Case history:

Mr JB is a 34 year old security alarm installer. He has been with his company for 12 years. The job requires him to repeatedly climb ladders, work in roof spaces and maintain and sustain awkward postures.

JB was driving to a job when he was involved in a motor vehicle accident. JB sustained a fracture to his left hip, resulting from the head of the femur pushing through the acetabulum (the cup-shaped socket of the hip joint).

His fracture was managed conservatively and he was on crutches for three months while the fracture healed.

He was encouraged to remain active and later began physiotherapy, which is still ongoing, on a weekly basis.

He also undertook regular swimming and hydrotherapy for six months while the treatment payment was covered, but since having to pay for his own treatments, his attendance has dropped.

Since the accident JB has had persistent soreness and aching in his hip. Review by an orthopaedic surgeon resulted in an MRIs and an arthroscopy of the hip. He was advised to avoid high impact activities, to slow the development of hip arthritis that is expected to develop as a result of the injury.

Physically his hip movement is restricted to varying degrees in flexion, extension and external rotation.

JB's doctor has recommended work restrictions of no frequent climbing of stairs or ladders.

JB returned to work as an alarm tester, which required him to visit sites, but not climb ladders or onto roofs. Each testing job takes between five minutes and two hours. These duties require him to frequently get in and out of his utility vehicle, which he finds physically challenging.

He is undertaking full time hours – but is just coping with the physicality of these tasks.

JB lives at home with his wife and two children. He is now having financial difficulties, due to a decrease in overtime payments, and may now be forced to sell his house.

JB has become despondent about his future employment options and is already presuming he will eventually be put off work by his current employer.

It is likely JB will continue to have long term hip problems, with a possible deterioration and development of osteoarthritis likely. A hip replacement will eventually be needed.

He will not be able to return to pre-injury duties. In the current role he is barely coping, but doesn't see other options to maintain his income.

Key Messages:

Adequate rehabilitation is simply not enough – a long term view is required.

JB has been a loyal worker who has accepted his injury and its resulting restrictions with regard to his employment.

Currently, JB's rehabilitation could be described as just adequate. But because he is giving his best efforts and not making complaints there is no continued rehabilitation activity.

With 30 working years ahead of him a long term plan is needed.
 

What should occur?

1. Input from the treating surgeon, with information on

• The likely progression of hip problems
• What can be done to minimise progression of hip arthritis
• Appropriate restrictions

2. A discussion about the viability of job options with the current employer, taking into account these restrictions. The current employer will know the worker, including his background skills, experience and his approach. They may or may not have suitable long term work for JB. The earlier this can be clarified the better.

3. JB needs a clear understanding of the situation, including job options with the current employer; expectations about pay include any expected pay rate reductions, duration of benefits etc.

4. Long term job options should be identified, based on

• The restrictions
• Job options with the current employer
• JB's level of skill and experience and previous work history.

Training needs should be identified and commenced, as well as rather than instead of modified work. There may need to be accommodations to the work program, to allow time for training needs.

5. Motivation is a key element of success. JB's motivation will be enhanced through:

1. Positive support
2. Identifying realistic job options, ones that he considers are within his capacity and areas of interest. Jobs that pay as well or better will more likely interest JB, particularly noting his family commitments.
3. Family support. He may wish to have his wife accompany him to activities such as a vocational review.
4. Giving JB the tools to explore long term work options, such as:
   • Websites that outline training in his areas of work
   • The opportunity to talk with others who have had similar experiences
   • Websites that allow him to browse and look at jobs being advertised
   • A meeting with a careers counsellor at the local TAFE
5. Senior management encouragement

The benefits of assisting JB, a previous stable worker who is a family man and seen as a good guy by his colleagues, are significant to the organisation.

Injury management staff are motivated by assisting and achieving a positive outcome. Work colleagues see the way the organisation behaves, and are more likely to feel positively towards the organisation. Discretionary effort improves with better morale, and the organisation develops a reputation for being a ‘good corporate citizen.'