Hip fracture advice requested

Jim Newmark

I would appreciate advice. The details of how I fractured my hip last week are on http://jimnewmark.blogspot.com/ but suffice it to say that I am a fit 55 year old, about 2000 -3000 (perhaps more? Haven't counted for years) commuting and touring miles a year with some audax thrown in. I sustained a Type 3 subcapital fracture of the hip after a fall six days ago that was screwed, and I have now about three months of non weight-bearing on my left leg to endure, with possibly a total hip replacement at the end if this fails. I know that I will lose a lot of lower body fitness - no way round this, but would like some sort of structured programme for presumably upper body fitness for the first few months, and then, hopefully, a further programme to get me back to full cycling fitness after this. Currently I have virtually no upper body strength, never bothered, but now it seems to be forced upon me. As I work by targets rather than general recommendations, can somebody point me somewhere? I am medically qualified, but have no experience of the structured training programmes that I probably now need.
PS This was a "never thought it would happen to me" incident. Anybody heard that before? At least it wasn't a head injury. Legislation aside, how does ANY cyclist now not wear a helmet?

binlinus

Jim

I fractured my hip (femoral neck) earlier this year. I'm 46. Nearly back to normal now.

Are you up and about and on crutches and putting some weight on the leg? What has the surgeon or consultant told you to do? Usually you can put a fair amount of weight on the leg because it is pinned and do several walking sessions every day on the crutches. You need to get moving little and often for starters.

If the fracture was not displaced (you are unclear about that) then it should heal and you won't need a hip replacement. X-rays will reveal if blood is flowing to the bone properly.

Bin

Dr_Death

Garden Stage 3 Hip fractures are displaced.

I would have thought they would get you weight bearing (at least partially) quicker than three months. I would double check this with your consultant and physio....

Oh, and if you ignore all the adverts this site seems reasonable....

http://www.health24.com/fitness/Programmes/16-1347.asp

ut_och_cykla

Find a doctor/physio who will make clear what you can / can't do and then a gym where you can do what you can. Plenty of upperbody stuff can be done seated adn if you can between exercise stations adn work without loading hip you should be able to do well. A rehab gym with space for wheelchairs maybe - You can see I'm not a medic person - but a keen weight trainer blessed with a fantastic gym nearby!
Can you swim later on by the way?
Good luck

Jim Newmark

Thanks for this - all useful stuff. I am sure he did say at least three months non weight-bearing but I will check this again. Pain is not the issue, as there won't be any, but it is to minimise the chance of AVN (about 50%). As I understand it, the screws are designed to hold the femoral head in perfect anatomical position and not for weight-bearing.

Alex_Simmons/RST

When in hospital the only "aerobic" exercise I was able to do to lift the HR a bit, was using a hand cycle ergometer.

binlinus

Jim Newmark wrote:

Thanks for this - all useful stuff. I am sure he did say at least three months non weight-bearing but I will check this again. Pain is not the issue, as there won't be any, but it is to minimise the chance of AVN (about 50%). As I understand it, the screws are designed to hold the femoral head in perfect anatomical position and not for weight-bearing.

You said on your blog that you passed the stair climbing and descending test before you left hospital. I am presuming you were instructed to do what I was told to do and that is to put most of your weight on your good leg and and a little weight on the bad leg. If that is the case you will be weight-bearing already. Are you?

The reason I ask is that mobility on your crutches is the most important exercise you can do. You will over the next four weeks move from two crutches to one crutch and finally to a walking stick (depending on your progress). The strength and the endurance in your upper body will come with your mobility. You should be aiming to walk up and down a couple of flights of stairs with one hand on the banister (it is essential to hold the banister or handrail) and the other hand should hold both the supporting crutch and the other crutch (quite tricky at first).

You need to move, and move safely on your crutches. You should be able to use a stationary cycle in a gym (or turbo at home) after a few weeks if you can get flexibility in the knee. You could also use the cross-trainer in the gym. I was told after four weeks to be able to fully bend my knee. As you're a bit older than me you maybe need an extra week. But you are otherwise very fit. Once you are using the stationary cycle and the cross-trainer your recovery will be very quick and your fitness will return. But get to that point in your own time.

Flexibility at the hip will take time and I was told to take it easy for the first eight weeks. Again your monthly x-ray will monitor your progress and your consultant should advise.

I would avoid going to a swimming pool as the slippery surfaces from the changing room, shower and to the pool will cause havoc with crutches. If you have a friend to look after you, then it's OK. But I'd avoid slippery surfaces (including pavements in wet weather).

Speak to your fracture consultant and ask what you can do. Make sure they understand you are a cyclist and want to get back to fitness as soon as you can.

HTH

Bin

Jim Newmark

Thanks for this, Binlinus, and the time you have spent on it - but with all due respect, I do not think that you are correct, bearing in mind the nature of the fracture. This is Garden Stage 3 subcapsular fracture and the priority is not to get back to full fitness for that limb but to preserve the blood supply for the sake of the 40-50% possibility of keeping my own hiip. Your fracture was probably Intertrochanteric, the most common type of traumatic fracture - in which case I would be laughing (well, perhaps not laughing).
Weight bearing for the next three months has to be limited to balance only, and stationary cycling is out for the whole of that time (for the same reason, it equates to weight bearing)
I have accepted this. The question really related to ideas to regain upper body strength and perhaps doing something with my R leg.

binlinus

Jim

My fracture was of the femoral neck so not Intertrochanteric (I had to look that word up). I was told by the surgeon that although the fracture did not look displaced I may suffer necrosis. But evidence of necrosis does not show up for several weeks. As it turned out I haven't suffered necrosis, yet; and I've been told it is unlikely that I will.

If your consultant has said no cycling on a stationary bike for three months, then I'm not going to argue with that. And your consultant's advice is the best one to follow.

However, seated cycling on a stationary bike is not usually classed as weight-bearing. That's my understanding.

I am now advised to do more weight-bearing exercise (running and weight-lifting) as well as take vit D and calcium supplemnets as tests have shown that I suffer from osteopenia. You may have also been advised to have a bone density scan. I'd be interested to know if you have been advised to have a bone scan and how you progress.

I crashed in similar circumstances to you on a wet road.

Bin

Jim Newmark

Hi Bin

You could well be right. Perhaps I accepted his advice too easily. He is not a cyclist! I would have thought spinning at least is non weight-bearing.

Your fracture was indeed similar to mine except that it was not displaced. This makes a big difference in terms of the future of the hip, as the assumption is that the blood flow, the main part of which goes round the capsule of the joint, is likely to remain intact. The feeling, based really on intuition more than evidence, is that the operation to fix a displacement back to an absolutely anatomically correct position should take place as an orthopaedic emergency to give as good a chance as possible to avoid necrosis (AVN - avascular necrosis) - which it was as I had it done under spinal within eighteen hours. My XR actually showed a Garden Stage 2 , moving onto 3 later (?during the movements necessary for the spinal anaesthetic) so I think I have a better chance than most.

You are right - I think that you are out of the woods. Sequential XRs should give cause for guarded optimism (or pessimism) in probably a couple of months.

I have not been offered a bone scan or vit D, but I think that in most circumstances those would be indicated for low impact trauma fractures.

Thanks again

Jim

Dr_Death

TBH I would have thought that three Richard screws would have provided enough stability to allow for partial weight bearing, but then I'm no orthopod (you can tell, as my knuckles don't drag on the ground ;-) ). I would double check with the Ortho consultant as to what exactly constitutes weight bearing in their mind. If they so no weight bearing at all then I would think even sitting, static biking is out and you are gonna have to resign yourself to a stick thin leg.....

Hope the link in the first post has something useful... Maybe that getting in touch with physio via your consultant may be useful for some upper body training ideas... Maybe as a 'favour', there have to be some advantages to working for the NHS and I struggle to think of any of the others??


Steve

simplesimoncardiff

can you swim? :shock:

Billyounger

Hi, I am just over a thing called F.A.I . Which is a growth on the hip bone which catches on the pelvis and tears the cartliage causing lack of movement and groin pain. I was told it was arthrightus, but i carried on until i found a consultant who had seen this before, he operated which was to trim up the tear and to file the hip bone , yes lots of staples ! off work for 2 months ,exercise bike after 2 weeeks , short bike rides of 6 mile every day, which made me sleep all afternoon ha ha, up to 20 miles after 1 month once a week, and back to Karate after the 2 months whilst doing the 6 miles i had to use a crutch to get to and from my shed ha ha , so be positive listen to your body and Doctors you will soon be over it , note my FAI can happen to people from 18 to 35 this is the most common age i am 47. Good luck keep smilling

Bill

JRosenbrier

Hi,

I am a full time cyclist racing in France for the last eight years. I suffered the same injury as yourself in a race August 17th. I have a grade 2 fracture which was pinned with 3 screws, and like yourself will have to endure 3 months non weight bearing on the leg. I have decided to stay in France for my rehab instead of returning to the UK. Here I go to a day hospital for physio 5 days a week. For me this has consisted of active hip mobility exercises up to the permitted 90 deg flexion, electrostimulation on the quadriceps to avoid muscle wastage and after 3 weeks I was allowed to start exercising both my quads and hamstrings on the weights machines. As long as the hip flexor muscles are isolated I am told there is no risk with this. I am currently able to lift 30kg with both quads. Or for an endurance workout drop it to 20kg for sets of 400 reps, it certainly gets the heart rate up!
I have my next xray on the 25th sep and if all is ok I will be able to start walking in a swimming pool with the water level up to the neck, like this you are only 10% of your real weight.

Good luck with your rehab

Jonathan.

Jim Newmark

Thanks so much for this, Jonathan - it is EXACTLY the sort of posting for which I had hoped, and also reassuring in that the operation and the advice seems identical to that which I received. I did look at Steve (Dr_Death's) suggested site, (thanks Steve) but it seems a bit hard to follow for someone who is not used to specific training regimes. It is now two weeks since my fall and I am now pain-free and the problem is more stiffness and trying to remember not to weight-bear on that side.
Physio now seems to be the priority and I was going to sort that out for next week - I can now print out your suggestions and get them to understand how important it is to me. I have never been any good at racing, but live for my bikes for the long-distance and commuting stuff

753forme

Hi Jim,
Sorry to hear about your accident. I had a dynamic hip screw put in after breaking the femoral neck in 4 places in december. I was non-weight bearing for six weeks - yes the muscle wastage wasn't good but ultimately I would bear out what binlinus says even though your injury is diiferent - i'm not a medical type - I did use a static bike after 4weeks and found it helpful and worked hard at the physio when this began. I commuted and audaxed before the accident and have got back to it now(July-August). Good physio is vital and will make a big difference. I did no swimming and my upper body strength is very poor but I found all the work on the sticks builds up your strength. Ultimately it takes time. I'm 48 and was doing similar miles to you - so you will get back to it eventually.
HTH.

binlinus

Jim

Give us an update. How are you doing?

Bin

Jim Newmark

Hi, and thanks for the interest! All the support here and at home does help a lot. Now four weeks to the day since it happened, and I am now completely pain-free, which I think is good news as I have been told that a non-union would probably be painful at this stage. However, I can't be sure of this for another four weeks when the first review and XR is booked. Still more than a possibility of AVN in the future, but I won't know that for a long time yet.

I have been to physio twice (he is a cyclist, so understands the issues) and am trying to take it seriously, but have realised that he is not a personal trainer and the main work has to be at home . Not really concealing his shock at how generally stiff I am, and how tight my hamstrings are, he then showed and demonstrated the exercises and gave me a plan to work to - but now I am becoming increasingly active on crutches, and managing train journeys to work and conferences, I am beginning to wonder if I will have time (which may be an excuse, as the exercises are, frankly, boring). Using the crutches and non weight-bearing on one leg for reasonable distances is gratifyingly hard work and much less boring than the exercises, so this may become the mainstay of my training for the next few weeks, or at least until I am allowed to get back on the turbo-trainer. My dreams of taking the opportunity to develop a six-pack, achieving fantastic upper body strength, and becoming the next wheel-chair ParaOlympic champion started disintegrating when we borrowed the self-propelled wheel-chair from Red Cross. Weak arms and rough roads make it really difficult to handle, and it hasn't moved from the garage where we left it after the first try-out - my contribution being to wave my arms around the wheels to show willing while my wife pushed.

Thanks again

Horton

Glad to hear things are looking up. Whilst I haven't ever fractured my hip, I've been unlucky enough to rupture ligaments in shoulder, knee and ankle (different accidents thankfully) over the last few years. Given the sports I enjoy, I need maximum strength in these joints and if I can offer one little piece of advice, do the exercises the physio has given you!!! I appreciate they're as boring as watching paint dry, but they will make a huge difference to final mobility/usability - as well as rectifying previous problems like tight hamstrings etc.

I know there is an obvious difference to a fracture compared to ligament damage, but for what it's worth, 2 years ago, I landed on my head and shoulder snowboarding suffering grade 2/3 damage to the ligament around the a/c joint. Was offered the choice of surgery then physio, or just plain physio - took the latter option, worked very hard and apart from an unsightly lump on my shoulder, it's now fine. Not long after I did my shoulder, my brother did much the same thing but was advised by his surgeon that surgery would result in quicker return to use so he opted for the knife option. He was really slack with the physiotherapy after the event, and now can barely raise his arm above shoulder level.

Best of luck with your recovery and give the exercises a go. You may also want to check out pilates to try and imprive your flexibility when your leg's stronger.

V-twin

Hi Jim,

Sounds good. I can only endorse what you have concluded about crutches. I broke my hip in 2006 and committed myself to a sure-but-steady approach getting further on the crutches each day up to two miles. I then kept it at that distancen and I think that regime plus plenty of calcium, good diet and sleep got me through. TBH I put cycling to the back of my mind - obviously I wanted to get back to it - but getting strong - slowly and constructively - was my goal. Interestingly the consultant said to me that the rate of recovery would be directly proportional to how fit I was when the accident occurred; so it had paid to be a fit 55 year-old!


It seemed to work and I got back to the turbo trainer in due course then back on the road; cleared of AVN, compression screws removed and now life is normal.

Good luck with the recovery - my motto was 'make progress slowly' that way the improvements can be consolidated and you don't regress.


V-T

Jim Newmark

Horton wrote:

I landed on my head and shoulder snowboarding suffering grade 2/3 damage to the ligament around the a/c joint. Was offered the choice of surgery then physio, or just plain physio - took the latter option, worked very hard and apart from an unsightly lump on my shoulder, it's now fine. Not long after I did my shoulder, my brother did much the same thing but was advised by his surgeon that surgery would result in quicker return to use so he opted for the knife option. He was really slack with the physiotherapy after the event, and now can barely raise his arm above shoulder level.

I know you are right - and will keep the exercises going and have a look at Pilates, which has always been a mystery to me. I had what sounds like an identical a/c joint injury to yours a couple of years ago in another cycling fall (even before this latest event I overheard my son telling his friend that his father broke very easily) and I received the same advice about surgery but physio was never mentioned. It is fine now apart from the lump. I do work better with targets - perhaps I can persuade the locals to consider crutch-walking to be the Bradford equivalent of bog-snorkling and organise a local event.