Body placement in hip fractures/screws

[ANH_RN]

What exactly are the rules of placement of a pt with a hip screw. I read that they can't lay on the affected side, but others say you can. I know you can't lay on the other side without having a pillow in between the legs. This was my weakness in nursing school and I'm wondering about a general census on this topic. Also do they allow you to elevate your feet (particularly in someone that's prone to skin breakdown)?

Thanks

[TiredMD]

There's no simple answer to this question. It will depend on the type of implant used, the fracture pattern, the presence of a fracture/dislocation, and surgeon preference.

For a brief summary sheet, see: http://www.ucop.com/agrp/docs/la_hipfrac.pdf

[Roy Fokker, BSN, RN]

and surgeon preference.

May I ask why? Your other points made sense (type, location etc.) - but I'm scratching my head over this one.

If research says "Pts. with 'type A fractures' with 'type r procedure' and type 'x' implants should not lie on the operative side" - why should a surgeon's preference matter?

Thanks.

cheers,

[ANH_RN]

There's no simple answer to this question. It will depend on the type of implant used, the fracture pattern, the presence of a fracture/dislocation, and surgeon preference.

For a brief summary sheet, see: http://www.ucop.com/agrp/docs/la_hipfrac.pdf

Thanks for the website. So basically you have to keep hips abducted with no adduction past midline, no flexion past 90 degrees (so keeping feet elevated should be okay), and keep toes upright in bed. Depending on what type of fracture it is.

[TiredMD]

If research says "Pts. with 'type A fractures' with 'type r procedure' and type 'x' implants should not lie on the operative side" - why should a surgeon's preference matter?

Certain rules are somewhat set in stone. For example, a patient with a fresh arthroplasty, you don't want to place stress on the joint in such a way that it will cause a dislocation; hence no adduction past midline, flexion past 90, etc etc.

But other rules are softer, not based on research but tradition and who you trained with. I once rotated with a Joint group where one surgeon insisted on an abduction pillow after all his hips while in bed for four days postop. The other only did it for one day. These kinds of minor clinical questions aren't normally addressed in large-scale clinical trials, and so you practice what your mentors practiced, unless research actually comes out contradicting you or you have a bad outcome with what you're doing.

Much of what we do is not addressed by research, but contradicting a surgeon's preference on post-op management is never a good idea. Thus, if an Orthopod isn't clear about the activity or motion restrictions for a patient, you save yourself a butt chewing by asking up front. This is what I do as a resident, ditto for the smart nurses.

[Roy Fokker, BSN, RN]

But other rules are softer, not based on research but tradition and who you trained with. I once rotated with a Joint group where one surgeon insisted on an abduction pillow after all his hips while in bed for four days postop. The other only did it for one day. These kinds of minor clinical questions aren't normally addressed in large-scale clinical trials, and so you practice what your mentors practiced, unless research actually comes out contradicting you or you have a bad outcome with what you're doing.

Ahhh, I see.

Got it.

Thanks :)

cheers,

[locolorenzo22, BSN, RN]

usually, our hip patients are kept from being on their operative side...I personally like to encourage patients to stay on their backs, but make sure to shift weight from time to time, keep legs elevated, roll ankles, do not bend over 90 degrees, and keep a pillow between legs to help keep abducted.

those that have to be on their side, I offer to put a pillow between legs and one under butt, and do NOT turn over without assistance. also don't WALK without help...although a lot do anyways.

[morte, LPN, LVN]

when i went to NS, yes, in the era of the saber tooth tiger, they were only allowed to be ON the operative side; to prevent dislocation, with pillow between knees of course and a minimal turn at that

[diane227, LPN, RN]

On our floor it depends on the surgical approach used, anterior or posterior. You can find the standard of care for both if you search on the web. Make sure your patients go home with instructions appropriate for the type of surgery they had.