To present the physiotherapy strategy and the selection process of a trans-tibial prosthesis for a patient with trans-tibial amputation and other multiple traumatic injuries.To present the physiotherapy strategy and the selection process of a trans-tibial prosthesis for a patient with trans-tibial amputation and other multiple traumatic injuries.
This case is a 20-year-old male who experienced anterior and posterior cruciate ligament and lateral collateral ligament injuries, knee popliteal artery injury, and tibial and peroneal nerve injuries due to traffic trauma. On the day of the trauma, the patient underwent revascularization for a popliteal artery injury. Following the revascularization, the knee arthrodesis was performed, and isometric muscle strength training was started. The knee joint was significantly instable after the removal of the knee arthrodesis. Therefore, the range of motion exercise and muscle strength training were carefully provided not to increase pain. Range of motion exercises for the knee joint were provided to achieve 0° extension and 120° flexion, and the hyperextension movement of the knee was carefully avoided. In addition to the range of motion exercises and muscle strength training, the Neuromuscular Electrical Stimulation was used to manage the pain during manual muscle strength exercises for the knee joint. However, over time, severe sensory disturbance and motor paralysis caused by nerve damage led to ulceration, infection, and plantar flexion contracture of the foot. Due to these complications, amputaion was performed a year after the accident. In post-amputation rehabilitation, the Total Surface Bearing socket was selected to prevent blood flow disturbance and wound formation potentially caused by local compression. A thigh corset with a metal post knee joint was also provided for anterior-posterior instability as a result of knee ligament injury.
Continued physiotherapy intervention allowed him to maintain muscle strength and range of motion in the lower limbs and trunk. After providing an appropriate lower limb prosthesis, the patient stopped experiencing knee pain, instability, or wound formation and was able to regain walking at an early stage after the prosthesis was fitted. Eventually, the patient was discharged two months after amputation and could return to work.
Physiotherapy was provided in combination with electrotherapy, focusing on maintaining function with limited movement of the affected limb. As a result, the patient was able to be discharged early after the prosthesis was fitted without any disuse syndrome. This case study demonstrates that a comprehensive assessment strategy, including the residual function of the knee joint, blood flow in the revascularized area, sensory disturbance and wound formation, is crucial to providing an appropriate lower limb prosthesis option.
This case report may help clinicians provide effective physiotherapy and appropriate prosthesis selection for patients with multi-ligament knee injuries.
multi-ligament knee injuries
amputaion
