A 35-year-old male client was admitted due to severe burns around his right hip. Which position is most important to use to maintain the maximum function of this joint?
A. Hip maintained in 30-degree flexion
B. Hip at zero flexion with leg flat
C. Knee flexed at 30-degree angle
D. Leg abducted with a foam wedge
Correct Answer: B. Hip at zero flexion with leg flat
The maximum function for ambulation occurs when the hip and leg are maintained at full extension with neutral rotation. Although the client does not have to spend 24 hours in this position, he or she should be in this position (in bed or standing) longer than with the hip in any degree of flexion.
Option A: Anti-contracture positioning and splinting must start from day one and may continue for many months post-injury. Legs should be positioned in a neutral position ensuring that the patient is not externally rotating at the hips.
Option C: Patients rest in a position of comfort; this is generally a position of flexion and also the position of contracture. Without ongoing advice and help with positioning, the patient will continue to take the position of contracture and can quickly lose ROM in multiple joints. Once contracture starts to develop it can be a constant battle to achieve full movement, so preventative measures to minimize contracture development are necessary.
Option D: Splinting helps maintain anti-contracture positioning particularly for those patients experiencing a great deal of pain, difficulty with compliance, or with burns in an area where positioning alone is insufficient. If the injured site is over joint surfaces, special precautions should be taken to identify all possible joint contractures.
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