Rehabilitation after Femoral Neck and Intertrochanteric Fractures in the Elderly

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  • KAGAYA Hitoshi
    Department of Rehabilitation Medicine, School of Medicine, Fujita Health University

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  • 高齢者の大腿骨頸部・転子部骨折とリハビリテーション
  • コウレイシャ ノ ダイタイコツ ケイブ テンシブ コッセツ ト リハビリテーション

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Abstract

Femoral neck and intertrochanteric fractures are common in the elderly. These types of fractures affect about 90,000 people each year in Japan. At present, most such fractures are operated on. Immediate unrestricted weight-bearing after surgery is usually allowed. Conservative treatment may be considered if a patient can bear long-term bed rest and accept the risk of having a less functional outcome. Isometric quadriceps muscles and ankle range of motion exercises are important therapies to use before surgery. The appropriate intensity for rehabilitation is still controversial. The majority of the functional recoveries occur within the first 6 months, but further outpatient rehabilitation is still effective in patients without severe physical or cognitive impairments. About half of all patients recover their prefracture activities of daily living. Patients who are older or who are disoriented after surgery recovered least in terms of instrumental activities of daily living. In this group, even patients with uneventful healing courses did not regain their prefracture health-related quality of life level. Deep vein thrombosis, pulmonary infarction, palsy of the common peroneal nerve, fall, avascular necrosis of the femoral head, screw dislodging and removal, dislocation and infection are all possible risks factors after femoral neck and intertrochanteric fractures.

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