Recovering from Severe Leg Fractures: Improving Knee Flexibility After Surgery

Severe foot fracture, with the knee able to bend only 90 degrees?

Hello Doctor: I sustained a left leg fracture due to a car accident as follows: On February 27, 2018, I underwent surgery for the application of an external fixator on the left tibia and closed reduction with internal fixation using steel nails for the fractures of the second, third, and fourth metatarsals and the proximal phalanx of the left fifth toe.
On March 5, 2018, I had surgery for the reduction and internal fixation of the left femoral neck, femoral shaft, and supracondylar femur fractures.
On March 12, 2018, I had the external fixator removed, and underwent internal fixation for the left tibial and femoral shaft fractures, along with partial patellectomy.
On July 2, 2018, I had arthroscopic surgery for patellar adhesions.
Due to the severity of my injuries, I only began continuous rehabilitation on May 8, 2018.
Currently, I can bend my knee to nearly 90 degrees, which is my limit.
The rehabilitation physician advised me to wait until the bones heal before engaging in more aggressive rehabilitation, as there is a risk of re-fracture if I push too hard before the bones are healed.
Are there any other methods to improve the bending of my knee? Will my leg heal properly? Thank you, Doctor, for your guidance.

Maike, 50~59 year old female. Ask Date: 2018/08/25

Dr. Cai Shanglin reply Orthopedics

It is recommended to have the original surgeon follow up with an X-ray to confirm that rehabilitation can begin, as the bone needs to be stable before starting rehabilitation.

Reply Date: 2018/08/25

More Info

Recovering from severe leg fractures, especially those involving multiple bones and complex injuries, can be a challenging and lengthy process. Your situation, involving fractures of the tibia, fibula, femur, and patella, along with surgeries and rehabilitation, requires a careful and structured approach to recovery. Here are some insights and recommendations based on your current condition and the information provided.

Understanding Your Current Condition
1. Knee Flexibility and Range of Motion: Achieving a full range of motion (ROM) in the knee after such significant injuries can take time. The fact that you are currently able to flex your knee to about 90 degrees is a positive sign, but it is understandable that you wish to improve this further. The stiffness you are experiencing is likely due to a combination of factors, including the healing of soft tissues, the presence of scar tissue, and possibly muscle atrophy from disuse.

2. Bone Healing: It is crucial to ensure that the bones are healing properly before engaging in more aggressive rehabilitation. Your healthcare team is right to prioritize bone healing, as premature stress on healing bones can lead to complications, including nonunion or malunion of fractures.

Recommendations for Improving Knee Flexibility
1. Gentle Range of Motion Exercises: Continue with gentle range of motion exercises as tolerated. These can include passive stretching, where a therapist or a family member helps you move your knee through its range of motion. This can help prevent stiffness without putting too much stress on the healing bones.

2. Physical Therapy: If you haven't already, consider working with a physical therapist who specializes in post-surgical rehabilitation. They can tailor a program specifically for your needs, focusing on gradual progression of knee flexion and strengthening exercises for the quadriceps and hamstrings.
3. Use of Continuous Passive Motion (CPM) Machines: If available, using a CPM machine can be beneficial. This device gently moves your knee through a controlled range of motion, which can help improve flexibility without requiring active effort from you.

4. Hydrotherapy: Water-based exercises can be particularly effective for rehabilitation. The buoyancy of water reduces the load on your joints while allowing you to perform movements that may be difficult on land. This can help improve flexibility and strength without risking further injury.

5. Strengthening Exercises: Once your doctor gives the green light, incorporate strengthening exercises for the quadriceps and hamstrings. Exercises like straight leg raises, heel slides, and eventually more weight-bearing activities can help rebuild muscle strength and support the knee joint.

6. Patience and Consistency: Recovery from severe fractures takes time. It is essential to be patient and consistent with your rehabilitation efforts. Celebrate small improvements, as they can lead to significant progress over time.

Monitoring and Follow-Up
- Regular Check-Ups: Keep up with your follow-up appointments to monitor the healing process of your bones. Your healthcare provider may recommend imaging studies to assess the status of your fractures and ensure that they are healing correctly.

- Listen to Your Body: Pay attention to any pain or discomfort during exercises. If you experience significant pain, it may be a sign that you are pushing too hard, and you should consult your therapist or doctor.

Conclusion
In summary, while your current knee flexion is at 90 degrees, there are several strategies you can employ to improve your range of motion and overall recovery. Focus on gentle exercises, work closely with a physical therapist, and ensure that you are allowing adequate time for your bones to heal. With dedication and the right approach, you can achieve better knee flexibility and regain functionality in your leg. Remember, recovery is a journey, and every small step counts toward your overall progress.

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