Functional Mobility with Hip Fractures and Replacement – Flashcards

1. Femoral Neck Fractures -common in people over 60 -more common in women than men -osteoporosis usually present 2. Intertrochanteric Fractures -between the greater and lesser trochanter -results in direct trauma over the trochanter as a result of a mechanical fall -most common in older women 3. Subtrochanteric Fractures -1 to 2 inches below the lesser trochanter -usually due to direct trauma (falls, MVA) -occur most often in people younger than 60

Open Reduction Internal Fixation

No, just weight bearing precautions.

NWB - non-weight bearing TTWB - toe-touch weight bearing PWB - partial weight bearing WBAT - weight bearing as tolerated FWB - full weight bearing

no weight at all can be placed on the extremity involved

only the toe can be placed on the ground to provide some balance while standing...90% of the weight is still on the uninvolved leg (patient can be instructed to imagine that an egg is under their toe)

50% of the person's body weight can be placed on the effected leg

patient is allowed to judge how much weight they can put on the affected leg without causing too much pain

the patient should be ale to put 100% of their weight on the affected leg without causing damage to the fracture site.

Restoration of joint motion and management of pain by hip replacement can be indicated for people with osteoarthritis (or Degenerative Joint Disease), rheumatoid arthritis, or other conditions such as dysplasia. Osteoarthritis or DJD typically occur in weight bearing joints such as the knee, hip and vertebra. Other diseases such as lupus or cancer, and some medications (e.g. corticosteroids/Prednisone) can compromise the blood flow to the hip joint and lead to avascular necrosis

1. To alleviate pain 2. To restore joint range of motion

1. A bipolar arthroplasty (known as otal Hip Arthroplasty THR): both the socket and femoral head are replaced. 2, Hemiarthroplasty (HA): typically only the femoral head is replaced

Anterolateral approach hip precautions are: 1. no hip external rotation 2. no hip extension 3. no hip adduction across the midline of the body 4. WBAT Posterolateral approach hip precautions are: 1. no hip flexion over 60-90 degrees (surgeon will specify) 2. no hip internal rotation 3. no hip adduction (across the midline of the body) 4. WBAT Hip precautions are observed typically for 6-12 weeks

The patient could dislocate their hip during the muscle and soft tissue healing phase. This can lead to further, more invasive surgery.

The role of the Occupational Therapy is to perform any assessments needed for the evaluation such as body functions, UE ROM and strength and coordination. These are done before the functional evaluation. The OTA participated in the assessment of performance skills, ADL, and IADL and can gather data to contribute to the OT eval. During the evaluation process, the OT and OTA must observe any signs of pain and fear during movement. The OTA plays a major role in intervention planning and implementation by training patients in the use of assistive devices, peoper transfer techniques, and compensatory techniques while maintaining adherence to precautions during purposeful and occupation-based activities. The OT and OTA collaborate in intervention planning, documentation, and discharge planning. The OTA can play a role along with the OT in providing education classes prior to surgery. Many hospitals offer "joint camp" or community education lectures on how to make one's home safer from falls.

Within 1 - 3 days post op

1. graded dressing/bathing/toileting - training in use of assistive devices for LE BADL and adherence to WB or Hip Precautions 2. Balance - consider both time & quality of standing 3. Physical Activity Tolerance - take into account the fubnctional activity and address endurance appropriately 4. Independent Living Skills - work from simple interaction with the environment to completion of actual, relevant homemaking skills

1. dressing stick 2. sock aid (sock donner) 3. reacher 4. long handled shoehorn 5. long handled sponge 6. elastic shoelaces 7. leg lifter (or a gait belt) 8. bedside commode (with front legs 1-2 "clicks" lower for posterior hip precautions) 9. transfer bath benches (with front legs 1-2 "clicks' lower for posterior hip precautions) 10. Elevated Toilet Seat (do come with a cut out on right or left side for hip flexion precautions) 11. Three in one commode (1-2 "clicks" down in front)

1. Hemovac - plastic drainage tube at the surgical site to assist with blood drainage. 2. Abduction Wedge (form wedged placed between legs) 3. Balanced Suspension (to support affected leg) 4. Bedside Commode Chair 5. Sequential Compression Devices (SCD's) - used post-operatively to reduce the risk of thrombosis (sleeves that fit over the lower leg and air is sequentially pumped into the plastic sleeve and then pressure release - acts as a pumping motion) 6. Anti-Emoblus Hose/Compression Stocking - to assist circulation, prevent edema, reduce the risk of DVT. (put on while patient still supine in bed) 7. PCA = patient control administration device for pain alleviation

-It is recommended that the patient sleep supine with a foam abductor wedge or pillow between their legs. -Initially may be easier for patient to get out of bed movin toward their non-operated leg. Pt needs to be able to get in and out of bed from either side. -Support upper body by extending the arms and leaning back, gradually turning the entire body as one unit to the edge of the bed -NO ROLLING! -Use of an overbed trapeze may be helpful initially, but wean off use as soon as possible -Strengthen the trunk to assist with supine to sit -When initially getting in and out of bed, a leg lifter can be used to assist moving the operated leg, however should be discontinued as the operated leg gets stronger. -For posterior hip precautions, keep the operated hip "open", not flexing over 90 degrees

1. A firmly based chair with armrests is recommended. 2. Patient is instructed to extend the operated leg forward (to open the hip angle to under 90 degrees flexion) 3. Reach back for the armrests 4. Sit slowly 5. For the patient with a posterior approach, do not lean forward when sitting down

1. Patient extends the knee of the operated leg 2. Push off the armrests supporting the body weight with the non operated leg. 3. For patients with posterior hip precautions, have patient scoot forward to the edge of the chair and lean back.

place a wheelchair cushion or folded blankets on the chair to raise the seat height. An elevated toilet seat or an over the toilet commode (OTC) (called 3 in 1 commode) can be used for the toilet.

low, soft seated chairs, recliners and rocking chairs

1. Use of a "3 in 1" (or Over The Toilet (OTC)) commode is recommended for use on the toilet. The front legs can be lowered one click to accommodate hip flexion restrictions. 2. Toilet hygiene should be completed by wiping between the legs in a sitting position or from behnd in a standing position with caution to avoid rottion of the hip. 3. Patient needs to stand up using FWW in recommended manner to turn (quarter step turns) to access the sink to wash hands. DO NOT rotate the trunk or hip.

1. A second person present is advised in case assistance is needed. 2. Ensure non-skid strips or stickers are recommended 3. To enter the shower stall, the walker/crutches enter first. The operated leg next, following by the non-operated leg. 4. A shower chair with adjustable legs (front legs can be lowered one click for posterior hip flexion precautions) can be used 5. Grab bars should be installed if a balance problem is present 6. Hand Held Shower Hose 7. Long Handled Bath Brush

1. Transfer Tub bench training 2. Patients who like tub baths will have to forgoe the luxury during the hip precaution period. 3. Sit on the edge of the bench as if sitting in a chair, 4. Carefully swing legs over the tub while adhering to hip precautions. 5. A leg lifter can be use to assist the operated leg. 6. Grab bars 7. Long Handled Bath Brush

1. Try to avoid bucket seats (good luck, most cars nowadays have bucket seats) - bench seat is recommended. 2. Car TF technique: (push the car seat all the way back first) a. Instruct patient to back up to the passenger seat b. hold onto a stable part of the care c. place the operated leg forward of the nonoperated leg d. slowly sit in the car (follow the stand to sit procedures!) e. Remembering to lean back, patient slides the buttocks toward the drivers seat f. The upper body and LEs then carefully move as one unit to turn to face the forward direction g. The seat back can be reclined to accommodate posterior hip precautions

1. Sit in a chair with arms or edge of bed for dressing 2. Instruct patient in their hip precautions (instruct, demo to patient, have patient return demo) 3. Instruct patient in use of assistive devices to compensate for hip precautions such as reacher, dressing stick for donning and removing shoes; 4. When donning pants, the operated leg is dressed first by use the reacher or dressing stick to bring the pants over the foot and up to the knee. 5. A sock aide is used to don socks or knee-high nylons 6. a reacher or dressing stick is used to remove socks. 7. A reaching, long-handled shoe horn and elastic shoelaces can assist with donning shoes while maintaining hip precautions.

1. Refer to the techniques under shower/tub transfers 2. Sponge bathing is indicated until the physician permits the patient to shower. 3. Patients are instructed to sit to wash their legs (shower chair or transfer bath bench) 4. A long handled bath sponge or brush is used to reach the lower legs 5. Soap on a Rope can be used to prevent the soap from dropping 6. A hand towel can be wrapped around a reacher to dry the lower legs.

1. Avoid any heavy housework until joint is fully healed. This includs vacuuming, lifting, and bedmaking. 2. Commonly used items in the kitchen should be kept at countertop level. 3. Items can be moved by using an apron with large pockets, sliding items along the countertop, using a utility care, attaching a small basket or bag to a walker or wearing a "fanny pack". 4. Use a reacher to access low cabinets, pick up items off the floor, place dishes in the lower rack of the dishwasher, place pet food dish on the floor 5. Light meal prep should be done a stovetop or with a microwave or toaster within easy countertop reach. 6. Use of a standard oven should be avoided (follow those hip precautions!!!) 7. Need to problem solve for pet care and feeding.

reaching for cones peg/pegboard designs from standing UE exercises with wrist weights bean bag toss pulle exercises from standing one-handed theraband exercises, balloon bat (with or without wrist weights) batting the swiss ball

dowel with weights dowel with theraband UE bike (ergometer) balloon bat playing catch with swiss ball play catch with weighted ball

carrying an exercise ball moving large bulky items tapping a balloon - to react to movement

Hygiene/grooming from standing item retrival using reacher opening/closing doors dust clothes manipulation / hygiene with toileting cleaning countertops or full length mirror

Folding towels or clothes Retreiving items from cabinets above and ablow waist height watering plants wash and dry dishes decorating bulletine boards/doors/treatment areas dust clean windows/kitchen area sweeping

Cooking wash and dry dishes straighten (not make) the bed retrieving items from the fridge trash removal