Rehabilitation after a hip fracture includes measures aimed at healing the damage and restoring lost functions. As statistics show, almost a quarter of Russian residents are included in the risk group; every 5 minutes a hip fracture is recorded in our country. Not everyone receives qualified medical care, but the quality of the patient’s adaptation depends on recovery after surgery. For everything to go well, rehabilitation after injuries to the musculoskeletal system should take place in special medical centers. In such institutions, the patient will always be under the supervision of doctors who will be able to adjust the measures taken.
When should you start rehabilitation after a hip fracture? – the first steps should be taken already on the first day after immobilization of the limb. First, you need to perform breathing exercises, and later physical therapy is prescribed to prevent bedsores along with diet, physiotherapy and massage.
Types of fractures
When reconstructing the femur, it is important to classify fractures as follows:
- Open;
- Closed;
- With and without displacement.
It is also necessary to identify the complexity of the lesion, the degree of negative impact on the body, and select individual appropriate treatment for the patient.
This pathology is one of the severe injuries, without intervention which can trigger a disease, the consequences of which can be irreversible.
Rehabilitation will achieve results only with long and patient exposure to the affected area of the body. Important! In case of complicated injuries with the formation of fragments, a course of exercise therapy prescribed by a very experienced specialist is required, so as not to cause additional harm due to inept actions.
Features of rehabilitation after a hip fracture
To fully restore the body, a course of rehabilitation should be carried out. Therapeutic gymnastics exercises depend on the individual characteristics of a particular person, his age, the severity of the fracture, as well as previous diseases, including oncology.
It is much easier for young people to restore limb mobility than for older patients. Rehabilitation in an elderly person after a hip fracture becomes much more complicated due to the presence of diabetes mellitus, dementia, and the inability to perform osteosynthesis. Possible formation of a false joint.
Often, with a severe comminuted fracture, pensioners are no longer able to restore motor function, becoming disabled, and are in a supine position for the rest of their lives. Also, the risk of mortality from this injury increases by up to 60% , so older people should be especially careful.
During rehabilitation, a course of exercise therapy is simply irreplaceable for elderly patients. It will quickly restore the ability to walk and improve the overall tone of the body.
A fracture of the head or neck of the femur will force you to spend at least 3 months in bed, but rehabilitation should begin no later than the second day after the injury.
For each patient, the duration of the supine position is determined individually, reaching 6 months , which depends on the age and complexity of the injury. If it is possible to carry out osteosynthesis, then this period can be reduced by an order of magnitude, but only when there is no harm to the body.
If a closed-type impression fracture does not heal, a false joint is formed, which prevents independent walking, which in itself is a severe disability. In such moments, a sanatorium will not help, which is why it is not even offered during rehabilitation.
Features of recovery in elderly patients
In old age and old age, all metabolic and, accordingly, recovery processes slow down. As bone density decreases, fracture healing becomes more difficult. The problem is that surgical treatment is often contraindicated for this category of patients. After all, they suffer from various chronic diseases, osteoporosis, which does not allow the metal plate to be firmly fixed on the femur. And with conservative treatment tactics, rehabilitation is less effective.
Elderly patients have a significantly higher risk of developing life-threatening complications: congestive pneumonia, pulmonary embolism, sepsis due to infected bedsores. This is why they require constant care:
- It is necessary to regularly turn them over in bed, change the position of the head and limbs. This will prevent the development of bedsores and thrombosis;
- You can purchase a special anti-decubitus mattress. However, note that it does not eliminate the need for turns;
- The skin should be regularly washed and treated with antiseptic solutions, especially in areas that have been in a compressed state for a long time - the back of the head, sacrum, shoulder blades, heels;
- To prevent aspiration pneumonia, feed the patient only in a sitting or semi-sitting position supported by pillows. Otherwise, food particles may enter the respiratory tract and cause inflammation;
- At the stage of late rehabilitation, special devices will help facilitate adaptation to everyday life: a frame above the bed that you can grab onto and stand up, special handles and chairs in the bathroom that make self-service easier, something like a railing in the hallway.
Diet
To quickly restore the ability to walk, you should ensure that you eat food rich in minerals, proteins, and vitamin D. Every day you should try to consume:
- Seafood;
- Eggs;
- Fermented milk products, including low-fat fish;
- Sea cabbage and cauliflower;
- You should not refrain from consuming compote made from dried fruits, which replenishes the mineral composition in the bones.
When taking these products, the femoral part of the limb heals faster after a fracture. Even during rehabilitation in a sanatorium, a nutritionist prescribes appropriate nutrition containing excess calcium and vitamin D.
Attention! A specialized diet must be followed for a long, constant period, without interruption, even after the cessation of exercise therapy procedures, for complete restoration of the femoral neck.
Diet is necessary to not only add calcium required for bone healing, but also to maintain optimal weight. Excess body weight puts stress on the damaged joint and increases the recovery time of the damaged limb.
Manual therapy after cast removal
Therapeutic massage is also necessary after the immobilizing bandage is removed. At this stage, a deep type procedure is shown.
The chiropractor pays attention to:
- lumbosacral area;
- buttocks;
- knees;
- hips;
- shins;
- hip joint.
Makes patting, stroking movements, and also uses the “chopping” technique. Prolonged immobilization in most cases makes the joints weak or completely immobile. The knees are especially affected, so it is necessary to warm them up.
Attention should be paid not only to the joints, but also to the area around them. Foot massage should also include treatment of ligaments and muscle tissue. You cannot practice intense movements at the very top of the thigh if the postoperative sutures have not yet healed.
Massage when applying a coxite bandage
Sometimes the specific nature of the injury requires the application of a high coxite bandage. In this case, foot massage is difficult. A healthy limb must be patted down. It is highly recommended to pay attention to the area of the segmental roots of the affected leg by making a hole in the plaster layer.
Additionally, mechanical vibration is performed. In this case, it is only possible through a plaster cast. Manipulations are performed using an ebonite vibrator. When the foot and lower leg are not covered with a bandage, they must be massaged.
The knee area requires increased attention. To prevent stiffness, chiropractors try to target the area through a window cut into the cast.
The benefits of exercise therapy
Therapeutic gymnastics helps with injuries of the femoral neck:
- Improving blood flow through the vessels in the fracture area. Stagnation of blood can significantly damage the health of the limb and the entire body as a whole;
- Slowing down the atrophy of muscle tissue and increasing overall tone, and special massage greatly helps;
- Strengthening the muscles in the legs, in particular the hip joint;
- Reducing stiffness and feeling of heaviness in the hip;
- Restoring the ability to support the legs after an injury, the severity of which can vary widely;
- Providing memories of correct walking skills and posture.
Classification
Classification of fractures based on the presence or absence of concomitant internal damage to tissue and skin is divided into open and closed.
Open fracture
A complex category of injury with prolonged wound healing and the threat of bone infection with subsequent development of acute osteomyelitis.
Diagnosed by fragments that have broken through the skin. Fragments of a broken bone damage a considerable area of muscle tissue, blood vessels and nerve endings. The intensity of blood loss directly depends on the size of the damaged vessel, and in some cases this factor can be critical.
As a result of severe pain and bleeding, breathing and heart rate are disrupted, the victim is in a state of panic, up to a short-term loss of consciousness. In some cases, an open hip fracture is accompanied by traumatic shock.
Closed fracture
With a closed fracture without displacement, there is no damage to the internal tissue and skin. Due to visually mild symptoms, the victim sometimes continues to lean on his leg while walking. In this case, the fracture can be intra-articular in nature and destroy the condyles of the tibia.
You can suspect a closed form of a hip fracture as a result of some kind of injury based on several first signs when you normally try to lift your leg:
- severe pain occurs;
- a fragment of the tibia protrudes;
- When palpating the damaged leg, an uncharacteristic crunching sound is sometimes heard.
Contraindications
Massage is prescribed already on the third day after the start of exercise therapy or osteosynthesis, but it is necessary to monitor body temperature, preventing it from increasing.
At first, the massage is performed only in the lumbar region, then they move on to warming up the healthy lower limb. If a closed type fracture occurs and the condyles and head of the femoral bone are damaged, and the formation of a false joint begins, then the massage is carried out most carefully, since this injury is classified as severe and can lead to disability.
Important! When the temperature rises, rehabilitation in the form of massage is strictly prohibited!
If vascular dementia is detected, then massage and therapeutic exercises should be carried out in a limited manner. It is necessary to help patients in specialized rehabilitation centers.
To restore independent walking function, older people are advised to use walkers for faster rehabilitation.
First aid
External signs and complaints of the victim may confirm the fact of a fracture. You can further verify this by lightly tapping him on the heel or thigh. In case of severe reciprocal pain, you should immediately consult a doctor and immediately provide first aid.
What to do if you have a hip fracture?
1. Some analgesics will partially help relieve unbearable pain and stop traumatic shock. Ketoprofen, Ibuprofen, any of their analogues or lidocaine spray are suitable as a local anesthetic.
2. Lay the victim on his back, on a hard, flat surface, but do not remove his shoes or clothes. Displaced hip bones during movement can significantly aggravate the condition.
3. The entire length of the injured leg should be completely immobilized. To do this, you will need to apply a splint along the side of the body and securely fix the joints. But the tire should not come into contact with the skin, much less the wound. Otherwise, be sure to place soft cushions at each joint. If using something as a splint is not possible, tie both legs of the victim.
4. In case of an open fracture with heavy bleeding, it is necessary to apply a tourniquet just above the open wound and be sure to record this time.
Set of exercises
Rehabilitation after a hip fracture can be carried out at home. Moreover, the patient’s advanced age is not an obstacle to the procedures.
Let's consider the basic exercises for rehabilitation at home:
- Lie on your back, tense and relax alternately the muscles of the injured thigh. These actions help to maintain the tone of both condyles;
- Grasp the edge of the bed with your hands. The foot of the injured leg should be rested on the prepared stand until pain appears;
- While lying on your back, roll over from one side to the other, then onto your stomach, using the help of relatives or other people;
- Bend the knee of the healthy limb and lift the injured leg, but the number of approaches should not be more than 4 times and as slowly as possible.
- When at least 14 days have passed since the injury, movements of the knee joints are allowed, first with the help of assistants, and after 3-4 sessions independently;
- Lying on your back, lean on your upper limbs, try to sit down and lower your sore leg to the edge of a horizontal surface. At first, this exercise should be performed a maximum of 3 times, gradually increasing the load and duration;
- This action is performed in the late period of rehabilitation, when it is possible to assume a standing position. Leaning on the headboard and standing next to it, tilt your body forward, while bending your healthy leg and putting it back, extending your toe. Repeat the exercise no more than 10 times in one approach.
- Swing the injured leg according to the intended body movement, describing the eight, leaning on the healthy lower limb. Carry out this action at least 5 times until pain appears in the injured hip.
This exercise therapy complex will help improve blood flow in the damaged area, and also ensure restoration of the functionality of the femoral head and condyles.
For complete rehabilitation, it is recommended to continue treatment in a special boarding house or sanatorium in order to fully restore the functioning of the damaged hip.
Diagnostics
As a rule, the fact of a fracture is obvious from external symptoms. The traumatologist clarifies the time and details of the injury that occurred, and uses palpation to determine the location of the source of pain.
Heavy bleeding requires a laboratory blood test, and in case of complications with hemarthrosis, an ultrasound of the knee joint will be required.
But the X-ray results in this situation are of the greatest value in determining the type, clear localization of the fracture and the presence or absence of displaced fragments. If extensive damage to internal tissue or blood vessels has occurred, an MRI is additionally prescribed to objectively assess the condition.