After the fracture of the leg and its plaster cast removal, the most important concern of the patient is when will they resume walking. For this, they have to follow proper
If you are the person who had this unfortunate fracture or if you are a rehabilitation professional, you will benefit fromthis article. We have covered the rehabilitation protocol for each day starting from dayone when the fractured leg is operated on to the final day when a person startswalking. So, let’s get started.
Table of Contents
- Tibia fibula fracture physiotherapy rehabilitation
- Classification of tibial shaft fracture
- Surgical treatment for Tibia shaft fracture
- Complications of broken tibia and fibula
- Tibia fracture physiotherapy rehab protocol
- Download: Tibia fibula fracture rehabilitation protocol pdf
- Phase-I: Maximum protection phase
- Phase-II: Range of motion and early strengthening
- Importance of ROM exercises
- Importance of strengthening exercises
- Phase-III: Progressive strengthening
- Phase-IV: Advanced strengthening
- Final word
Tibia fibula fracture physiotherapy rehabilitation
Fracture of the tibial shaft is among the most common long bone fracture. The fracture may be closed with minimal displacement, or it may be a complicated open fracture where the fracture segment comes out of the skin.
Management and prognosis of tibial shaft fractures are influenced by their location in the bone (proximal, middle, or distal third) and their orientation (transverse, oblique, spiral, or comminuted). Displacement and angulation play a role when determining treatment. So, it is very important to know the classification of tibial shaft fracture before we read further.
Classification of tibial shaft fracture
The commonly used classification system is OA/OTA (Orthopaedic Trauma Association). It uses the alphanumeric system of classification based on the bone involved and the particular region of the bone involved.
The AO/OTA classification designates the region of the bone by a letter (A, B, C) for the severity of the fracture, and a number (1, 2, 3) indicating increasing complexity and comminution1.
- The letter A is used to designate simple fracture,
- Letter B is for multi fragmentary (comminuted) fracture and
- The letter C designate for multi fragmentary complex fracture respectively.
- Type 1 represents mild to moderately severe fractures with superficial abrasions or contusions.
- High-energy fractures and deep abrasions with associated swelling comprise Type 2 injuries, often with impending compartment syndrome. Finally,
- Type 3 injuries include extensive skin and muscle damage, often caused by a crush injury, a severe fracture pattern, and compartment syndrome.
Surgical treatment for Tibia shaft fracture
Different types of fracture need different treatment approaches, for a closed, minimal displacement fracture (Type 1) can be managed by a long leg cast. Types 2 and 3 injuries almost always are managed operatively, with poorer outcomes related to the severity of soft tissue injury and fracture comminution1.
The surgical process involves open reduction internal fixation (ORIF) with an inter-medullary rod, intramedullary fixation, or external fixation. After the surgery, the operated limb is immobilised for a month and a half. Immobilisation means making the operated limb not move. The purpose is to allow the surgical process to take its own time to heal without any disturbance.
The process of immobilisation differs from doctor to doctor butthe most common way to do it is by applying a plaster cast. And, It is during this long-term immobilization period due to lack ofproper care, most of the secondary complications develop.
Complications of broken tibia and fibula
Most of the complications happen secondary to long term post-operative immobilization.
- Disuse atrophy- Decrease in muscle bulk due to long-term rest.
- Muscle weakness
- Muscle contracture- Long-term immobility causes muscle contracture
- Joint stiffness- Muscle contracture,
in turn , leads to joint stiffness - Odema.
We can prevent such kind of secondary complications by starting acalculated movement and physiotherapy
Tibia fracture physiotherapy rehab protocol
The goal of the surgical and rehabilitative team focuses on the return of a patient to their previous level of function often in the setting of competing for short-term goals2. Before reaching the point of walking we have to ensure that all the component of walking is intact. And this is the main motive of the protocol.
These include the flexibility of lower limb joints, like the hip joint, knee joint, and ankle joint. Ensuring sufficient strength of anti-gravity muscles and most important is the weight-bearing capability on theaffected limb. We need to start postoperative physiotherapy from the verynext day of the surgery after the leg is immobilisation and the patient is still on the bed.
Download: Tibia fibula fracture rehabilitation protocol pdf
In this article, we are going to learn just an overview of the protocol. However, if you need a complete step-by-step guide with clear illustration and instructions, then you can download the “Patients’ guide for tibia fibula fracture rehabilitation protocol“.
We will use this amount for the maintenance of the website so that I can keep giving you useful information.
Phase-I: Maximum protection phase
This
We have to be careful while selecting exercises during this period, the exercises should be static in nature with minimal or no movement at the surgical spot.
The exercises I would recommend is static quadriceps exercise (knee press) and ankle plantar flexion and dorsiflexion
Phase-II: Range of motion and early strengthening
By this period surgical pain would have subsided. here we have to begin exercises to improve joint range of motion and focus on strengthening all the muscles of the lower limb.
Importance of ROM exercises
Joint stiffness associated with surgical repair of periarticular fractures may have long-term effects on mobility, gait, and function. Knee stiffness, which is a reduced range of motion (ROM) resulting in functional limitations, can impact normal leg swing and ability to ascend and descend stairs as well as rise from a seated position, particularly when entering or exiting a vehicle2.
The limited extension may result in a limp, quadriceps strain, functional leg-length shortening, and patellofemoral pain, thus compounding the resulting dysfunction2.
A few of the recommended ROM exercises are knee bending exercise and hip abduction as shown in the figure.
Importance of strengthening exercises
Muscle weakness around the thigh, knee and lower leg are very common after a tibial fracture. Weakness is actually secondary to the long term rest and immobilization period.
Home-based strength-training regimens moderately but significantly improve strength, balance, and functional mobility. Additionally, strength training provides a long-term reduction in patients’ perceived difficulty completing activities of daily living (ADLs) compared to controls2. Strength training starting even as late as 6months post-fixation can provide significant improvement of functional outcomes for an extended period of time even beyond the end of treatment.
Phase-III: Progressive strengthening
Early weight-bearing protocols2:
| Injury type | Common fixation methods | Recommendation for initial weight bearing |
| Tibial shaft fracture | External fixation | Immediate weight bearing as tolerated |
| Intramedullary fixation | Immediate weight bearing as tolerated | |
| Comminuted/high-grade tibial fracture | ORIF | NWB for 6–12 weeks |
| External fixation | Conflicted, likely support some duration of NWB | |
| Intermedullary fixation | Immediate weight bearing as tolerated |
Start partial weight-bearing exercise using crutches. Observe the gait pattern and teach the correct gait pattern.
Phase-IV: Advanced strengthening
During this phase, we need to start full weight-bearing.
Final word
After the surgery, the person goes through psychological stress. Your physiotherapist has many roles not only to come out of physical disability but also to motivate you in each and every step of rehabilitation. Rehabilitation should emphasize the return to functional abilities.
Author Profile
Sunit. S. Ekka
Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.
Reference
1 ↑ Hoyt, Benjamin W., Gabriel J. Pavey, Paul F. Pasquina, and Benjamin K. Potter. “Rehabilitation of Lower Extremity Trauma: A Review of Principles and Military Perspective on Future Directions.” Current Trauma Reports 1, no. 1 (March 1, 2015): 50–60. Visit
2 ↑ Courtney, P Maxwell, Joseph Bernstein, and Jaimo Ahn. “In Brief: Closed Tibial Shaft Fractures.” Clinical Orthopaedics and Related Research 469, no. 12 (December 2011): 3518–21. https://doi.org/10.1007/s11999-011-2086-5.
FAQs
How long is rehab for a broken tibia and fibula? ›
Recovery from a tibia-fibula fracture typically takes about three to six months.
How long is physical therapy for broken fibula? ›NON WEIGHT BEARING PERIOD OF PHYSICAL THERAPY
This contributes to the prolonged healing time and requires a period of about 6 weeks where no weight is put on that leg. Depending on the severity of the break and the complexity of the surgery that time could be even longer.
When surgery is required these cases take around 4 months to heal. After this healing period, Physical Therapy most often continues until at 6 months, a patient is typically able to return to a normal life, albeit with certain limitations.
Do you need physical therapy after a fibula fracture? ›A broken fibula may be very painful, but sitting on the couch and letting it heal on its own is probably not the best approach. While your fibula—the long, thin outside bone of your lower leg—is healing, you should stay mobile through the use of a walking boot and physical therapy.
How many days will it take to walk normally after a tibia fracture? ›If you had surgery for your tibial plateau fracture, you can put a little bit of weight on the leg after 6 weeks with the goal of walking normally by the 10th week. If you did not have surgery for your tibial plateau fracture, you can start walking safely with a knee brace in 4-6 weeks.
When should I start physio after broken tibia? ›A snapped tibia or fibula is going to take some time to fully recover. You'll need to let your bones to start mending long enough before being training. Healing typically takes six to eight weeks and for those recovering from surgery it may be 12 weeks before you may begin rehabilitation.
How long should a physical therapy session last? ›On average, physical therapy sessions last between 30 and 60 minutes with a frequency of two to three times a week. Of course, your sessions may be longer or more or less frequent depending on your condition and what was deemed the best course of treatment.
How can I speed up the healing of a broken fibula? ›Elevate the injured leg as much as possible, during sitting and sleeping. One key to success after fibula bone fracture surgical procedure is to decrease swelling by compression and elevation. The faster the swelling subsides, the faster is the recovery.
How long does it take for physical therapy to start working? ›Muscle: 2-4 weeks. Tendon: 4-6 weeks. Bone: 6-8 weeks. Ligaments: 10-12 weeks.
Is physiotherapy necessary after fracture? ›PT for a fracture is necessary not only because it helps you to recover faster, but also because they can help you deal with any damage to the nerves or joints caused by your broken bone. This allows you to regain full range of motion after therapy is completed.
Can tibia fracture heal in 3 months? ›
Recovery time for a tibia fracture typically takes 4-6 months to heal completely. If the fracture is open or comminuted, healing time may take longer. Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery.
How long is physical therapy after a fracture? ›In general, a fracture should be healed by about eight weeks after the injury with adequate physical therapy 5. However, a patient's rehabilitation timeline will vary depending on the type of fracture and a patient's age and fitness level, among other factors.
What is the physical therapy for a broken fibula? ›Physical therapy usually begins with ankle strengthening and mobility exercises. Once the patient is strong enough to put weight on the injured area, walking and stepping exercises are common. Balance is a vital part of regaining the ability to walk unassisted. Wobble board exercises are a great way to work on balance.
How long is physical therapy for a broken leg? ›How Long Does Physical Therapy Take for a Broken Leg? While the answer to “how long does physical therapy take for a broken leg” can vary based on several factors, the average recovery time for a broken bone with physical therapy is six to eight weeks.
What exercises can you do with a fractured fibula? ›- Ankle stretch: Stretch your injured leg out and wrap a towel around the arch of your foot. Holding it by the ends, pull the towel toward you. ...
- Ankle rotation: Sit and place your ankle over the opposite knee. ...
- Ankle flexibility: Sit down and stretch out your injured leg.
A study looking at 166 surgically treated tibia fractures discovered that early weight-bearing exercise was linked with faster healing – even in participants who had fractures that weren't healing properly.
How do you strengthen your legs after a broken tibia? ›Hip, knee, ankle stretches and muscle work
Try ball wall squats, mini squats with support and hill and slope walking to encourage calf and ankle activity.
- Pain Decreases. No matter how big or small your fracture is, the one thing they all hold in common is the pain you'll experience due to it. ...
- Increased Mobility. ...
- Lack of Bruising. ...
- Swelling Subsides.
Tib/Fib fracture recovery EXERCISES (rehab & strength) - YouTube
When can I return to sport after tibia and fibula fracture? ›Many athletes who had a mid shaft tibia fracture will be able to make a successful return to sports. Some studies show that the time to return to sports may be shorter in the group treated with surgery. Studies in soccer players show that the recovery from a broken tibia can take upwards of 40 weeks.
Can a tibia fracture heal in 6 weeks? ›
How Long Does a Fracture Take to Heal? Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.
How many physiotherapy sessions will I need? ›Minor injuries you might expect 2-3 sessions of physiotherapy; soft tissue injuries you would be looking more towards 6 – 8 weeks, as this is roughly how long it takes for soft tissue to heal in most cases; and more chronic or serious conditions taking 2 or more months of treatment depending on the level of progress ...
How do I know if physical therapy is working? ›Your pain is less intense.
As you work through physical therapy you may notice that your pain is less sharp or is at a lesser degree than it was before. If your pain was at a 10 before, and now you can say it feels more like an 8, that's significant progress even though it still hurts.
Your body needs time to rest and heal, and going through your exercises every day doesn't provide the break your body needs. On the other hand, if you have a few different exercises, your provider may allow you to split them up and do them on alternating days.
What slows down bone healing? ›Smoking and high glucose levels interfere with bone healing. For all patients with fractured bones, immobilization is a critical part of treatment because any movement of bone fragments slows down the initial healing process.
What stimulates bone healing? ›Ultrasound enhances bone healing by encouraging the incorporation of calcium into the bone as well as stimulating certain proteins involved in the healing process. Bone stimulation with ultrasound is usually prescribed for 20 minutes a day.
What vitamins help heal broken bones? ›The two most important nutrients for bone health and fracture healing are calcium and Vitamin D. Both can be found in abundance in milk, but there are many other dietary sources as well. If you cannot consume enough calcium and Vitamin D in your diet, supplements can be found at most drug stores and supermarkets.
How many times a week can you do physical therapy? ›A typical order for physical therapy will ask for 2-3 visits per week for 4-6 weeks. Sometimes the order will specify something different. What generally happens is for the first 2-3 weeks, we recommend 3x per week.
How do I get the best results from physical therapy? ›- Understand your diagnosis. More often than not, when patients start physical therapy, it is because they have pain. ...
- Attend your appointments. ...
- Each appointment is about more than exercise. ...
- Home exercise program performance. ...
- Be honest with your physical therapist. ...
- Keep exercising.
Results: Page 2 2 At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued [physician] care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10.
What happens if I don't do physical therapy? ›
Slower Recovery: Missing a physical therapy session will ultimately increase the time you will have to spend in recovery. The reason for this is because the exercises and activities that you will be engaging in a treatment session are designed to help you regain total movement ability.
Can fracture be cured by physiotherapy? ›Physiotherapy plays a vital role in the management of a fracture. You may come across a physiotherapist at different intervals during the rehabilitation. In the initial phase physiotherapy may help you to improve the strength of the unaffected limbs, prevent stiffness in joints around the fractured limb.
Can you walk after physiotherapy? ›However, you can rest assured that when you work with a physiotherapist they will do their best to get you to walk again. Continue reaching for more information on how physiotherapy improves walking ability.
Does tibia fracture heal completely? ›Recovery. Most tibial shaft fractures take 4 to 6 months to heal completely. Some take even longer, especially if the fracture was open or broken into several pieces or if the patients uses tobacco products.
Which takes longer to heal tibia or fibula? ›Recovery from a broken fibula may take six weeks or longer. A broken tibia heals even more slowly—four to six months or longer. To manage pain, opioids or anti-inflammatories may be prescribed.
Can a broken tibia and fibula heal without surgery? ›It is typically treated by setting the bone without surgery and using a cast to reduce movement. The cast is usually worn for about six weeks. Valgus deformity (knock knee) is one of the main potential complications after this fracture.
Does physical therapy speed up healing? ›Physical therapy for an acute injury can help eliminate pain, assist with the healing, and improve your physical health. This therapy helps heal the injured tissue and facilitates full mobility on its own. In cases where you've already gone through surgery, physiotherapy can help you recover much faster.
Does physical therapy speed up recovery? ›Early intervention of physical therapy can speed up the recovery process by decreasing the time the body is able to compensate or perform “bad” movements, leading to increased complications or problems.
Does physical therapy promote healing? ›Physical therapy (PT) can be crucial in total body healing and mobility, as well as part of a rehabilitation plan before and after surgery. PT may be recommended to heal musculoskeletal injuries (with or without surgery) and to treat other medical conditions such as: Fractures. Sprains.
How long before you can walk on a broken tibia and fibula? ›It takes around 6 to 8 weeks for a minor fracture to heal. You'll probably need to use crutches or a wheelchair during this time, until it's possible to put weight on the leg again. You'll be shown how to safely use any mobility equipment you're provided with.
How long in a cast for broken tibia and fibula? ›
It is typically treated by setting the bone without surgery and using a cast to reduce movement. The cast is usually worn for about six weeks. Valgus deformity (knock knee) is one of the main potential complications after this fracture.
How painful is a broken tibia and fibula? ›Those with tibia and fibula fractures have severe pain at the location of the injury. Often there is a deformity present in the limb or a wound where the bone protrudes through the skin. If the fibula is only fractured, depending on severity, walking may be tolerable but likely very painful if it's at the ankle level.
Can you walk on a fractured fibula and tibia? ›Because the fibula is not a weight-bearing bone, your doctor might allow you walk as the injury recovers. You also might be advised to use crutches, avoiding weight on the leg, until the bone heals because of the fibula's role in ankle stability.
How long is physical therapy for a broken leg? ›How Long Does Physical Therapy Take for a Broken Leg? While the answer to “how long does physical therapy take for a broken leg” can vary based on several factors, the average recovery time for a broken bone with physical therapy is six to eight weeks.
When can I walk again after fibula fracture? ›It and the tibia, the larger bone, therefore, support all of your weight when standing. Because of this and unlike other types of injuries and conditions, a broken fibula usually requires six weeks to three months before patients are able to return to their normal routine.
How do I know if my fracture is healing? ›- Pain Decreases. No matter how big or small your fracture is, the one thing they all hold in common is the pain you'll experience due to it. ...
- Increased Mobility. ...
- Lack of Bruising. ...
- Swelling Subsides.
Elevate the injured leg as much as possible, during sitting and sleeping. One key to success after fibula bone fracture surgical procedure is to decrease swelling by compression and elevation. The faster the swelling subsides, the faster is the recovery.
How do I know if my broken fibula is healing? ›After an injury, it can take up to 12-16 weeks to make a full recovery. Your doctor will use X-rays to see how well your fracture is healing. They'll also look to see when they can remove the screws, if you have them.
Is a bone completely healed when a cast comes off? ›It is important to understand that after the immobilisation time has elapsed and the cast/brace is removed, the fracture is often not COMPLETELY healed, but is healed with enough strength that ongoing immobilisation is not required.
What helps broken bones heal faster? ›In particular, calcium, vitamin D and protein will be important during the bone healing process, so be sure you're focusing on food sources rich in these nutrients, including dark, leafy greens, broccoli, fish, meat, yogurt, nuts and seeds.
What is the fastest way to heal a broken tibia? ›
A study looking at 166 surgically treated tibia fractures discovered that early weight-bearing exercise was linked with faster healing – even in participants who had fractures that weren't healing properly.
Which takes longer to heal tibia or fibula? ›Recovery from a broken fibula may take six weeks or longer. A broken tibia heals even more slowly—four to six months or longer. To manage pain, opioids or anti-inflammatories may be prescribed.
How do I transition from walking boot to shoe? ›Day 1 – Wear a good running shoe for 1-2 hours then return to your CAM Boot for the rest of the day. 2. Day 2 – Wear the shoe for 2-3 hours then return to your CAM Boot for the rest of the day.
Can a tibia fracture heal in 4 weeks? ›Depending on health and injury pattern this bone can take 3-4 months to heal without surgery. In the initial few weeks, fractures treated without surgery tend to be painful or uncomfortable until the healing process matures over a few weeks.
Can I walk on a broken fibula after 4 weeks? ›You have sustained a fracture to your outside ankle bone (fibula). This takes approximately 6 to 8 weeks to heal, although pain and swelling can continue for three to six months. You can walk on the foot as comfort allows although you may find it easier to walk with crutches in the early stages.