From the Guidelines
Tibial and fibular (tib-fib) fracture repairs typically require rehabilitation to ensure optimal recovery and prevent complications. After surgical or non-surgical treatment of these fractures, a comprehensive rehabilitation program is essential for optimal recovery, as highlighted in a recent scoping review 1. Rehabilitation usually begins with protected weight-bearing using crutches or a walker, gradually progressing to full weight-bearing as healing occurs. Some key considerations for rehabilitation include:
- Resolution of bony tenderness
- Pain-free walking
- Evidence of radiological healing in high-risk cases
- Strength, functional, and loading tests
- Identification of contributing factors to the initial injury Physical therapy typically starts with gentle range of motion exercises, followed by strengthening exercises for the ankle, knee, and hip muscles, as well as addressing biomechanical abnormalities and muscle imbalances that may have contributed to the initial injury 1. Balance and proprioception training are incorporated as healing progresses, along with functional exercises that mimic daily activities. The rehabilitation process generally lasts 3-6 months, though this varies based on fracture severity, treatment method, and individual factors. Rehabilitation is crucial because it helps restore strength, flexibility, and function while preventing complications like muscle atrophy, joint stiffness, and abnormal gait patterns, ultimately improving the patient's quality of life 1. Without proper rehabilitation, patients may experience persistent pain, weakness, and functional limitations that could affect their ability to return to normal activities and quality of life. Addressing core and proximal strength, as well as incorporating high-impact training and plyometric exercises, may also be beneficial in certain cases, as they can help improve lower extremity bone mass and reduce the risk of future injuries 1.
From the Research
Importance of Rehabilitation in Tibial Fractures
- Rehabilitation is a crucial aspect of recovery from tibial fractures, as it can significantly impact the patient's quality of life and ability to return to normal activities 2, 3.
- Studies have shown that early range of motion exercises and weight-bearing can be beneficial for patients with tibial fractures, while immobilization may not provide any additional benefits 2.
- Ongoing rehabilitation with a focus on quadriceps strengthening and proprioception exercises is recommended to achieve better clinical outcomes 2.
Variability in Rehabilitation Practices
- There is variability in the use of outpatient physical therapy (OPT) following tibial fractures, with some patients not receiving OPT at all 3.
- The timing of OPT initiation, length of care, and number of visits attended can vary significantly depending on patient, injury, and treatment-level factors 3.
- Further research is needed to standardize referral and prescription practices for OPT following tibial fractures 3.
Long-term Outcomes
- Long-term follow-up studies have shown that patients with tibial fractures can achieve good or excellent clinical and radiographic outcomes, even with uncomplicated treatment with a plaster cast 4.
- The clinical and radiographic outcomes are not significantly affected by the amounts of angulation, level of fracture, or length of immobilization 4.
Need for Standardized Rehabilitation Protocols
- There is a need for standardized rehabilitation protocols for patients with tibial fractures, as current practices are inconsistent and lack uniformity 5.
- Scoping reviews and systematic reviews can help identify commonalities across studies and inform the development of evidence-based rehabilitation guidelines 5.