Background and Purpose:
Patients with a recent sternotomy are told to restrict the use of their upper extremities for a period of weeks or months after the procedure. However, when a patient with a recent sternotomy sustains a hip fracture, a mobility dilemma results. The purpose of this case study is to describe a risk/benefit dilemma in which sternotomy restrictions were at direct odds with a patient's need for early activity after a hip fracture.
The patient is an 80-year-old woman who was 6 days postoperation for open heart surgery when she fell and fractured her left hip. After hip surgery, she demonstrated reduced tolerance to weight-bearing to the operative leg. Her acute care recovery was facilitated by the removal of sternotomy restrictions, permitting her to be standing and walking early in her recovery.
The patient completed 7 physical therapy sessions in the acute care setting, and was able to progress quickly, walking for the first time on postoperative day 2. She was discharged to a skilled nursing facility, and then her home. The patient regained the ability to ambulate independently without an assistive device in the community.
This is a case study in which early mobility after hip fracture was valued more highly than strict adherence to sternotomy restrictions. After a risk/benefit analysis with the cardiothoracic surgeon, the patient was allowed to use her upper extremities for functional mobility and upper extremity ergometer for continuation of cardiac rehabilitation. She recovered well without sternotomy or hip surgery complications.