James T. Cavanaugh
© 2020 Shawn Novella
Background and Purpose: The annual incidence of femoral shaft fractures is about 10 per 100,000. When these injuries prompt bone to be resected, limb lengthening surgery may be utilized. However, the surgery takes a toll on the patient’s postoperative functional mobility. There is limited information regarding specific home health rehabilitation programs post surgery. The purpose of the report was to investigate the effect of a comprehensive home health PT program on the patient’s LE functional mobility, post bilateral limb lengthening surgery. Case Description: The case report details a 51-year-old male patient’s traumatic bilateral femoral fractures, osteomyelitis, and intramedullary limb lengthening surgery using the Precice System. The patient underwent an eight-week home health physical therapy program three times a week. This consisted of stretching the hamstring muscles, standing balance training, strengthening the hamstring, quadricep, calf, and hip muscles, and gait training as these have potential to promote long bone regeneration, strength, and functional mobility in the lower extremities. Outcomes: The patient displayed improvements in lower extremity strength (2-3/5 to 3-3+/5), range of motion of the knees (left, 50° of flexion and -20° of extension to 65° and -7°) (right, 90° of flexion and -20° of extension to 122° and -5°), and the Tinetti Balance Assessment Tool (8/28 to 18/28). Discussion: Noted improvements were made in the patient’s outcomes, which may have been due to the physical therapy treatment provided. Despite positive outcomes, the patient had residual weakness, ROM impairment, limited mobility and remained at risk for falling. Increasing intervention intensity may expedite results, but may also slow or damage the limb lengthening process. Further research is warranted to fine-tune a safe exercise intensity.
Novella, Shawn, "Restoring Functional Mobility In A 51-Year-Old Male Post Intramedullary Limb Lengthening Surgery Following Helicopter Crash: A Case Report" (2020). Case Report Papers. 123.