Can Manual Manipulation Surgery Be Done After Leg Fracture with Metal Implants?

Manual therapy for lower extremities surgery

Hello, I was in a car accident at the end of December last year, which resulted in an open fracture of the tibia and fibula, along with comminuted cartilage damage in my knee.
I had a steel plate and screws inserted.
Initially, my knee was adhesed and could not bend, but later during manual rehabilitation, it was torn apart, leading to some inflammation.
Currently, I can maintain a flexion angle of 90 degrees.
When I try to flex my knee further, the muscles on the sides and front of my thigh feel very tight and painful.
I feel very anxious and scared about going to rehabilitation, which affects my appetite and sleep.
I would like to know if it is possible to perform manipulation surgery under anesthesia given that I have steel plates and screws inserted.

Miss Wang, 20~29 year old female. Ask Date: 2018/04/14

Dr. Li Yongheng reply Orthopedics

Hello, it has been 3-4 months since your surgery, and you should be able to undergo manipulation surgery with anesthesia.
You can discuss this with your surgeon and ask them to arrange it.
However, I want to remind you that if you do not actively participate in rehabilitation after the manipulation surgery, the improvement may only be temporary, and adhesions could form again if you remain inactive.
Therefore, the improvement in your range of motion may still be minimal.
It is essential to endure the pain and actively engage in rehabilitation after the surgery.
Keep it up, and I wish you a smooth recovery in your rehabilitation.
Wishing you a speedy recovery.

Reply Date: 2018/04/14

More Info

Manual manipulation surgery, also known as manipulation under anesthesia (MUA), can indeed be performed after a leg fracture with metal implants, such as plates and screws. This procedure is often considered when a patient experiences stiffness and limited range of motion following a fracture, especially when there are complications like adhesions or scar tissue formation around the joint. In your case, the history of an open fracture and subsequent complications with knee flexion indicates that manipulation may be a viable option to restore mobility.

Before proceeding with MUA, it is essential to have a thorough evaluation by your orthopedic surgeon. They will assess the stability of the implants and the overall condition of the knee joint. If the implants are secure and there are no signs of infection or other complications, the surgeon may recommend MUA as a means to break up adhesions and improve range of motion. The procedure typically involves the patient being placed under general anesthesia, allowing the surgeon to manipulate the joint without causing pain.

However, it is crucial to understand that MUA is not a standalone solution. Post-manipulation rehabilitation is vital for achieving long-term success. After the procedure, you will need to engage in a structured physical therapy program to strengthen the muscles around the knee, improve flexibility, and prevent the reformation of adhesions. The rehabilitation process can be uncomfortable and may require a significant commitment, but it is essential for regaining function.

Regarding your concerns about pain and anxiety related to rehabilitation, it is entirely normal to feel apprehensive, especially after experiencing significant trauma and subsequent complications. Open communication with your healthcare team is vital. They can provide reassurance, pain management strategies, and support throughout the rehabilitation process. Additionally, addressing any underlying anxiety through counseling or support groups may also be beneficial.

In summary, MUA can be performed after leg fractures with metal implants, provided that the implants are stable and there are no contraindications. It is essential to follow up with your orthopedic surgeon to discuss the potential risks and benefits, as well as to establish a comprehensive rehabilitation plan post-procedure. Remember, the goal of MUA and subsequent therapy is to restore your knee function and improve your quality of life, so maintaining a positive outlook and staying engaged in your recovery process will be key.

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