Event Title

Physical therapy Treatment Of a Non-Surgical Bimalleolar Ankle Fracture: A Retrospective Case Report

Author/ Authors/ Presenter/ Presenters/ Panelists:

Krystal Kofoed, Governors State UniversityFollow

Location

Hall of Governors

Start Date

4-8-2022 4:00 PM

End Date

4-8-2022 6:00 PM

Abstract

Background/Purpose: Ankle fractures are becoming more frequent in the aging adult patient population. Depending on the severity of the fracture, surgical fixation may be required; diagnostic imaging can aid the decision process for invasive or conservative treatments of ankle fractures. There is a lack of standardized physical therapy protocols to follow for non-surgical bimalleolar fractures and therefore the purpose of this retrospective case report is to describe the examination, interventions, and outcomes of physical therapy treatment.
Case Description: The patient was a 49-year-old male who experienced a left bimalleolar ankle fracture that followed a crush injury. The patient did not require surgical repair due to the severity determined by the diagnostic imaging performed in the emergency department. The patient was immobilized in a cast for six weeks, followed by three weeks in a CAM boot. The patient began physical therapy intervention 39 days after the injury. The following interventions were utilized: manual therapy techniques, dry needling, cupping, therapeutic exercise and activity, and neuromuscular re-education.

Outcomes: The lower extremity functional scale (LEFS) was used to assess the patient’s level of function. The patient’s score was 33 at the time of the initial physical therapy evaluation and improved to 80 by discharge from physical therapy. The patient’s pain in the left ankle was abolished by the 8th visit. The left ankle presented with decreased range of motion and strength, compared to the unimpaired side, at the first physical therapy visit and made quick improvements leading to an early discharge. The patient also demonstrated improved functional movements with no compensations at the end of the patient’s plan of care.

Discussion: Improvements were seen across all measurements which supports the use of conservative treatment approach and the use of exercises that focused on strength, balance, and proprioception to assist in returning patients to their prior level of function. The patient did go against the physical therapist’s recommendations for the timeframe of returning to previous high-impact activities. This resulted in increased pain following the activity. Additional studies should be performed to assess the effect of patient’s compliance to physical therapists’ recommendation following a bi-malleolar fracture.

Presenter:
Krystal Kofoed
Physical Therapy Doctoral Student

Faculty / Staff Sponsor

Dr. Roberta K. O'Shea
Professor, College of Health and Human Services

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Apr 8th, 4:00 PM Apr 8th, 6:00 PM

Physical therapy Treatment Of a Non-Surgical Bimalleolar Ankle Fracture: A Retrospective Case Report

Hall of Governors

Background/Purpose: Ankle fractures are becoming more frequent in the aging adult patient population. Depending on the severity of the fracture, surgical fixation may be required; diagnostic imaging can aid the decision process for invasive or conservative treatments of ankle fractures. There is a lack of standardized physical therapy protocols to follow for non-surgical bimalleolar fractures and therefore the purpose of this retrospective case report is to describe the examination, interventions, and outcomes of physical therapy treatment.
Case Description: The patient was a 49-year-old male who experienced a left bimalleolar ankle fracture that followed a crush injury. The patient did not require surgical repair due to the severity determined by the diagnostic imaging performed in the emergency department. The patient was immobilized in a cast for six weeks, followed by three weeks in a CAM boot. The patient began physical therapy intervention 39 days after the injury. The following interventions were utilized: manual therapy techniques, dry needling, cupping, therapeutic exercise and activity, and neuromuscular re-education.

Outcomes: The lower extremity functional scale (LEFS) was used to assess the patient’s level of function. The patient’s score was 33 at the time of the initial physical therapy evaluation and improved to 80 by discharge from physical therapy. The patient’s pain in the left ankle was abolished by the 8th visit. The left ankle presented with decreased range of motion and strength, compared to the unimpaired side, at the first physical therapy visit and made quick improvements leading to an early discharge. The patient also demonstrated improved functional movements with no compensations at the end of the patient’s plan of care.

Discussion: Improvements were seen across all measurements which supports the use of conservative treatment approach and the use of exercises that focused on strength, balance, and proprioception to assist in returning patients to their prior level of function. The patient did go against the physical therapist’s recommendations for the timeframe of returning to previous high-impact activities. This resulted in increased pain following the activity. Additional studies should be performed to assess the effect of patient’s compliance to physical therapists’ recommendation following a bi-malleolar fracture.

Presenter:
Krystal Kofoed
Physical Therapy Doctoral Student