Rehabilitation Protocol after Dynamic Compression Screw (DCS) Placement for Proximal Femur Fracture

Preoperative and Perioperative Phase

The American Society of Anesthesiologists recommends preoperative evaluation to include assessment of cardiovascular, respiratory, renal, cognitive, and nutritional status to optimize perioperative management 1, 2
Adequate analgesia should be administered from admission, preferably with regular paracetamol and avoiding non-steroidal anti-inflammatory drugs 1, 3
Thromboprophylaxis should be initiated early and maintained throughout the perioperative period 1

Pain control should be achieved through multimodal analgesia with regular paracetamol, avoiding potent opioids in patients with renal dysfunction 1
Hypothermia prevention strategies should be implemented actively 1
Monitoring of vital signs, neurovascular status, and surgical wound care is essential 4
Early mobilization with assistance for sitting and basic transfers should be initiated 2, 5

Assisted bipedalization should be started according to tolerance and fracture type 2, 5
In stable fractures, partial weight-bearing can be initiated with technical aids (walker or crutches) 6
Progressive weight-bearing should be gradual, according to fracture stability and bone quality 6, 2

Progressive weight-bearing should continue, according to fracture stability and bone quality 6, 2
In fractures stabilized with DCS, full weight-bearing can usually be initiated between 6-8 weeks, earlier than with conservative management 2

Progression to full weight-bearing should be based on radiological evidence of consolidation 6, 2

In elderly patients, the primary goal is to recover previous mobility and functional independence 1, 2
Rehabilitation should be more aggressive in young patients but conservative in those with severe osteoporosis 6

Adequate hydration and nutrition should be maintained throughout the rehabilitation process 1
Measures to prevent pressure ulcers should be implemented 1
Thromboprophylaxis should be continued according to hospital protocol 1, 4
Fall prevention should be achieved through education and environmental adaptation 1, 2