Tibial shaft fractures and post-operative physical therapy management: a case report

Abstract

Background and Purpose: Tibial fractures rank as the most common long bone fracture site in the body and frequently require surgical repair followed by intense physical therapy to regain optimal function. Unfortunately, protocols for rehabilitating this injury are limited in scope to surgical, not physical therapy, management or are altogether non-existent. Therefore, this case report aims to give physical therapists guiding principles for rehabilitating patients with tibial shaft fractures.

Case Description: The patient is a 44-year-old male who had a motor vehicle accident and fractured both his right tibia shaft and fibula. He had a tibial open reduction internal fixation and no operative repair to his fibula. On intake, the patient reported extreme pain and lack of range of motion in his knee and ankle. In addition, the patient had pain in a common peroneal nerve distribution that extended down the lateral aspect of the calf on to the dorsum of the foot. The interventions given included therapeutic exercises, neuromuscular re-education and manual therapy for the knee, ankle, and joints of the foot.

Outcomes: Ankle and knee range of motion and strength improved significantly to allow for patient return to daily functional tasks. Lower Extremity Functional Scale (LEFS) score improved from 15 to 34 and 5 Times Sit to Stand (5xSTS) improved from unable to perform to 10 seconds. Patient pain level measured via Numeric Pain Rating Scale (NPRS) went from a three with post-operative oxycodone use to a four without opioid use.

Discussion: Physical therapy interventions targeting the knee, ankle, and joints of the foot may be beneficial for increasing range of motion and strength in patients with ORIF tibial shaft fracture repair.