Dynamic Hip Screw

[sdkashif]

I would be interested to know the detailed physiotherapy programme for a patient undergoing dynamic hip screw surgery for the upper end of femur. I know that the Active range of motion exercises should be started as soon as the pain permits. But I want to know when the partial weight bearing and full weight bearing should be started while doing the gait training of patient with the assistive devices.

I am waiting for the awswer.

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[somasimple]

Hi,

normally the partial weight bearing begins quickly 2/3 days after the surgery and full weight bearing depends from pain but normallly has to be reached around 30/45 days.

Often this kind of surgery brings a bit of unpleasant pain around hip and it is why many patients have to remove the material.

[sjmcdon]

Usually this decision is made by the orthopod based on the surgery, in most instances they have protocols, in the unit I worked in the patients were generally weight bearing as tolerated from PO1. Progressing to FWB as able.
Hope this is of some use to you.

[mwupt]

Well I agree! But most ortho surgeons recommend early weight-bearing (as early as PO1). I've handled a lot of post-DHS pxs and I consider other factors to proceed with ambulation training with an assistive device (crutches or walker) such as the general condition of the px (hemoglobin level, orthostatic hypotension, strength of the univolved lower extremity and upper extremities and pain tolerance, etc.)

Sometimes even if the px's condition permits ambulation and you have the go signal from the ortho surgeon, it would be his fear that would prevent from proceeding. You have to convince him that it's alright or make ways to alleviate his fear. It's a case to case basis.

If you have some clarifications , you can email me. I hope i've contributed something. GOOD LUCK!

[Aamir Bhatti]

Hi this is aamir a physiotherapist from Pakistan.

I would like to add something here for DHS. Actually, We put the patient between parallel bars the second postopertive day to see how much he can weightbear without pain. In our hospital we have track of parallel bars, if patient is able to complete the track without any pain or discomfort we allow the patient to partial wieght bear with axillary crutches.

Thanks

[sdkashif]

Many thanks for adding the reply to the question. Well, I agree that partial weight bearing should be started 2/3 days after the surgery and full weight bearing depends from pain but normally has to be reached around 30/45 days. However, the views of the orthopaedic surgeon should also be kept in mind while rehabilitating the patient. A sound liaison should be made between the physiotherapist and the othopaedic surgeon. As the progress of the condition of the patient varies from one case to another. So the alternation in the management of the patient is also made according to that.

[shakayaka]

Hi!

Im Sharika a physio syudent from S'pore. I am aware of the weight bearing status of a patient with DHS. However i was wondering if there are any limitations in terms of range of motion in patients with DHS. As in the case of THR, hip flexion range is usually limited to 90 degrees. Is there any such limitations for pts undergoing DHS?
Thanks so much for your help! 8)

[sanne]

HI

In Holland we start mobilization as soon as possible. partial weight bearing starts the second day after surgery. The stay in the hospital for 5 or 6 days. Full weight bearing starts almost always within 14 days after surgery.
greetz sanne

[CBR150]

Hi!

Im Sharika a physio syudent from S'pore. I am aware of the weight bearing status of a patient with DHS. However i was wondering if there are any limitations in terms of range of motion in patients with DHS. As in the case of THR, hip flexion range is usually limited to 90 degrees. Is there any such limitations for pts undergoing DHS?
Thanks so much for your help! 8)

I think the similar to THR, the limitation of flexion range is depend on the site of incision, any other colleagues can answer this question

[CBR150]

I think the similar to THR, the limitation of flexion range is depend on the site of incision, any other colleagues can answer this question

if only dynamic hip screw is done, no limitation of flexion range is needed

[Josephine]

Quite so - there should be no limitation on ROM or the op hasn't been done properly! And DHS ops are always done on a lateral incision, never a posterior as hemiarthroplasties and THRs are sometimes done. The patient has to be on an orthopaedic table which will allow egress of an image intensifier and traction to reduce the fracture, thus a posterior incision would be somewhat ..... difficult!