The pain and physical limitations that follow your patient's femur fracture can severely restrict her independence. These limitations are further compounded with a shattered bone fracture that has necessitated surgical intervention. Understanding the goals of your patient and the options for treatment will guide you in making decisions to help her rehabilitate after a shattered femur fracture.
Acute Phase
Pain management is vital during all phases of recovery, especially during the acute phase when the pain can be quite severe. Utilize ice during the first 48 hours to control edema, wrapping your ice treatment in at least one layer of towel to reduce the risk of skin irritation. Moist heat can be used thereafter, but would be contraindicated if your patient has staples in the incision. Work closely with nursing staff to coordinate premedication to provide pain medicine at least 30 minutes prior to the start of your therapy session to optimize pain relief. Manage your patient's pain because pain will significantly hinder his motivation and ability to participate in activities. Initiate foot and toe range of motion on the fractured foot, taking care not to move the rest of the leg. Focus on substantial strength training on the unaffected leg to prepare that leg for ambulation. Use weights on the unbroken leg and have the patient perform leg lifts, knee bends and ankle bends.
Nonweight Bearing
Your patient will not be allowed to bear any weight on her shattered leg for at least six weeks, and often up to three months. Focus your treatment on progressing your patient from standing, to transferring and then ambulating, teaching her the proper sequencing to maintain nonweight bearing at all times. Because these tasks are physically challenging for most patients, especially geriatric and bariatric patients, it is vital to educate her on the importance of maintaining her nonweight bearing at all times. After your patient's shattered femur fracture, she will have a high risk of refracturing or microfracturing the bone, dislodging the pins and plates and disrupting the healing process every time she bears weight on her leg.
Weight Bearing Phase
As your patient progresses from nonweight bearing to partial weight bearing or weight bearing as tolerated, he will be able to more fully participate in functional tasks. Train your patient on strategies to safely and effectively use a walker, cane or crutches while walking, preparing a meal or completing bathing and dressing. For a higher functioning patient, you can initiate stair navigation, which is usually the last barrier to returning home.
Transition to Home
Once your patient is able to complete essential daily tasks like ambulation and stair negotiation, he can safely return home. However, therapy needs to continue to address his stair climbing and obstacle navigation during functional ambulation while he is in his own environment. Additionally, your patient will need to strengthen his muscles further to facilitate return to community life. Use standing squats, leg lifts and ankle presses to strengthen his broken leg.
