Aftercare following treatment of extraarticular fractures
Introduction
Impediments to the restoration of full knee function after distal femoral fracture are fibrosis and adhesion of injured soft tissues around the metaphyseal fracture zone, joint capsular scarring, intra-articular adhesions and muscle weakness.
Continuous passive motion is a low load method of restoring movement and is a useful tool n the early post operative phase. It must be used in combination with muscle strengthening programs. With stable fracture fixation, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient.
The regimens suggested here are for guidance only and not to be regarded as proscriptive.
Functional treatment
Unless there are other injuries, or complications, joint mobilization
may be started immediately postoperatively. Both active and passive motion of
the knee and hip can be initiated immediately postoperatively. Emphasis should
be placed on quadriceps strengthening and straight leg raises. Static cycling
without load, as well as firm passive range of motion exercises of the knee,
allow the patient to regain optimal range of motion.
Weight bearing
Touch-down weight bearing (10-15 kg) may be performed immediately with
crutches, or a walker. This will be continued for 6-10 weeks postoperatively.
Touch-down weight bearing progresses to full weight bearing gradually over a
period of 2 to 3 weeks (beginning at 6–10 weeks postoperatively). In general,
patients are fully weight bearing without devices (e.g., cane) by 16-20
weeks.
Follow-up
Wound healing should be assessed at two to three weeks postoperatively.
Subsequently 6 week, 12 week, 6 month, and 12 month follow-ups are usually
made. Serial x-rays allow the surgeon to assess the healing of the
fracture.
Implant removal
Implant removal is not essential and should be discussed with the
patient, if there are implant-related symptoms after consolidated fracture
healing.
Thrombo-embolic prophylaxis
Consideration should be given to thrombo-embolic prophylaxis, according
to local treatment guidelines.