Group 6

Hip (Proximal Femur) Fracture

Cabal,Bryan Christopher

Yadao, Julius

Dionaldo, Rheamae

Evangelista, Rei Carlos

Tuliao, Jon Irvin

Tolentino, Jeremy Daniel

ETIOLOGY:
 Falls
 Age
 Gender
 Race
 Institutionalization/Hospitalization
 Medical co-morbidities
 Hip Geometry
 Medication
 Bone density and body habitus
 Diet
 Smoking
 Alchohol consumption
 Fluorinated water

EPIDEMIOLOGY:
 Worldwide, in the year 2000, there were estimated to be 1.6 million hip fractures
 300,000 hip fractures occur each year in United States

ANATOMY:
 Femoral Head
 Intertrochanteric Line
 Neck
 Greater and Lesser Trochanter

MUSCLES
 Gluteus medius
 Gluteus Minimi
 Piriformis

KINESIOLOGY:
 Ball and Socket
 Abduction
 External Rotation of the thigh
 Flex
 Internally rotatate the hip

SUBJECTIVE:
I. Hip Anatomy (Proximal Femur)
- The proximal femur that connects to the hip bone that articulates with the
acetabulum of the pelvis that makes or form a hip joint, proximal part of
femur consist of the head and neck with the greater and lesser trochanter.
 Then within the hip part with the muscles gives action to make a movement
of the thigh and hip there is pisiformis, gluteus medius and minimi. The
gluteus medius and gluteus minimi action is to abduct the thigh at hip joint
and prevent adduction of the thigh at hip joint , then was innervated by
superior gluteal nerve with the nerve root of L4,L5,S1, then Piriformis was
inserted at greater trochanter and the external rotators of the thigh.
II. Kinesiology
- May all the movement of the thigh at hip joint be impaired caused by the
fracture of the proximal end of the femur which has a possible changes of
the gait of the patient according to its action and movements, then may
result of a slower gait movement.
III. Medical and Surgical Background
- According to the hip fracture of the proximal femur it was needed to be put
a procedure of surgery to the patient and it may needed to know which part
are fractured, if it’s a intrascapular and extrascapular, so the hitted part of
the case was the intertrochanteric fracture, so the case wasa typical
extrascapular fracture, and it may put pins and screws for a femoral head
was not displaced.
IV. Treatment
- Operative Management
 Surgical Intervention was needed to avoid further complications to
the patient’s case where to avoid patient’s femur head to be
dislocated to it’s place while fractured, so it may give a arthroplasty
procedure to it and avoid avascular necrosis. The primary goal of
the surgery is to bring back the normal or near normal ROM of the
thigh at hip joint, then to relieve the pain and be functionally move
it so well, without a complication of avascular necrosis.
- Postoperative Management
 It will needed to be focus on rehabilitation for a patient after the
surgery, then it may needed to be intensive and multidisciplinary,
because of it can return the patient’s condition to normal, possibly,
or near normal, the patient needed to be rehabilitate with the weight
bearing as tolerated (WBAT), to find out if the patient can progress
to its improvement and to identify the improvement of it.

V. Initial Evaluation
General Information:
Name: CV
Address: Hilltop Lagro, Quezon City
Sex: Male
Age: 58 y/o
Citizenship: French
Civil Status: Married
Handedness: Left-Handed
Occupation: Manager
Religion: Catholic
Previous Work: N/A
Referring Unit:
Referring MD: Dr.Villanueva
Date of Admission: October 15, 2018
Date of IE: December 4, 2018
Diagnosis: Hip Fracture of the Proximal Femur

c/c: “Nahihirapan sa pag-galaw pabukaka ang binti at kumikirot at hirap iikot”

PT Translate: “I have a difficulty to abduct and externally rotate the thigh at hip joint”
Px’s Goal: For the affected bone structure, and muscle.

HPI:
The case of CV, a 58y/o, M, (+) Htn, ( - ) DM, the patient was diagnose with Hip
Fracture of the Proximal Femur.
According to the patient’s case that the patient was a manager in occupation in a mall
in a fast food restaurant, when the patient is about to make a leave, the patient did not saw
plate on the floor that result the patient to trip down and still manage to use its (R) elbow to
secure the patient’s face against the floor, and thought that pain from the hip joint was just
temporary and goes to the hospital after 3 days of pain, then was referred to rehabilitate after
the surgery.

Patient’s MHx:
( + ) Hypertension
( + ) Undergone Sugery year 2018
( - ) Pulmonary & Cardio disease
( - ) Allergies
( + ) Other Traumatic Injury
Family MHx
Father Mother
Hypertension (+) (-)
Allergies (-) (-)
DM (-) (-)
Pulmonary Dse (-) (-)
Heart Dse (-) (-)
Father deceased from Stroke.
Personal/Social Hx:
Personality Type: Type A
Lifestyle: Independent, Perfectionist, Active
Parents:
80 y/o
85 y/o
Sibling/s:
48 y/o, working
60 y/o, retired
55 y/o, working
Wife:
 55 y/o, working
Children:
25 y/o working
20 y/o college
27 y/o working
H/W/E Ax:
Home Situation:
The house, have three floors, place widen and have enough space, the bedroom to
bathroom is near for it has two bathroom the bedroom and living room.
Type of Work:
Pre- Surgery: Manager
Post- Surgery: Manager

OBJECTIVE:

Vital signs

Vital Signs Normal Values a during p

Blood Pressure (BP) <120/80 mmHg 117/75 120/80 mmHg 118/80
mmHg mmHg
Pulse Rate (PR) 60 – 100 bpm 85 bpm 100 bpm 82 bpm
Respiratory Rate 12 – 20 cpm 14 cpm 20 cpm 18 cpm
(RR)
Temperature 37.5oc 35oc 36.9oc 36.4oc
Findings: All vs are normal

OI:
- The patient is able to handle a good conversation and has a good alertness. The
patient also enters the room with assistance from other person and wearing braces

Palpation:

(+) MuscleGuarding on (R) Elbow

ROM
All major joints of (R) Hip are found to be WNL, pain-free & c (N) end-feel
except for the following:
END (R) ROM (L) END
FEEL NORMAL FEEL
VALUES

Firm 0-120˚ Hip Flexion - 0-100 ˚ Firm

120 ˚
Firm 0-20 ˚ Hip Extension 0-10 ˚ Firm
- 20 ˚
Firm 0-40˚ Hip Abduction 0-20˚ Firm
– 40˚

Firm 0-20˚ Hip Adduction 0-10˚ Firm

- 20˚
Firm 0-45˚ Hip Internal 0-25˚ Firm
Rotation - 45˚
Firm 0-45˚ Hip External 0-25˚ Firm
Rotation - 45˚

Findings: LOM on all (R) Hip movement.

Significance:
LOM is d/t pain and muscle weakness, the treatment should be including ROM,
MMT,Resistance and Weightbearing Exercises.Pt will experience difficulty in
performing Basic ADLs such as walking, running, bathing and Going to Work.

MMT:
The test was used to assess muscle strength. All muscle groups in UE. Grossly
assessed graded 5/5 except for the ff:

MOTION (R)
Hip Flexors 3 (Fair)
Hip Extensors 3 (Fair)
Hip Abductors 3 (Fair)

Hip Adductors 3 (Fair)

Hip Internal Rotators 3 (Fair)

Hip External Rotators 3 (Fair)

Findings: (+)Decreased muscle strength on (R) Hip.

Significance: Decreased muscle strength of the Pt’s (R) Hipthat could cause to the
difficulty in performing ADL specially his Strengthening, Resistance and
Weightbearing exercises should be included in the Tx plan to help the Pt perform
ADLs difficulty.

Equilibrium Test:
Gait Analysis:
Reference Limb (R) LE
 PT Impression:

Pt is medically undergone in ORIF of the Proximal Femuron his (R)

Hip. The LOM on the (R) Hip and according to the Pt. the pain is (PS3/10) upon
performing Range of Motions on (R) Hip, the movement of muscle weakness upon
all Hip movements of the currently available range all leading to mild to moderate
difficulty in performing ADLs such as walking, dressing LE and running. Pt has
good prognosticating factors as to returning to previous function of (R) LE
because the pt conditionis can be rehabilitate to its pre-fractured state.

Assessment
PT Diagnosis:

The Patient had been diagnose of rotator cuffs injury and it is confirm the anxillary procedure
especially MRI and some spec

PT Prognosis

The pt’s prognosis is very good since the prognosis of rotator cuffs injuries is good for pt
under 60 y/o both operative and non operative treatment.

Problem List

 pain
 Lom of all movements
 Difficulty of walking
 Weakness of hip abductor and rotator
 Decrease of joint proprioception

Long term Goal:

  Rehabilative – to go back to Normal state or near-normal
 Participation – to return or able to walk without a problem in gait pattern
 Preventive – to prevent pain, and possible avascular necrosis

Short Term Goal

 To walk in parks and malls

 To go up and down stairs

Plan

Problem List

1. Pain
2. LOM
3. Difficulty in walking
4. Weakness of Hip abductor and rotator
5. Decrease of joint proprioception

PT Management

1. AAROM for LOM

2. Ambulation training for difficulty in walking
3. Side lying leg lift with theraband for resistance for weakness of abductor and rotator
4. Balance Training or Wobble Board for Decrease Joint Proprioception
5. Immobilization for Pain

Preventive:

Avoid possible complication and avoid patient to fall.

Home Exercise

 AAROM
 MMT
 Wobble board
 Sit – to – Stand
 Stand – to – Sit
 Sit-up – to – Sit
 Walk with ambulatory device