patella dislocation with tibia fracture

[Thiri Nwe]

hello friends,
I'm a junior physiotherapist. Now I'm working as a volunteer in Yangon Orthopedic Hospital in Myanmar. My patient is 23 -year old man. He has patella dislocation with Tibia fracture. Swelling and inflammatiion around the knee is so large. Muscle wasting is present and evident. Knee joint limitation is bad. Flexion is 25 degree and extension is 15 dg.Movement is so limited. Firstly I gave him static quadricep exercise mainly with pillow. Assisted active ex for knee and hip ex are givenwith heel drag. Suspension ex for hip is given. After 3 days , I planned to give him small weight spring ex for knee extensors and glueti muscle.Then, in sitting position, reciprocal knee bending and straightening ex are given.His ROM is increased to 85 dg and 10 dg. High - Weight spring ex is continued. Swelling is reduced. Sand bags are used for PRE. In third week in parallel bar, standing and weight shifting are trained. In fourth week, walking is trained and gait training is corrected. Walking aids are used to support. Finally half- squating and continued to 3/4 squating . Stationary bicycle was used to further training. So please give me advice for my patient.
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[linbin]

hi
according to you what is restricting the knee ROM?
whats the end feel in flexion?
hows the tissue pliability in the thigh?

longitudinal traction within the knee in minimal flexion
if tissue pliability is less,try myofascial release technique
combine moist heat to thigh and stretching to flexion direction
mild glides if joint play is affected

[Thiri Nwe]

hello Linbin,
thanks a million for your advice. Joint limitation can be caused by scar tissue from stitches. Moreover, 2 pins are used for fracture in tibia. Now skin condition is good. May I discuss you if I have difficulties because I'm a junior physiotherapist. I need to read so many books. I also need examination to be skillful. Please share me your knowledge and experiences.
I wish you good health and great happiness.
yours sincerely, thiri

[linbin]

hi friend
if you feel that scar is limiting the knee ROM, try methods to loosen it
deep transverse friction
myofascial release
try applying moist heat before the techniques

examination and clinical skills will come with practise and critical analysing the literature and integrating good ones into practise.you will definitely gain it.the moment you joined this community you are destined to achieve it
good luck
keep posting