dynamic hip screw physiotherapy protocol pdf

3.1 Goals of Physiotherapy Post-DHS Surgery

The primary goals of physiotherapy post-DHS surgery include restoring hip mobility, improving strength, and enhancing functional independence. These goals are achieved through structured exercises, gait training, and progressive weight-bearing activities, ensuring patients regain their ability to perform daily tasks and return to their pre-injury activity levels. The focus is on minimizing complications, optimizing recovery, and preventing long-term disabilities. Physiotherapy also aims to reduce pain and inflammation, promoting a smooth transition from post-surgical care to active rehabilitation, thereby improving overall patient outcomes and quality of life.

3.2 Key Principles of Rehabilitation

The key principles of rehabilitation post-DHS surgery emphasize restoring hip function, promoting mobility, and preventing complications. These principles include early mobilization, gradual weight-bearing progression, and pain management to ensure patient comfort and adherence. Rehabilitation focuses on strengthening the hip and surrounding muscles, improving balance, and enhancing proprioception. Additionally, the use of assistive devices and orthotics is encouraged to support recovery and reduce strain on the hip. A patient-centered approach, tailored to individual needs and goals, is essential for optimal outcomes. These principles guide the structured progression from immobilization to functional independence, ensuring a safe and effective recovery process.

Immediate Post-Surgical Phase (0-2 Weeks)

The immediate post-surgical phase focuses on pain management, wound care, and early mobilization to prevent complications and promote healing. Gentle exercises and assistive devices are utilized to support recovery.

4.1 Pain Management Strategies

Effective pain management is crucial during the immediate post-surgical phase to enhance patient comfort and facilitate early mobilization. Pharmacological interventions, such as NSAIDs and short-term opioids, are commonly prescribed to alleviate acute pain. Non-pharmacological methods, including ice therapy, transcutaneous electrical nerve stimulation (TENS), and psychological support, are also employed. Gentle exercises and proper positioning are encouraged to reduce discomfort while promoting healing. The goal is to minimize reliance on narcotics and ensure a smooth transition to rehabilitation. Pain assessment tools guide personalized treatment plans, ensuring optimal recovery outcomes during the initial two weeks post-DHS surgery.

4.2 Early Mobilization Techniques

Early mobilization post-DHS surgery is vital to prevent complications and promote recovery. Techniques include gentle exercises, partial weight-bearing ambulation, and the use of assistive devices like walkers or crutches. Patients are encouraged to perform non-weight-bearing movements initially, progressing to partial weight-bearing as tolerated. Physiotherapists guide patients through controlled mobilization to avoid stressing the implant while enhancing joint mobility and muscle activation. These strategies aim to restore functional independence and reduce the risk of prolonged bed rest-related issues, such as stiffness or thrombosis. Early mobilization is tailored to individual recovery stages, ensuring safety and optimal healing outcomes.

Early Rehabilitation Phase (2-6 Weeks)

This phase focuses on gradually increasing mobility and strength, with exercises like range of motion, progressive resistance, and gait training to restore functional hip movement and stability.

5.1 Range of Motion Exercises

Range of motion exercises are critical in the early rehabilitation phase, focusing on gentle, controlled movements to restore hip joint mobility without overloading the healing fracture. These exercises include flexion, extension, abduction, and internal rotation, performed in both non-weight-bearing and partial weight-bearing positions. The goal is to prevent stiffness and promote functional movement patterns. Patients are encouraged to perform these exercises 2-3 times daily, using assistive devices like walkers or canes for support. Progression to more dynamic movements, such as seated marching or side-lying exercises, is gradually introduced to enhance flexibility and strength, ensuring a foundation for advanced rehabilitation phases.

5.2 Weight-Bearing Status and Gait Training

Weight-bearing status is tailored to promote fracture healing while minimizing complications. Initially, patients may be partial weight-bearing, progressing to full weight-bearing as healing advances. Gait training focuses on restoring a normal walking pattern, using assistive devices like walkers or canes for stability. Techniques include weight-bearing exercises, heel-to-toe walking, and stair navigation. The goal is to enhance independence, reduce limp, and ensure proper biomechanical alignment; Regular assessments of weight-bearing tolerance and gait mechanics guide progression, ensuring safe and effective mobility restoration. This phase is pivotal for achieving functional independence and preparing for more advanced rehabilitation activities.

Intermediate Phase (6-12 Weeks)

This phase emphasizes progressive strengthening, balance training, and proprioception exercises to enhance hip stability and functional movements, preparing for advanced activities and daily living tasks.

6.1 Strengthening Exercises for the Hip and Lower Limb

The intermediate phase focuses on strengthening exercises to improve hip and lower limb muscle function. Exercises such as clamshells, bridges, and side-lying leg lifts target the glutes and hip abductors. Progression to weight-bearing exercises like mini squats and step-ups is introduced. Resistance bands or light weights may be incorporated to enhance strength. Functional activities, such as single-leg stands and balance drills, are also emphasized to improve proprioception and stability. These exercises are tailored to the patient’s progress, ensuring a gradual increase in intensity to promote optimal recovery and prepare for more advanced movements in the next phase of rehabilitation.

6.2 Balance and Proprioception Training

Balance and proprioception training are critical in the intermediate phase to restore stability and coordination post-DHS surgery. Exercises such as single-leg stands, wobble board training, and heel-to-toe walking are commonly used. Patients progress from static to dynamic balance activities, incorporating functional movements like reaching or shifting weight. Proprioceptive drills, such as joint position sense exercises, enhance neural feedback and muscle control. These interventions improve overall stability, reduce fall risk, and prepare the patient for more advanced functional activities. The exercises are tailored to individual progress, ensuring a safe and effective transition to higher-level rehabilitation goals.

Advanced Phase (3-6 Months)

The advanced phase focuses on functional restoration, high-level strengthening, and sports-specific drills, aiming to maximize independence and return to pre-injury activity levels and mobility.

7.1 Functional Restoration and ADL Training

Functional restoration and ADL (Activities of Daily Living) training in the advanced phase focus on helping patients regain independence in daily tasks and achieve pre-injury functional levels. This phase emphasizes task-specific exercises to improve coordination, balance, and strength, enabling patients to perform activities like dressing, bathing, and household tasks safely. Physiotherapists use assistive devices and adaptive techniques to facilitate participation. Patient education on proper body mechanics and energy conservation is also prioritized to ensure long-term independence and reduce the risk of re-injury. The goal is to restore normal movement patterns and enable patients to reintegrate into their daily routines effectively;

7.2 High-Level Strengthening and Sports-Specific drills

High-level strengthening and sports-specific drills are introduced to restore advanced functional capabilities, particularly for patients aiming to return to athletic activities. These exercises focus on improving power, endurance, and agility through dynamic movements and resistance training. Plyometric exercises, such as jump squats, and agility drills, like cone weaving, are commonly incorporated. Sports-specific simulations, such as mimicking golf swings or tennis serves, are tailored to the patient’s athletic goals. The use of resistance bands, balance boards, and functional equipment enhances neuromuscular control; Progression is monitored to ensure safety and optimal performance, preparing the patient for unrestricted return to sports or high-level physical activities.

Outcome Measures in DHS Rehabilitation

Outcome measures assess rehabilitation progress, including clinical assessments, functional outcomes, and patient-reported scales. Tools like gait analysis and strength tests evaluate recovery effectiveness and guide treatment adjustments.

8.1 Clinical Assessment Tools

Clinical assessment tools in DHS rehabilitation include goniometers for measuring hip range of motion, dynamometers for assessing strength, and gait analysis to evaluate walking patterns. Pain levels are often assessed using visual analog scales (VAS), while functional abilities are measured through standardized questionnaires like the Harris Hip Score. These tools help quantify recovery progress, identify limitations, and guide treatment modifications. Regular assessments ensure tailored interventions, promoting optimal outcomes and minimizing complications. Continuous monitoring with these tools supports evidence-based decision-making, enhancing the effectiveness of the physiotherapy protocol and patient recovery.

8.2 Radiological and Functional Outcomes

Radiological assessments, such as X-rays and CT scans, are crucial for evaluating fracture healing, screw placement, and bone alignment post-DHS surgery. Functional outcomes focus on the restoration of hip mobility, strength, and patient independence. Tools like gait analysis and the Harris Hip Score measure functional recovery. Radiological findings guide treatment adjustments, ensuring proper healing and hardware stability. Functional outcomes highlight improvements in daily activities and mobility, aiding in assessing the effectiveness of the physiotherapy protocol. Together, these outcomes provide a comprehensive evaluation of recovery, helping to optimize treatment and predict long-term results for patients undergoing DHS surgery.

Complications and Their Management

Complications post-DHS surgery include screw loosening, infection, and malunion. Physiotherapy manages these with gentle exercises, pain management, and careful mobilization to promote recovery while addressing issues.

9.1 Common Complications Post-DHS Surgery

Common complications after DHS surgery include screw loosening, infection, and malunion. Screw loosening can occur due to inadequate fixation or bone quality issues. Infections, though rare, may require antibiotics or surgical intervention. Malunion, where the bone heals in an incorrect position, can lead to functional limitations. Additionally, implant failure or hardware-related complications may arise, necessitating further surgical correction. These complications highlight the importance of meticulous surgical technique and post-operative monitoring to ensure optimal recovery outcomes and minimize the risk of prolonged rehabilitation or additional interventions.

9.2 Physiotherapy Interventions for Complications

Physiotherapy interventions for complications post-DHS surgery focus on addressing specific issues while promoting recovery. Pain management strategies, such as gentle exercises and modalities, are employed to reduce discomfort. For patients with limited mobility, techniques like soft tissue mobilization and joint mobilization are used to improve flexibility. Strengthening exercises target the hip abductors and external rotators to enhance stability. Gait training with assistive devices helps restore normal walking patterns. Additionally, proprioceptive exercises are incorporated to improve balance and prevent falls. These interventions are tailored to the patient’s condition, ensuring a structured and progressive approach to overcoming complications and achieving optimal functional outcomes. Regular monitoring and adjustments are essential for effective rehabilitation.

Evidence-Based Practice in DHS Rehabilitation

Evidence-based practice in DHS rehabilitation relies on research and clinical guidelines, utilizing tools like EMG measurements and outcome assessments to ensure effective, personalized care and optimal recovery.