training with assistive devices is initiated. The physical therapist will guide the patient on proper gait mechanics and safe ambulation techniques.
• Functional activities⁚ Basic functional activities, such as transferring from bed to chair and dressing, are gradually introduced to improve independence and prepare the patient for home discharge.

During this phase, close monitoring of the patient’s progress and pain levels is essential. Adjustments to the exercise program may be necessary based on individual responses and healing progress.

Phase II⁚ Intermediate Rehabilitation (Weeks 3-6)

Phase II marks a significant progression in rehabilitation, focusing on increasing strength, endurance, and functional capacity. The emphasis shifts towards more challenging exercises and activities to prepare the patient for a return to daily living. Key objectives of this phase include⁚

• Increased range of motion⁚ As healing progresses, the range of motion exercises become more dynamic, incorporating active movements and stretches to improve hip flexion, extension, abduction, adduction, and rotation.
• Progressive strengthening⁚ Strength training exercises are intensified, incorporating resistance bands, weights, or body weight to strengthen the hip flexors, extensors, abductors, adductors, and rotators.
• Balance and coordination exercises⁚ Balance and coordination exercises are introduced to improve stability and prevent falls. These exercises may include standing on one leg, tandem stance, and reaching activities.
• Functional activities⁚ Functional activities are expanded to include activities such as stair climbing, walking longer distances, and performing household tasks. The physical therapist will guide the patient on proper techniques and safe progression.
• Proprioceptive exercises⁚ Proprioceptive exercises, which challenge the body’s ability to sense its position in space, are incorporated to enhance balance, coordination, and stability. Examples include standing on uneven surfaces or performing exercises with closed eyes.
• Endurance training⁚ Endurance training activities, such as walking, cycling, or swimming, are introduced to improve cardiovascular fitness and stamina.

Patients should gradually increase the intensity and duration of their exercises throughout this phase. It is crucial to monitor pain levels and ensure that exercises are performed within a pain-free range.

Phase III⁚ Advanced Rehabilitation (Weeks 7-12+)

Phase III focuses on achieving functional independence and returning to desired activity levels. This phase emphasizes strength training, endurance exercises, and functional activities that mimic daily life and recreational pursuits. The goals are to⁚

• Maximize strength and endurance⁚ Exercises are further intensified to increase strength, power, and endurance. This may involve higher resistance levels, repetitions, and sets.
• Progress functional activities⁚ Functional activities are expanded to include more challenging tasks, such as running, jumping, and sports-specific drills. The physical therapist will assess the patient’s ability to perform these activities safely and effectively.
• Improve balance and coordination⁚ Balance and coordination exercises continue to be emphasized to improve stability and reduce the risk of falls.
• Address specific functional limitations⁚ If the patient has any specific limitations, such as difficulty with stairs or carrying heavy objects, the physical therapist will focus on exercises and activities that address those limitations.
• Develop a personalized home exercise program⁚ The physical therapist will work with the patient to develop a home exercise program that can be continued after formal therapy sessions end. This program will focus on maintaining strength, flexibility, and functional capacity.
• Prepare for return to work or leisure activities⁚ The physical therapist will help the patient gradually return to work or leisure activities; This process may involve a gradual increase in activity levels and participation in simulations of work or recreational activities.

The duration of Phase III will vary depending on the individual’s goals, progress, and overall health status. The physical therapist will work closely with the patient to determine the appropriate duration of this phase and to ensure a safe and successful return to desired activity levels.

Home Exercise Program

A home exercise program is essential for maintaining progress and achieving long-term recovery after a hip ORIF procedure. It reinforces the exercises learned in therapy and helps to prevent stiffness, weakness, and pain. The physical therapist will design a personalized program that addresses the individual’s specific needs and goals. This program may include⁚

• Range of motion exercises⁚ These exercises help to maintain flexibility in the hip, knee, and ankle. Examples include hip flexion, extension, abduction, adduction, internal and external rotation, and knee flexion and extension.
• Strengthening exercises⁚ These exercises target the muscles surrounding the hip and leg, which are crucial for stability, balance, and functional activities. Examples include quadriceps sets, hamstring curls, hip abductions, and glute bridges.
• Balance exercises⁚ These exercises help to improve stability and reduce the risk of falls. Examples include single-leg stance, heel-toe walking, and standing on a foam pad.
• Functional exercises⁚ These exercises simulate daily activities and help to improve overall function. Examples include walking, stair climbing, and getting in and out of a chair.

The frequency and intensity of the home exercise program will depend on the individual’s progress and tolerance. It is important to listen to your body and stop if you experience any pain. The physical therapist will provide guidance on proper form and technique and may suggest modifications if needed.

Common Exercises

A variety of exercises are commonly used in hip ORIF rehabilitation, tailored to the individual’s needs and progression. These exercises aim to restore range of motion, strength, and function in the hip and surrounding areas. Examples of common exercises include⁚

• Heel Slides⁚ Performed while lying on your back, this exercise involves sliding your heel towards your buttocks, improving hip flexion.
• Straight Leg Raises⁚ Lying on your back with your leg straight, lift your leg a few inches off the bed, engaging your quadriceps and improving hip flexion.
• Hip Abductions⁚ Lie on your side with your injured leg on top. Keeping your leg straight, slowly lift it away from your body, strengthening hip abductor muscles.
• Glute Bridges⁚ Lying on your back with knees bent, lift your hips off the ground, engaging your glutes and hamstrings, improving hip extension and strengthening core muscles.
• Hamstring Stretches⁚ Sitting on the floor with your leg extended, reach towards your toes to stretch the hamstring muscles, improving hip flexion and reducing tightness.
• Quadriceps Stretches⁚ Standing, reach back and grab your foot, gently pulling your heel towards your buttocks, stretching the quadriceps muscles, improving hip extension.

These exercises are typically progressed gradually, increasing the repetitions, sets, and resistance as tolerated. It is crucial to maintain proper form and technique to avoid injury. The physical therapist will provide detailed instructions and modifications as needed.

Interprofessional Management

Effective management of patients with hip ORIF involves a collaborative approach between various healthcare professionals. This interprofessional team ensures comprehensive care, addressing the patient’s physical, functional, and psychosocial needs. Key members of the team include⁚

• Orthopedic Surgeon⁚ The surgeon oversees the surgical procedure, monitors healing progress, and provides guidance on weight-bearing restrictions and activity limitations.
• Physical Therapist⁚ The physical therapist develops and implements a tailored rehabilitation program, focusing on restoring range of motion, strength, balance, and functional mobility.
• Occupational Therapist⁚ The occupational therapist assists patients with activities of daily living, such as dressing, bathing, and household tasks, promoting independence and participation in daily life.
• Nurse⁚ Nurses provide ongoing monitoring, pain management, and education on wound care, medication, and safety precautions.
• Social Worker⁚ Social workers address psychosocial concerns, provide support for discharge planning, and facilitate access to community resources.
• Pharmacist⁚ Pharmacists ensure appropriate medication management, addressing potential drug interactions and side effects.

Regular communication and coordination among these professionals are essential to ensure seamless care, optimize recovery, and facilitate a smooth transition back to the patient’s home environment. This collaborative approach enhances patient outcomes, promotes a holistic recovery process, and minimizes potential complications.

Discharge Planning

Discharge planning for patients following hip ORIF surgery is a crucial step in ensuring a smooth transition back to home and community life. It involves a comprehensive assessment of the patient’s functional abilities, support systems, and home environment. This collaborative process, involving the patient, family, and healthcare team, aims to optimize recovery and minimize the risk of complications or readmissions. Key elements of discharge planning include⁚

• Functional Assessment⁚ Evaluating the patient’s mobility, strength, balance, and ability to perform activities of daily living, such as walking, stairs, dressing, and bathing.
• Home Environment Evaluation⁚ Assessing the home for safety hazards, accessibility, and availability of necessary assistive devices, such as ramps, grab bars, and walkers.
• Support System Assessment⁚ Identifying the patient’s social support network, including family members, friends, or caregivers, who can assist with post-discharge care and support.
• Education and Training⁚ Providing the patient and caregivers with clear instructions on home exercise programs, medication management, wound care, and safety precautions.
• Referral to Community Resources⁚ Connecting patients with home health services, physical therapy, occupational therapy, or other community resources that may be needed to support their recovery.

Effective discharge planning promotes a seamless transition, empowers patients to manage their recovery, and minimizes the risk of readmissions or complications. It ensures that patients receive the necessary support and resources to thrive in their home environment after discharge.