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Hip Fracture Physiotherapy
A hip fracture is a crack, a break or fracture in the long thigh
bone, near the hip joint.
These kinds of hip injuries and fractures are more commonly in elderly and individuals who have compromised bone health such as having osteoporosis, and these bones are fragile and break easily due to fragility. It can be as easy as a small bump against a firm surface, a twist or an actual slip and fall.
That being said, hip fractures can also happen in high-trauma incidences such as
- motorbike/car/vehicular-related accidents
- sports such as wrestling, mix martial arts
- falling from height or with force
There are four locations of hip fractures:
- femoral head fracture
- femoral neck fracture
- subcapital fracture or intra-capsular fracture
- subtrochanteric fractures that involve the shaft of femur as well
Unfortunately...there is high mortality risk and rates usually associated with hip fractures (up to 35%). This is because of the causes and sub-risks related to hip fractures, which are:
- elderly, who because of these hip fractures, be it managed with surgery or not, may become more home and worse is bed-bound, which may compromise their lung function, which can lead to lung infections (hence will require a lot of chest physiotherapy as well as fracture rehab physiotherapy, which helps them get up and about)
- high velocity/impact accidents with risk of multiple injuries
That being said, our senior physiotherapists have treated and managed hundreds if not thousands of hip fracture cases, so we are more than confident to help provide hip fracture physio for you or your loved ones.
Signs and symptoms of hip fractures
As mentioned earlier, there are two general groups of individuals who suffer from hip fractures:
- elder, who had a fall or bump that caused the fracture
- younger population who got the hip fracture from a high-impact accident/sports
Patients always present with pain and most of the time, will not be able to weight bear
on the affected leg or hip because of the pain. In some cases, the referring doctor will advise if the patient can full weight bear or partial weight bear or no weight bear, but even then the pain experienced may limit their hip movement.
hip fracture Risk factors
patients who fractured their hips, generally
they sustained a pathological fracture, of which the
most common causes are:
- Osteoporosis-weakened fragile bones
- Presence of metabolic bone diseases e.g. Paget's disease, osteomalacia, osteopetrosis and osteogenesis imperfecta
- Bone cancers or tumors
- Previous bone fractures that hadn't healed or didn't heal properly
- Cancer that had spread/traveled from another site (metastatis)
- Bone infections
Diagnosing hip fractures
Diagnosing hip fractures is fairly direct and straight forward. Patient who had a fall or accident and reports painful hips (sometimes they may not report pain due to the adrenaline), and the attending doctor will request X-ray immediately and 2 weeks time to confirm hip fracture or not.
Why patients may need another x-ray in 2 weeks time is generally moreso when patient's immediate x-ray doesn't present any fractures due to swelling or very small fractures, but can be easier seen in 2 weeks time.
hip fracture Management
For hip fractures that are obviously clear fractures, patients should consider corrective surgery, unless it's just a very minor crack with no displacement (ie known as "stable undisplaced fractures/cracks") or patient has other conditions that doesn't allow surgery.
If the fracture is clear, displaced (or worse, fragmented and/or rotated), patient will always benefit from immediate corrective surgery rather than just rest in bed, because being bed-bound/immobile has a few bad risks including compromised lung functions and risk of lung/chest infections.
Of course, there will be presence of pain with or without surgery, but the difference is with corrective surgery is that patient can have the chance to be mobile by day 1 post surgery, to move around, and have hope. And we as senior orthopedic physiotherapists will do our utmost to get them to sit to stand, stand, do activities and exercises in standing, to walking a few steps, to walking around, to walking further and more.
The ability to have freedom to sit up, move about and around, is a
wonderful experience that will bring meaning and smile and hope to any
patient, young or old. And it is this hope and experience that will also help to accelerate recovery, shorten need for physiotherapy in the long run, and more.
That's why patients with hip fractures especially, be it having conservative (non-surgery) or choosing for surgery, will always 100% benefit from orthopedic physiotherapy with us. That's why orthopedic surgeons will always refer for physiotherapy to train patient's mobility, chest function and more.
For simple hip fractures, the operating orthopedic surgeon will tend to use screws and plates to preserve the bone, but for older patients with serious hip fractures, they may recommend a full hip replacement instead, which allows for immediate mobilization and even to walk around (which helps a lot in chest function, recovery rate, motivation etc).
If your surgeon by accident forgot to refer you to physiotherapy, gently nudge and remind them (they're often very busy and overworked, so sometimes will forget - check the doctors we serve), or you can contact us directly too, and we'd be more than happy to serve.
In some situations, the doctors or family may determine that the risks associated with surgery may be too high, then the management focus will automatically change to non-surgical hip fracture management, which entails:
- no operational procedures
- protect the hip fracture and prevent worsening (eg further displacement etc)
- prevent secondary infections such as lung/chest infections (requires chest physiotherapy)
- prevent secondary issues such as pressure sores (skin breakdown) etc due to prolonged immobilization (requires mobilization physiotherapy)
In some cases, the doctor may call for patient to be bed-bound and apply traction to position the hip fracture properly, coupled with daily (sometimes up to three times daily) chest physiotherapy and bed-side physiotherapy. This is to prevent chest infection, pneumonia, joint stiffness, pressure sores, deep vein thrombosis (DVT) etc
hip fracture potential Complications
The are potential medical complications related to hip fractures. Common ones are:
- non-union where the fractured parts healed independently without uniting
- mal-union where the fractured ends connected in a mal-aligned position
- secondary infections like sepsis and chest/lung infections eg pneumonia
- avascular necrosis (AVN) where blood flow to the fractured site is disrupted and the site starts to decay
Prognosis of hip fracture recovery
Fractures of any kinds are painful and stressful events to elderly patients. In fact, hip fractures and spine fractures are one of the most painful, stressful and potentially life threatening if poorly managed (as mentioned above).
Hip fractures will require active ongoing physiotherapy (chest, mobilization, ambulatory) for full recovery.
Post operative physiotherapy
Where suitable, patients with hip fracture and hip fracture/replacement surgery tend to respond well to
- chest physiotherapy
- mobilization physiotherapy
- ambulatory physiotherapy
- strengthening, balance and stamina physiotherapy
- community physiotherapy
and aim for the patient to achieve 100% recovery post surgery and post surgery physiotherapy.
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Phoenix Rehab Singapore Core Services And Specializations
Phoenix Rehab Group works with specialist
physiotherapists and specialist rehab therapists who are highly
trained, qualified, experienced and passionate to provide high level of
expert care to our patients.
PHYSIOTHERAPY & PHYSICAL THERAPY
HAND THERAPY & SPLINTING
Patients who sustained injuries to their elbows, forearms, hands, wrists
(sprains and fractures) and fingers, and requires Hand Therapy to increase the function of their hand
following injuries or post-operations as well as custom made hand splints.
Commonly treated hand pain injuries includes wrist and finger fractures, de Quervain's tenosynovitis, carpal tunnel syndrome, trigger finger, tennis elbow, golfer's elbow and more.
CLINICAL PILATES & WELLNESS PILATES
Clinical Pilates is a form of physical exercise that focuses on posture,
core stability, balance, control, strength, flexibility, and breathing. It is a system of safe and effective exercises, which
meet specific individual needs, to treat a wide range of injuries
You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.
TRADITIONAL CHINESE MEDICINE (TCM)
DEEP TISSUE RELEASE & SPORTS MASSAGE THERAPY
Sports and deep tissue release massage helps to increase nutrient-rich blood
flow to tired , tight and tense muscles to accelerate recovery and shorten downtime. It also prevents
muscles from scar tissue micro-tears (and potential ruptures), and increases muscle
Done regularly, it will keeps your muscles healthy and fit with body/movement-confidence.
All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB). See our entire team here by location and specialization.
At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
help you recover as well as provide treatment in the same session. Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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