The client has severe burns around the right hip. Which position is most important to be emphasized by the nurse that the client maintains to retain maximum function of this joint?
A. Hip maintained in 30-degree flexion, no knee flexion
B. Hip flexed 90 degrees and knee flexed 90 degrees
C. Hip, knee, and ankle all at maximum flexion
D. Hip at zero flexion with leg flat
Correct Answer: D. Hip at zero flexion with leg flat
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 at a time in this position, he or she should be in this position (in bed or standing) more of the time 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 B: When burns occur to the flexor aspect of a joint or limb the risk of contracture is greater. This is due to the position of comfort being a flexed position; also the flexor muscles are generally stronger than the extensors so should a burn occur to the extensor aspect, patients can use the strength of the flexors to stretch the particular area.
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.
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