Hip stability post-op (femur ORIF)

[Dani Physio]

Hello. I am looking for advice...I am a final year student doing my final prac exam soon.
My pt is a 17yr old male, involved in a MVA 2 1/2 months ago. He is a waterpolo player. He fractured his femur (upper 1/3 shaft) and ankle. They fixated the femur with an intramedullary nail, but incision was laterally, over glut medius and ITB (I don't think TFL was damaged). Ankle was put in POP only. NWB 6/52. He is now on 1 crutch and moonboot during the day. Afternoons he only uses crutch. He complains of limping and weakness in his affected leg. He has a very bad limp, and walks in abduction with affected leg. Shortened stance phase on affected side, with severe abduction of affected leg during gait. Decreased knee flexion in gait and PF & DF are limited due to ankle fractures & immobilization.

However, his muscle strength is not as poor as expected on affected side and he is able to walk without crutch if need be (balance poor).

My diagnosis was confirmed when I was told by a qualified physio that his main problem is hip instability (glut medius). Any ideas on improving hip stability esp glut max & med will be appreciated. Hydrotherapy?? Hip abduction ex's such as single leg circles?

Thank you!
Danielle

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[Dr Damien]

Dear Danielle
is he in any pain when he walks? and how do you mean he walks in abduction? is there a hip drop on the non affected side when he walks..? what exercises is he doing...? sometimes wearing an ortho boot causes the deviations primarily because it is higher causing an apparent LLD; making the wearer walk in what seems to be abduction to compensate for this...

Cheers

[Dani Physio]

He says he feels no pain, just as if his leg 'gives way'/decreased power. He gets pain on the medial side of his ankle but i think it's from the immobility. He doesn't get a noticable drop, but I'll check Trendellenburg. He keeps his affected leg abducted when he walks (without moonboot), as if he can't bring his hip in (?). So he puts his foot down outside his normal BOS. Thanks very much for replying!!