Post-Surgery Rehabilitation Challenges in Orthopedic Patients

Rehabilitation Issues After Orthopedic Surgery

Hello Dr.
Zhou: My mother (64 years old) had a car accident a year ago, resulting in a fracture of her ankle (the area between the tibia and the foot).
After surgery to insert a metal plate, the doctor said the operation was successful.
Although the swelling has decreased somewhat, there is still some swelling, and she cannot walk as she did before; her walking is slower, and her posture is not quite right.
The doctor said this is normal and advised my mother to apply heat and stay active.
Is this considered normal? Are there better rehabilitation methods? Thank you.

tom, 20~29 year old female. Ask Date: 2009/02/21

Dr. Zhou Lizhi reply Orthopedics

1.
Post-operative rehabilitation for ankle fractures should first consider the degree of fracture comminution and the stability provided by the fixation with screws.
If the ankle joint is stable after surgery, non-weight-bearing activities (dorsiflexion and plantarflexion) can be initiated.
After outpatient follow-up, partial weight-bearing with crutches can typically begin around six weeks post-surgery, with full activity resuming in approximately 3 to 4 months.

2.
After getting out of bed post-surgery, the foot will likely swell within about ten minutes.
Elevating the foot while lying down is the primary method to promote blood circulation and reduce swelling.

Reply Date: 2009/02/21

More Info

Post-surgery rehabilitation, especially in orthopedic patients, can often be a challenging and complex process. In your mother’s case, having undergone surgery for an ankle fracture, it is not uncommon to experience lingering swelling, altered gait, and discomfort even after the initial healing phase. Here’s a comprehensive overview of what to expect and how to optimize rehabilitation.

Understanding Post-Surgery Recovery
After an orthopedic surgery, such as the insertion of screws or plates to stabilize a fracture, the body goes through several stages of healing. Initially, inflammation and swelling are part of the body’s natural response to injury and surgery. This phase can last for several weeks, and while some swelling is expected to decrease over time, residual swelling can persist for months, especially in the lower extremities due to gravity.

Normal Recovery Expectations
1. Swelling: It is normal for the ankle to remain swollen for an extended period post-surgery. Factors such as activity level, time spent on the feet, and even weather can influence swelling. Elevation of the leg and regular movement can help mitigate this.

2. Gait Changes: Altered gait patterns are common after an injury and surgery. Patients often compensate for pain or instability, leading to a slower walking speed and potentially poor posture. This is a natural response as the body adjusts to the changes.

3. Pain and Discomfort: Pain levels can vary significantly among individuals. It is crucial to manage pain effectively, as uncontrolled pain can hinder rehabilitation efforts.

Rehabilitation Strategies
To enhance recovery and improve function, consider the following rehabilitation strategies:
1. Physical Therapy: Engaging with a physical therapist is one of the most effective ways to ensure proper rehabilitation. A therapist can design a personalized program that includes:
- Strengthening Exercises: Focus on the muscles surrounding the ankle to improve stability and support.

- Range of Motion Exercises: Gentle stretching can help restore flexibility and prevent stiffness.

- Balance Training: Activities that enhance balance can reduce the risk of future falls and improve gait.

2. Heat and Cold Therapy: As advised by your mother’s physician, alternating between heat and cold can help manage swelling and discomfort. Heat can promote blood flow and relax muscles, while cold therapy can reduce inflammation.

3. Gradual Increase in Activity: Encourage your mother to gradually increase her activity level. Start with low-impact activities such as walking or swimming, which can help improve cardiovascular fitness without putting excessive strain on the ankle.

4. Assistive Devices: If walking remains challenging, using a cane or walker can provide additional support and stability, allowing her to move more confidently.

5. Home Exercises: Simple exercises that can be done at home, such as ankle pumps, toe raises, and gentle stretching, can be beneficial. Consistency is key, so encourage her to integrate these into her daily routine.

6. Nutrition and Hydration: Proper nutrition plays a vital role in recovery. Ensure she is consuming a balanced diet rich in protein, vitamins, and minerals to support healing. Staying hydrated is equally important, especially if swelling is an issue.

When to Seek Further Help
If your mother continues to experience significant pain, swelling, or difficulty walking after several months, it may be worthwhile to consult her orthopedic surgeon for further evaluation. There may be underlying issues such as improper healing, hardware-related problems, or the need for additional interventions.

Conclusion
In summary, while it is normal for your mother to experience some lingering symptoms post-surgery, proactive rehabilitation through physical therapy, home exercises, and proper self-care can significantly enhance her recovery. Encourage her to remain patient and consistent with her rehabilitation efforts, as recovery from orthopedic surgery can be a gradual process. With time and appropriate care, she should see improvements in her mobility and overall function.

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