Comprehensive Recovery Strategies for Severe Lower Limb Fractures

Open fracture of the tibia, fibula, and closed fractures of the left femoral neck, femoral shaft, and supracondylar region of the left femur. Closed fracture of the left patella?

On February 27, 2018, a car accident resulted in: 1.
Open fracture of the left tibia and fibula; 2.
Closed fractures of the left femoral neck, femoral shaft, and supracondylar region of the femur; 3.
Closed fracture of the left patella; 4.
Closed fractures of the second, third, and fourth metatarsals of the left foot; 5.
Closed fracture of the proximal phalanx of the left fifth toe.
On February 27, 2018, a skeletal external fixator was applied to the left tibia, and closed reduction and internal fixation with steel nails were performed for the closed fractures of the second, third, and fourth metatarsals and the proximal phalanx of the left fifth toe.
On March 5, 2018, closed reduction and internal fixation surgery were performed for the fractures of the left femoral neck, femoral shaft, and supracondylar region of the femur.
On March 12, 2018, the external fixator was removed, and internal fixation was performed for the left tibial shaft fracture, along with partial patellectomy.
On July 2, 2018, arthroscopic surgery was performed for patellar adhesions.
Due to the severity of the injuries, I was hospitalized for nearly three months, starting rehabilitation on May 8, 2018.
The therapist was very cautious with knee flexion due to other fractures in the thigh and calf, and for three weeks, we focused on manual rehabilitation, achieving a maximum angle of 50 degrees.
The orthopedic surgeon advised me to perform exercises for the bowing motion, but progress was limited.
On July 2, 2018, I underwent arthroscopic surgery for severe patellar adhesions.
Starting July 9, 2018, I began using a continuous passive motion (CPM) machine for knee flexion rehabilitation, reaching a maximum angle of 115 degrees on August 3, 2018, while my actual flexion angle was nearly 90 degrees.
The rehabilitation physician indicated that more aggressive treatment would be pursued once the tibial bone (which had a comminuted fracture) healed.
The therapist mentioned that the current treatments—CPM, hydrotherapy, and electrical stimulation—were only to prevent excessive stiffness in the knee and maintain flexibility, and that more intensive rehabilitation would wait until the tibial bone healed.
Are there any other more aggressive treatments available to help me regain sufficient knee flexion for self-care and normal walking, so that I do not have a limp? I am genuinely very concerned.

Tong Dashuai, 50~59 year old female. Ask Date: 2018/08/05

Dr. Chen Yongxue reply Orthopedics

Hello, given the severity of the injury, a full recovery may be challenging.
Active rehabilitation therapy should ideally wait until the bones have healed for safety; otherwise, there is a risk of re-fracture.
Thank you.

Reply Date: 2018/08/05

More Info

Recovering from severe lower limb fractures, especially after a traumatic event like a car accident, is a complex process that requires a comprehensive approach. Your case involves multiple fractures, including open and closed fractures of the tibia, fibula, femur, patella, and metatarsals, which necessitates a tailored rehabilitation strategy. Here’s a detailed overview of recovery strategies that can aid in your rehabilitation journey.

1. Initial Phase of Recovery
After such extensive injuries, the first phase of recovery typically focuses on stabilization and healing. This includes:
- Immobilization: The use of external fixators and internal fixation devices is crucial for maintaining bone alignment and stability during the initial healing phase. It seems you have undergone surgeries to stabilize your fractures, which is essential.

- Pain Management: Managing pain effectively is vital. This may involve medications prescribed by your healthcare provider, including non-steroidal anti-inflammatory drugs (NSAIDs) if tolerated, or other pain relief methods.

2. Physical Rehabilitation
Once the initial healing has begun, physical rehabilitation becomes a priority. Given your situation, here are some strategies:
- Controlled Range of Motion (ROM) Exercises: Starting with passive and then progressing to active ROM exercises can help maintain joint flexibility. Continuous Passive Motion (CPM) machines, which you have already started using, are beneficial for knee joint mobility without putting too much stress on healing bones.

- Strengthening Exercises: As healing progresses, strengthening exercises for the quadriceps, hamstrings, and calf muscles should be introduced gradually. This can help restore muscle function and support the joints.

- Weight-Bearing Activities: Gradual introduction of weight-bearing activities is crucial. Initially, this may involve using crutches or a walker, transitioning to partial weight-bearing as tolerated, and eventually progressing to full weight-bearing activities.

3. Advanced Rehabilitation Techniques
Once the fractures have sufficiently healed, more aggressive rehabilitation techniques can be introduced:
- Aquatic Therapy: Water therapy can be an excellent way to strengthen muscles while minimizing stress on the joints. The buoyancy of water reduces the weight on your limbs, allowing for more comfortable movement.

- Manual Therapy: Techniques such as massage or myofascial release can help alleviate stiffness and improve circulation in the affected areas.

- Functional Training: This involves practicing movements that mimic daily activities, such as walking, climbing stairs, and getting in and out of chairs. This training is essential for regaining independence.

4. Monitoring and Adjustments
Regular follow-ups with your orthopedic surgeon and physical therapist are crucial. They can monitor your healing progress through imaging studies and adjust your rehabilitation program accordingly. If your tibial fracture is not healing as expected, they may consider additional interventions.

5. Psychological Support
Dealing with severe injuries can be mentally taxing. Engaging with a counselor or support group can help address any anxiety or depression related to your recovery process.

6. Lifestyle Modifications
Incorporating a balanced diet rich in calcium and vitamin D can support bone healing. Staying hydrated and avoiding smoking or excessive alcohol consumption is also beneficial.

7. Long-term Considerations
Understand that recovery from such extensive injuries can take time, often several months to a year, depending on the severity of the fractures and your overall health. Setting realistic goals and being patient with your progress is essential.

Conclusion
In summary, a comprehensive recovery strategy for severe lower limb fractures involves a combination of immobilization, gradual rehabilitation, advanced therapeutic techniques, and ongoing monitoring. It’s essential to communicate openly with your healthcare team about your concerns and progress. With dedication to your rehabilitation program and support from your medical team, you can work towards regaining your mobility and independence.

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