Mother just had surgery for an intertrochanteric hip fracture. She's 87-years-old and not as spry as she used to be. The nurses say the physical therapist will be up to her room today to get her up and walking. Is that really safe? I'm sure they know what they are doing but I'm worried just the same. What can you tell me?
The question of early mobility following surgery for a hip fracture is one that has been debated and studied quite a bit. Clearly, the complications of being bedfast are dangerous (e.g., blood clots, bedsores, pneumonia). So what is the best timeline for getting patients up and going after intertrochanteric hip fractures?
According to a recent review by an orthopedic surgeon published in Current Orthopaedic Practice, avoiding weight-bearing is no longer advised. The value of early mobility is clear now. So unlike in the past (when the patient might have been kept in bed or at least off that leg for up to six months), today's patient can get up soon after surgery. Pain is the guide so patients are allowed to put weight on the leg "as tolerated".
If the fracture was stabilized with metal plates, screws, or pins, the newer, improved fixation systems of this type allow for safe weight-bearing. Usually, a walker is supplied so the patient is supported and protected.
Sicker patients may find it more difficult to get up and moving quite so quickly. Sometimes just lifting the leg can seem like a tremendous effort. The physical therapist will know how much your mother can do in these early days. A program of movement, mobility, and strengthening will be started and slowly progressed according to your mother's abilities.
The goal is to restore normal function without compromising the healing surgical/fracture site. Preventing deformities and complications are important goals as well. Feel free to express your concerns and ask the hospital staff (surgeon, nurse, physical therapist) to help you understand the treatment plan.
William E. Albers,MD. Intertrochanteric Hip Fractures: Historical Perspective on Current Treatment Methods. In Current Orthopaedic Practice. September/October 2011. Vol. 22. No. 5. Pp. 405-411.
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