WAHT-PHY-005

It is the responsibility of every individual to ensure this is the latest version as published on the Trust Intranet

POST OPERATIVE PHYSIOTHERAPY REGIMES

FOLLOWING FRACTURE NECK OF FEMUR
This guidance does not override the individual responsibility of health professionals to
make appropriate decision according to the circumstances of the individual patient in
consultation with the patient and /or carer. Health care professionals must be prepared to
justify any deviation from this guidance.

INTRODUCTION
This physiotherapy guideline has been agreed within the Worcestershire Acute Hospitals
NHS Trust Consultants and Physiotherapy Managers for physiotherapy regimes following
elective and trauma and orthopaedic surgery.
The physiotherapy departments across the trust aim to provide equality of service
regardless of location.
All patients with fractured neck of femur are covered by this guideline.

THIS GUIDELINE IS FOR USE BY THE FOLLOWING STAFF GROUPS:

Physiotherapists

Lead Clinician(s)
Treena Currie

Senior Physiotherapist

Helen Hawkes

Senior Physiotherapist

Approved by Physiotherapy Clinical Governance

committee on:

21st January 2015

This guideline should not be used after end of:

21st January 2017

Key amendments to this guideline

Date
March 2003
June 2011

June 2011
Dec 2012
Jan 2015

Amendment
Approved by Clinical Effectiveness Committee
Minor changes to change for step by step guidelines
each day as patients are encouraged to progress at
their own rate.
Changes to contribution list
Changes to layout to combine protocols as they are
now similar regardless of procedure
Reviewed by Clinical Lead and resubmitted with no
changes

By:
Helen Hawkes

Helen Hawkes
Helen Hawkes
Helen Hawkes

Post operative physiotherapy regimes following fracture neck of femur

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WAHT-PHY-005
It is the responsibility of every individual to ensure this is the latest version as published on the Trust Intranet

INTRODUCTION
This physiotherapy protocol has been agreed with the Worcestershire Acute Hospitals NHS
Trust Consultants and Physiotherapy Managers for physiotherapy regimes following elective
and trauma and orthopaedic surgery.
The physiotherapy departments across the trust aim to provide equality of service regardless
of location.
COMPETENCIES REQUIRED
All qualified physiotherapy staff working in orthopaedic area should be aware of the
existence of this protocol and the location of where a copy of the protocol is kept.
The Senior Physiotherapist in each location will advise the physiotherapy assistants of any
protocols which apply to them. It is the responsibility of individual staff to keep themselves
upto date with any policies that would apply to them (checked at annual PDR)
PATIENTS COVERED - ALL CONSULTANTS
All patients with fractured neck of femur that undergo surgical fixation. This may be fixed with
a variety of methods including cannulated screws, dynamic Hip Screw (DHS), Hemiarthroplasty or a total Hip replacement. It would be decided by the surgeon taking into
account the site of the fracture, bone quality, patients previous mobility and co-morbidities.

It is not always possible to see patients pre-op as surgery is unplanned but if possible try
and do a quick pre-op assessment.
Pre-operatively (all patients)

Chest assessment
Teach post-op exercises if patient has capability to follow instructions, breathing
exercises, Static quads, Static gluts and active dorsi/plantar flexion of ankles.

All documentation for these patients is found in a care pathway, which is kept beside the
patients medical notes. Physiotherapy problem list and continuation sheets are found at the
back.
Post operative:
DAY 1:

Check chest.
Deep Breathing exercises, circulation exercises.
Static quads, static gluts.
Issue exercise sheet where appropriate.(info booklets available for DHS,
Hemiarthroplasty and THR)
Assist board exercises hip flexion, hip abduction.
Inner range quads, static quads.

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Check post op instructions for weight bearing status. Routine protocol would be FWB but
younger patients/cannulated screws/poor bone quality or poor fixation may need TTWB
or PWB for a period of time post-op.
Sit out with appropriate mobility aid if medically fit

DAY 2 ONWARDS:

Continue with exercises.

Progress mobility as preoperative state and weightbearing status allows.
Stairs assessment when/if appropriate.
Send patient home when safe or refer to community hospital.
Refer to community physiotherapy if further progress expected.
Refer to falls group if appropriate criteria.

MONITORING TOOL
STANDARDS:
Item
# NOF Mobilised 1st day post op

How will monitoring be carried out?

When will monitoring be carried out?
Who will monitor compliance with the guideline

%
95%

Exceptions
Sunday. Extended Bank Holidays.
Medically unfit.
Audit physiotherapy notes
Random per rotation
Site team lead

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It is the responsibility of every individual to ensure this is the latest version as published on the Trust Intranet

CONTRIBUTION LIST
Key individuals involved in developing the document
Name
Helen Hawkes
Katie Gromski
Katie Williams

Designation
Clinical lead Orthopaedic Physiotherapist
Orthopaedic Team Lead Physio - WRH
Orthopaedic Team Lead Physio - ALEX

Circulated to the following individuals for comments

Name
Designation
Jenny Robinson
Therapies Manager
Melwyn Periera
Clinical Director - Orthopaedics
Circulated to the following CDs/Heads of dept for comments from their directorates /
departments
Name
Directorate / Department
All current orthopaedic consultants across Orthopaedics
the acute trust.

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WAHT-PHY-005
It is the responsibility of every individual to ensure this is the latest version as published on the Trust Intranet

Supporting Document 1 - Equality Impact Assessment Tool

To be completed by the key document author and attached to key document when submitted
to the appropriate committee for consideration and approval.
Yes/No
1.

Comments

Does the policy/guidance affect one group

less or more favourably than another on the
basis of:

Race

no

Ethnic origins (including gypsies and

travellers)

no

Nationality

no

Gender

no

Culture

no

Religion or belief

no

Sexual orientation including lesbian, gay

and bisexual people

no

Age

no

2.

Is there any evidence that some groups are

affected differently?

no

3.

If you have identified potential

discrimination, are any exceptions valid,
legal and/or justifiable?

4.

Is the impact of the policy/guidance likely to

be negative?

5.

If so can the impact be avoided?

6.

What alternatives are there to achieving the

policy/guidance without the impact?

7.

Can we reduce the impact by taking

different action?

no

If you have identified a potential discriminatory impact of this key document, please refer it to
Human Resources, together with any suggestions as to the action required to avoid/reduce
this impact.
For advice in respect of answering the above questions, please contact Human Resources.

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Supporting Document 2 Financial Impact Assessment

To be completed by the key document author and attached to key document when submitted
to the appropriate committee for consideration and approval.
Title of document:

Yes/No

1.

Does the implementation of this document require any additional

Capital resources

no

2.

Does the implementation of this document require additional

revenue

no

3.

Does the implementation of this document require additional

manpower

no

4.

Does the implementation of this document release any

manpower costs through a change in practice

no

5.

Are there additional staff training costs associated with

implementing this document which cannot be delivered through
current training programmes or allocated training times for staff

no

Other comments:

If the response to any of the above is yes, please complete a business case and which is
signed by your Finance Manager and Directorate Manager for consideration by the
Accountable Director before progressing to the relevant committee for approval.

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