James T. Cavanaugh
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Background and Purpose: Ankle fractures are common in the North American adult population. The trimalleollar fracture is among the most common. This injury is typically treated surgically with positive outcomes. Common residual deficits post-surgery occur and often include muscle stiffness, decreased range of motion, and pain. As a result, patients typically receive subsequent physical therapy (PT). Some evidence suggests early mobilization after surgery is important, however, it has been debated that delayed rehabilitation yields similar outcomes. The purpose of this case report was to observe the impact of delayed PT on the outcomes and resolution of function post open reduction internal fixation (ORIF) of the ankle. Case Description: The patient was a 44-year-old female referred to PT post ORIF of the ankle. Due to the onset of Coronavirus Disease 2019 (COVID-19), after receiving an initial evaluation, she did not resume supervised PT until seven months post-surgery. Her treatment included manual therapy, range of motion (ROM), strengthening exercises, balance training, patient education, and a comprehensive home exercise program. She received PT one to two times a week for five weeks. Outcomes: This patient demonstrated improvements in all test and measures with exception of eversion ROM upon self-discharge. Improvements included right active dorsiflexion range of motion with knee straight (0 to 5 degrees) and flexed 20 degrees (2 to 10 degrees), plantar flexion strength (4- to 4+), and Lower Extremity Function Scale (53/80 to 70/80). Discussion: This case report suggests that delayed physical therapy following ORIF of the ankle can yield positive functional outcomes. Further research on postponed PT ought to be completed in order evaluate and further develop best practice should a patient require delayed intervention.
© 2020 Nathaniel Whitten
Whitten, Nathaniel, "Post-Operative Rehabilitation Of A Fractured Ankle During The COVID-19 Pandemic: A Case Report" (2020). Case Report Presentations. 12.