An ORIF procedure--open reduction internal fixation--is performed to stabilize a fracture of the femur at the hip. Depending on the location and severity of the fracture, your surgeon may decide to use a plate and screws or an intramedullary rod, which is placed in the hollow interior portion of the femur. In either case, the procedure is performed through an incision in the hip muscles, which are repaired at the end of the surgery but require rehabilitation to regain full strength and function.
Supine Exercises
Perform these lying face up on your bed. Beginning with quad sets, tighten your quadriceps--the muscles on the top of the thigh--by pushing the back of your knee down into the mattress and holding for five seconds. Move on to glute sets by squeezing your buttocks together, slightly lifting your pelvis and holding for five seconds. Perform heel slides by sliding your heel up the mattress toward your buttocks, then back down so the leg is flat on the bed. End with hip abduction by sliding the straight leg out to the side to a 45-degree angle and then sliding back to the starting position. Perform 10 repetitions of each exercise.
Sitting Exercises
The starting position is sitting comfortably in a firm chair with both feet flat on the floor. Beginning with hip flexion, lift your knee toward the ceiling in a marching motion and gently return the foot to the floor. Knee extension, sometimes called a long arc quad, is performed by straightening your knee while the thigh remains resting on the surface of the chair, then slowly lowering the leg to the starting position. Perform 10 repetitions of each.
Standing Exercises
Your surgeon will the amount of weight-bearing allowed on the injured leg in the early stages of recovery. Standing exercises should only be performed if you are able to safely maintain your weight-bearing limitations. Begin by standing on the non-operative leg and holding on to the back of a sturdy chair or a countertop to help keep your balance. Starting with hip extension, keep the knee of the injured leg straight and move the leg back behind you in a small movement. Avoid leaning forward at the trunk. Slowly bring the leg back to the starting position. Progress to hamstring curls by keeping the thigh of your repaired leg in a vertical position then bending your knee so that the foot moves toward your buttocks. Slowly lower the foot to the starting position. Finish with hip abduction by lifting the involved leg out to the side, making sure you do not allow any hip rotation. Gently return to the starting position. Perform 10 repetitions of each exercise.
Advancing
Once your surgeon has lifted your weight-bearing restrictions, you may begin to perform more challenging exercises with weight on the injured leg, suggest C. Kisner and L.A. Colby in "Therapeutic Exercise: Foundations and Techniques." You will also be encouraged to gradually return to regular activities. Many surgeons will prescribe outpatient physical therapy to help you regain full strength and function of the injured limb.
References
- "Campbell's Operative Orthopedics"; A.P. Whittle, Mosby Elsevier; 2007
- "Therapeutic Exercise: Foundations and Techniques, 5th Edition"; C. Kisner, L.A. Colby; 2007
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