Post-Fracture Recovery: Managing Pain and Mobility Challenges

Post-operative issues following a fracture?

Hello Doctor, I would like to inquire about my condition.
It has been approximately five months since my car accident, during which I sustained an open fracture of the left femur and a closed (displaced) fracture of the left tibia.
Since starting rehabilitation, the pain in my left knee has been increasing, accompanied by a grinding sound, and I am unable to lift my leg autonomously; I need to use both hands for assistance.
The rehabilitation physician mentioned that this may be due to soft tissue wear and that I often experience numbness in my foot.
When standing, my left foot tends to turn purple.
Is this a sequela? What methods can you recommend to alleviate the pain? Currently, I can only go up and down stairs by stepping with both feet on each step.
I have tried using one foot per step, but I feel weakness and pain in my left leg when going up, and I cannot bend my left leg naturally when going down.
Although I have achieved a range of motion of 130 degrees in bending, I struggle to perform this action smoothly when navigating stairs.
Additionally, I feel a pinching sensation at the top of my thigh, and when I sleep with my left leg extended, it tends to drift inward unconsciously.
Recently, with the unstable weather, I have also been experiencing soreness in my arms, as I had a fracture in my left humerus as well.
Is there a way to improve this soreness?

Xiao Chen, 20~29 year old female. Ask Date: 2022/03/28

Dr. Shi Guozheng reply Orthopedics

1.
Heat therapy can usually relieve muscle soreness, and anti-inflammatory pain medications can also be taken for relief.

2.
Before a fracture has fully healed, swelling in the lower extremities can occur; elevating the affected limb and performing some muscle contraction exercises can help reduce the swelling.

3.
For humeral fractures, it is also necessary to wait for the fracture to heal before experiencing less soreness; medication treatment can be considered.

Reply Date: 2022/03/28

More Info

Post-fracture recovery can be a complex and challenging process, especially after significant injuries like open fractures of the femur and closed fractures of the tibia. It is not uncommon for patients to experience pain, mobility issues, and other complications during their rehabilitation. Based on your description, it seems you are facing several challenges, including knee pain, difficulty with leg elevation, and potential soft tissue damage. Let's break down your concerns and explore some strategies for managing pain and improving mobility.

Understanding Your Symptoms
1. Knee Pain and Noises: The increasing pain in your knee, along with the "grating" or "crunching" sounds, could indicate soft tissue damage or cartilage issues. After a fracture, the surrounding soft tissues, including ligaments and tendons, can become strained or damaged, leading to discomfort and reduced function. The fact that you require assistance to lift your leg suggests significant weakness or instability in the knee joint.

2. Numbness and Color Changes: Experiencing numbness and discoloration (such as your foot turning purple) can be concerning. These symptoms may indicate issues with circulation or nerve compression, which can occur after fractures due to swelling or scar tissue formation. It's essential to discuss these symptoms with your healthcare provider, as they may require further evaluation.

3. Mobility Challenges: Struggling to navigate stairs and feeling weakness in your leg when bearing weight are common post-fracture issues. The fact that you can achieve a knee flexion of 130 degrees is a positive sign, but functional movements like stair climbing require not only range of motion but also strength and coordination.

Strategies for Pain Management and Mobility Improvement
1. Physical Therapy: Continuing with physical therapy is crucial. Your therapist can tailor a rehabilitation program that focuses on strengthening the quadriceps and hamstrings, which are vital for knee stability and function. They may also incorporate balance and proprioception exercises to enhance your ability to navigate stairs and improve overall mobility.

2. Pain Management Techniques:
- Modalities: Consider using modalities such as ultrasound, electrical stimulation, or heat therapy to manage pain and promote healing. These can help reduce inflammation and improve circulation.

- Medication: Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can help manage pain and inflammation. However, consult your physician before starting any medication.

- Ice Therapy: Applying ice to the knee after therapy sessions can help reduce swelling and pain.

3. Gradual Weight Bearing: If you are still experiencing significant pain when bearing weight, it may be beneficial to use assistive devices (like crutches or a walker) to reduce the load on your injured leg while you build strength. Gradually increasing your weight-bearing activities can help your body adapt and improve function.

4. Home Exercises: Engage in home exercises that focus on strengthening the muscles around the knee and improving flexibility. Simple exercises like straight leg raises, heel slides, and gentle stretching can be beneficial.

5. Addressing Numbness and Circulation Issues: If you continue to experience numbness or color changes in your foot, it is essential to consult your physician. They may recommend imaging studies or refer you to a specialist to assess for any vascular or neurological issues.

6. Managing Weather-Related Pain: Changes in weather can exacerbate pain in previously injured areas. Staying warm, using heat pads, and maintaining a consistent exercise routine can help mitigate these effects.

7. Psychological Support: Recovery from significant injuries can be mentally taxing. Consider seeking support from a counselor or joining a support group for individuals recovering from similar injuries. Mental well-being is an essential component of physical recovery.

Conclusion
Recovering from complex fractures takes time, patience, and a comprehensive approach to rehabilitation. It is crucial to maintain open communication with your healthcare team, report any new or worsening symptoms, and adhere to your rehabilitation program. With consistent effort and the right strategies, you can improve your mobility and manage pain effectively. Remember, recovery is a journey, and each small step forward is a victory.

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