During the 2022 Winter Olympic Games in Beijing, American skier Nina O’Brien was competing in the women’s giant slalom when she fractured her left tibia [1]. Tibia fractures are notoriously difficult to treat [2]. Physical therapy (PT) is a common recourse for tibia fracture patients, following surgical intervention [2]. Generally, PT may begin with a bed mobility routine, followed by transfers to and from the bed, to use of crutches or a walker, and finally, a transition to autonomous movement [2]. Although there is no single form of physical therapy that works for all tibia fracture patients, fortunately, therapists can draw on a wide variety of techniques to help patients recover [3].
Before delving into the stages of physiotherapy, it is important to consider the efficacy of PT on tibia fracture patients. Castillo et al. examined the effect of PT on the physical impairment of patients who had suffered lower-extremity trauma [4]. Of their 385 subjects, 202 patients had experienced tibia fractures [4]. They found that patients with an unmet PT need, as determined by a physical therapist, were significantly less likely to improve their gait pattern, walking speed, and stair climbing during the 12 to 24 month period following surgery [4]. They also exhibited less significant improvements in their functional independence and range of motion (ROM) scores in the 6 to 12 month post-operative period [4]. An appropriate physical therapy regimen is highly beneficial for people who have suffered from a tibia fracture.
Range of motion exercises are central to physiotherapy following tibia fracture. After conducting a literature review of 39 articles focused on tibial plateau fractures, Iliopoulos et al. concluded that patients should begin ROM exercises as soon as possible following surgery [5]. These exercises can include “passive, active, or active-assisted exercises” [5]. Many physiotherapists used continuous passive motion (CPM) devices to aim patients’ range of motion; AC sine-wave stimulation and closed-chain kinetic exercises may also be helpful [5].
Another prominent, albeit debated, element of post-fracture PT is immobilization. Tasheva and colleagues conducted a research study that focused on the use of immobilization in patients who experienced surgically stabilized proximal tibia fractures [6]. They found that two weeks of physiotherapy, which included near-complete immobilization for the first 30 days following surgery, resulted in the restoration of extension, successful control of edema and hypotrophy, and significant improvement of knee flexion [6]. However, Iliopoulos and colleagues suggest that, at least for tibial plateau fractures, immobilization may not lead to improved recovery and, in some cases, may result in poorer functional outcomes than non-mobilized patients [5]. Of course, immobilization is warranted when pain prevents patients from exercising, but the extent of recommended immobilization absent pain is uncertain.
In designing a PT regimen, physiotherapists may wish to consider the three weight-bearing stages [3]. The first stage is non-weight-bearing, during which the leg is immobilized, but passive knee and residual joint ROM can begin [3]. Afterward, the patient may graduate to partial weight-bearing [3]. During this stage, the patient may engage in active knee ROM, hydrotherapy, and closed kinetic chain exercises, among other movements [3]. Finally, during the full weight-bearing phase, the patient should focus on regaining full function and developing strength, [3]. (Note: this routine is aimed at tibial plateau fracture patients, so therapists treating distinct fractures should adjust the exercises to meet their individual patients’ needs.)
Physical therapy is a powerful means of helping tibia fracture patients recover, especially following surgery. Medical practitioners should consider recommending ongoing physical rehabilitation to their patients to ensure long-term functional improvements.
References
[1] Associated Press, “Nina O’Brien suffered compound fracture in leg during giant slalom at Olympic Games in Beijing,” ESPN, Updated February 7, 2022. [Online]. Available: https://www.espn.com/olympics/skiing/story/_/id/33241078/nina-obrien-suffered-compound-fracture-leg-giant-slalom-olympic-games-beijing.
[2] N. C. Miller and A. E. Askew, “Tibia Fractures: An Overview of Evaluation and Treatment,” Orthopaedic Nursing, vol. 26, no. 4, p. 216-223, July 2007. [Online]. Available: DOI:10.1097/01.NOR.0000284648.52968.27.
[3] J. Van De Gucht, “Tibial Plateau Fractures,” Physiopedia, Updated 2011. [Online]. Available: https://www.physio-pedia.com/Tibial_Plateau_Fractures.
[4] R. C. Castillo et al., “Evidence of Beneficial Effect of Physical Therapy After Lower-Extremity Trauma,” Archives of Physical Medicine and Rehabilitation, vol. 89, no. 10, p. 1873-1879, October 2008. [Online]. Available: DOI:10.1016/j.apmr.2008.01.032.
[5] E. Iliopoulos and N. Galanis, “Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature,” SAGE Open Medicine, vol. 8, no. 2, p. 1-6, October 2020. [Online]. Available: DOI:10.1177/2050312120965316.
[6] R. Tasheva, “Physiotherapy After Surgically Stabilized Proximal Tibia Fracture,” Trakia Journal of Sciences, vol. 18, no. 2, p. 156-160, 2020. [Online]. Available: DOI:10.15547/tjs.2020.02.011.