Case Study: Post-Operative Rehabilitation Following Distal Tibial Fracture (Home-Based Care)

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Clinical Experience (2019-2020)

Presenting Complaint:

A 42-year-old male patient was referred for physiotherapy following open reduction and internal fixation (ORIF) for a distal tibial fracture sustained during a road traffic accident. The patient was recovering at home post-surgery and required a structured rehabilitation plan to regain mobility, strength, and functional independence. I conducted home visits to manage his recovery and guide his progression.

History and Background:

The patient underwent ORIF with plates and screws to stabilize the distal tibial fracture. By the time physiotherapy was initiated, he had been cleared for gradual weight-bearing and movement. He presented with swelling, pain on movement, reduced ankle and knee mobility, and difficulty with weight-bearing due to prolonged immobilization and surgical trauma.

The main goals were to reduce post-operative complications, restore range of motion, improve muscle strength, and assist him in returning to normal daily activities.

Assessment:

Initial home visit assessment revealed the following:

• Observation:

o Mild swelling and surgical scar over the lower leg

o No signs of infection or wound complications

• Palpation:

o Tenderness around the surgical site and anterior ankle

o Slight warmth due to healing

• Range of Motion (ROM):

o Ankle dorsiflexion and plantarflexion limited

o Knee flexion slightly restricted due to guarding

• Muscle Strength:

o General weakness in the calf, quadriceps, and tibialis anterior

• Gait:

o Non-weight bearing at the start; ambulation with assistance (walker)

• Functional Limitation:

o Dependent on caregiver for movement and unable to bear weight

Treatment Plan and Intervention:

I designed a personalized rehabilitation program carried out through progressive home-based physiotherapy sessions:

Phase 1: Early Rehabilitation (Weeks 1–2 of PT)

• Pain & Swelling Management: Ice therapy and limb elevation

• Scar Management: Gentle mobilization around the incision site

• Passive & Active-Assisted ROM Exercises: Ankle pumps, heel slides, gentle knee bending

• Isometric Exercises: Quadriceps, gluteal, and hamstring sets to prevent atrophy

• Bed Mobility & Transfers: Techniques to promote independence

Phase 2: Intermediate Rehabilitation (Weeks 3–4)

• Progressive ROM Exercises: Improved ankle dorsiflexion, plantarflexion, inversion, and eversion

• Strengthening: Theraband-based exercises for ankle and knee muscles

• Partial Weight-Bearing Training: Gradual introduction with walker under supervision

• Balance Training: Single-leg stance on unaffected side, progressing to affected side

Phase 3: Advanced Rehabilitation (Weeks 5 onward)

• Full Weight-Bearing Training: Transitioned to cane, and then unaided ambulation

• Functional Strengthening: Step-ups, mini squats, resistance exercises with weights

• Gait Re-Education: Correction of limp, proper foot placement, and stride

• Endurance Training: Walking drills, home task simulation (e.g., stairs, carrying items)

Outcome Measures:

• Pain Level: Reduced from 6/10 to 1/10

• ROM: Nearly full ankle and knee mobility regained

• Strength: Improved to normal levels in lower limb muscle groups

• Gait: Independent and pain-free without support

• Functional Activities: Fully resumed personal care, household tasks, and community ambulation

Prognosis:

The rehabilitation was successful. With consistent effort and adherence to the program, the patient achieved full functional recovery. He resumed an active lifestyle and expressed high satisfaction with the care provided. Follow-up communication confirmed he remained independent and pain-free in daily activities.

“This case emphasized the importance of patient-specific, phased rehabilitation—especially in a home setting where physical and psychological support is crucial. By applying my clinical skills and adapting to the home environment, I was able to guide this patient from immobilization to full independence. The positive feedback reinforced my belief in hands-on care, continuity, and tailored progression in post-operative fracture rehabilitation.”


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