good case fractures in lower limb...please help me!!

[amit]

hi friend,i got one patient for home visit.30 years old male (height-6 feet,weight-87kg)
who has got fracture pubic ramii,
fracture neck femur for which open reduction internal fixation(ORFI) done,
fracture shaft femur for which rod and screw fixation done,
fracture patellaa for which(8) shaped tension band wiring done,
fracture supracondylar tibia for which screw fixation done,
4th metatarsal and phalenge fracture where k wire was used for stabilisation....

fixation of fracture neck femur and tibia done 1 week ago. and other fixations done 3 weeks ago...
i m doing knee mobility,hip mobility...but wen i took him for sitting,standing in walker,walking...what shoulb my plan of managment right now????please suggest
if u hav any references please forward me.
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[msk101]

HI There,

I am assuming that all the fractures are on the same side -before doing the weightbearing things you really should check what the post-op protocols and surgeon's orders are for weightbearing status... eg. is it weightbearing as tolerated up to full weightbearing or is there a limitation to a certain number of kg's or a percent of your patient's body weight? are there any other surgical contraindications?

have you assessed quad's strength (SLR or inner range and/or static) and same for hamstring and glutes? can the patient bridge in supine? is your rehab so far only ROM or are you doing strengthening of the lower limbs and glutes?

if you can answer these questions then there will be some direction in your rehab plans and you can formulate goals and a safe progression for your patient.

cheers,
msk101