06/07/2024
Hip fracture locations and physical therapy 💡
👉 Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. (https://pubmed.ncbi.nlm.nih.gov/20804229/, https://pubmed.ncbi.nlm.nih.gov/22238628/, https://pubmed.ncbi.nlm.nih.gov/11562555/)
🦴 Ninety percent of all hip fractures in people 65 years and older result from a ground-level fall. Fractures from these low-energy traumatic falls are commonly called fragility fractures. (https://pubmed.ncbi.nlm.nih.gov/33522384/)
⚰️ Evidence indicates that those with hip fracture have substantially higher risk of death up to 1 year after fracture. One study found a 15-fold higher risk of death for those with hip fracture during the first month compared with their uninjured peers. (https://pubmed.ncbi.nlm.nih.gov/8171100/)
🔀 Hip fractures are anatomically classified in relation to the hip capsule as intracapsular (i.e., at the femoral neck) or extracapsular (i.e., intertrochanteric or subtrochanteric). Femoral-neck fractures may be nondisplaced (i.e., very little separation at the fracture site, occurring in approximately one third of femoral-neck fractures) or displaced (i.e., greater separation).
🔀 Fractures below the femoral neck are referred as intertrochanteric fractures, and those below the lesser trochanter as subtrochanteric fractures. (https://pubmed.ncbi.nlm.nih.gov/29166235/)
🔀Most hip fractures occur in the femoral neck or intertrochanteric area.( https://www.mdpi.com/2077-0383/13/12/3457)
📘 The Clinical Practice Guidelines for Physical Therapy Management of Older Adults With Hip Fracture by the American Physical Therapy Association encompasses 12 were strong recommendations (Level A evidence). (https://pubmed.ncbi.nlm.nih.gov/33522384/)
👉 The. Assessment recommendations were (n = 5):
1️⃣test and document knee extension strength;
2️⃣ administer and document the verbal rating scale for pain;
3️⃣ use the gait speed test, documenting features of test administration (eg, use of an aid);
4️⃣ use the Cumulated Ambulation Score in the acute and postacute settings to measure mobility until ambulating independently; and
5️⃣ use the Timed Up and Go test to measure mobility and falls risk, documenting features of test administration.
👉 Interprofessional management recommendations were (n = 7):
1️⃣participate in multicomponent, interprofessional non-pharmacological interventions for at-risk older adults undergoing surgery to prevent delirium;
2️⃣ assess risk factors for falls; and
3️⃣provide high-intensity resistance, balance, weight-bearing and functional mobility training; treat patients in a multidisciplinary orthogeriatric program,
4️⃣providing physiotherapy and early mobilisation;
5️⃣ assist transfer out of bed and ambulation as soon as possible after hip fracture surgery and at least daily, unless contraindicated;
6️⃣ provide opportunities for additional therapies to address deficits in strength, balance and function, if deficits remain beyond 8 to 16 weeks after fracture; and
7️⃣ provide recommendations to maximise safe physical activity.
Illustration: https://www.mdpi.com/2077-0383/13/12/3457
