Rehabilitation after a fracture of the condyle of the tibia

The goal of rehabilitation after a fracture of the tibial condyle is to restore the working capacity of the limb and return the patient to professional activities. Specific goals depend on the recovery period after surgery or immobilization, since such injuries are sometimes treated with surgery. The exercise program varies depending on the period of rehabilitation, and should continue until normal joint mobility is restored.

Features of fractures of the condyles of the tibia

The proximal end of the lower leg ends in a wide plane called the tibial plateau. The intercondylar eminence runs along its center, separating the medial and lateral condyles of the tibia. The plateau forms the articular surface, and the condyles are the attachment points for the muscles of the knee joint.

There are several types of condylar fractures depending on the mechanism of injury and its location:

Type 1 or pure split - a fracture of the lateral condyle with a displacement of less than 4 mm, which is caused by axial load in the vagal position of the joint;
2 types or split with elements of impression - split and compression of the tibia with displacement of the condyle by more than 4 mm.
Type 3 or pure impression - a compression fracture in which the articular surface is pressed into the lateral metaphysis of the tibia under a large axial load.
4 types or fracture of the internal condyle under the action of varus forces and axial load with a hyperextension of the joint - are considered the most difficult.
Type 5 or Y-shaped bicondylar fracture under the influence of intense axial load.
Type 6 - bicondylar fracture with dislocation of the metaphysis under the action of multidirectional forces.

In fact, with condylar fractures, the lateral or medial condyle is damaged, or both at once. The tendon of the semitendinosus muscle, the flexor of the knee joint, is attached to the medial condyle. The biceps femoris muscle is attached to the head of the fibula, which suffers from fractures of the lateral condyle of the tibia.

If the lateral condyle is damaged, the long extensor of the fingers, the lateral group (long and short fibular, tertiary) suffer. The soleus, popliteal, flexor hallucis longus, and tibialis posterior muscles may be affected. That is why during physical rehabilitation attention is paid to the stability and mobility of the lower leg.

The main stages of rehabilitation

Fractures of the condyles of the tibia are intra-articular, so the correct reposition of the fragments is important. If there was no displacement, then a plaster cast is applied. But a displaced tibial condyle fracture often requires surgery. The rehabilitation protocol is called postimmobilization or postoperative.

With conservative treatment, the plaster is removed after 8-10 weeks, but from the second day the patient can perform isometric loads for the quadriceps femoris muscle. A full load on the leg is possible after 16-20 weeks, depending on the healing of the fracture.

Rehabilitation begins a couple of days after the operation to reconstruct the condyles of the tibia. The following periods are distinguished: early postoperative, sparing training (functional), training.

During the first week, the following tasks are set:

reduction of inflammation (ice, the limb is elevated);
lack of axial load on the joint (crutches are used for 6 weeks, the knee is in full extension);
if possible, develop the patella (displace the patella with your hands, giving mobility to its tendons);
lay the limb in extension to avoid contractures;
from 2-3 days after the operation, isometric contraction of the quadriceps femoris muscle begins;
perform rotation of the feet, its flexion and extension.

When recovering from a fracture of the tibial condyle, it is important to respect the restrictions on the angle of flexion of the knee joint. The permissible range of flexion for the first three days is up to 10 degrees. The hip flexors, namely the semitendinosus and biceps muscles, are attached to the condyles. Therefore, they cannot be actively loaded. However, you can do the following exercises:

isometric tension of the quadriceps muscle for 6-30 seconds the first week;
knee extension with a towel roll under the shin.

After the 4th day of rehabilitation, the leg can be raised in an orthosis, it is not removed during the exercise. Produce lifts, abduction and adduction of the leg in the prone position. The angle of flexion in the joint is increased to 30 degrees by the end of the first week after surgery.

At the end of the second week of rehabilitation, the knee flexion angle in the orthosis is increased to 60 degrees. You can transfer up to 80% of your body weight to the affected leg while walking. According to the patient's condition, crutches are replaced with a cane.

At the end of the third week, knee flexion is acceptable up to 90 degrees, you can walk, leaning on the injured leg in an orthosis. In addition to the exercises listed above, flexion at the knee joint with sliding along the wall is added. The patient lies with his feet against the wall on his back, bending the injured leg at an angle of 90 degrees and resting on the surface. Sliding down, bend the joint passively under gravity.

Shallow squats supported by a chair are allowed - no deeper than 90 degrees of knee flexion.

Exercises for the back of the thigh:

Lying on your back, bend your leg and grab your foot. Try to straighten your knee by gently stretching the hamstring muscles.
Wrap the band around the foot, bring the knee closer to the chest and push it back while stretching the band.
Wrap the tape around the foot, bend and unbend the ankle, simulating rises on socks.

After 4-5 weeks, exercises in the pool begin when the stitches heal. It is acceptable to walk with water resistance, but not to dive. Assign exercises for the development of proprioception, joint stability:

An exercise bike is used for 10-20 minutes.
The muscles of the abdomen and lower back are strengthened: lifting the pelvis, twisting.
In the orthosis, a stand on one leg is performed with flexion of a healthy knee.
Learning to climb and descend stairs, and training begins with a small step height - 10 cm.

The goal at the stage of 6-8 weeks is to increase muscle strength, stretch them, and develop stability. The orthosis is removed, full movement in the joint is allowed. From 9-10 weeks, muscles begin to strengthen:

When extending and bending the legs, expanders or weights are used as resistance.
Supported squats and lunges are added.
Bosu balls are used to strengthen the stabilizing muscles - you can stand on them, squat.

Stretching is a must after every strength training session. In the presence of simulators for continuous passive movement, you need to develop a joint. Separately, patients are taught to reuse the limb when walking:

11-12 weeks, walking on crutches with 15% of the load from body weight on the affected limb is acceptable;
13-14 weeks - the allowable load increases to 25%;
15-17 weeks - 50% of body weight can be transferred to the leg;
18-19 weeks - transition to walking with a cane, gradual load on the leg 75-100% of body weight.

5 months after the fracture, you can fully visit the gym, athletes begin to jog.

The goal of physical rehabilitation after fractures of the condyle of the tibia:

Joint stability is the strengthening of small muscles that support the transfer of body weight to one leg.
Increase range of motion with stretching and massage. In rare cases, it is possible to restore 100% mobility. Exercise at an early and late stage contributes to this.
Motor control: performing exercises related to the functional use of muscles in different situations.
An increase in muscle mass, which is reduced due to immobilization. Power loads are used.

In addition to physical exercises, physiotherapy is used in medical rehabilitation. For the first 2-3 weeks, magnetic therapy is used to stimulate regeneration and relieve pain. For 1-2 months, ultrasound is used to improve trophism and bone fusion. Atrophied muscles are strengthened by electrical stimulation, and if movements are disturbed, amplipulse is used. Infrared laser helps relieve pain and inflammation.

Contractures are one of the consequences of immobilization, which are eliminated by massage, ozocerite and paraffin applications. The late rehabilitation stage is carried out in the conditions of sanatoriums for 3-5 months. To restore muscle function, medicinal electrophoresis with potassium and phosphorus, myoelectric stimulation is used. To prevent degenerative changes, mud applications and sodium chloride baths are applied. The temperature of mud and water is 38 degrees, the course is 12 procedures.

Conclusion

The healing of a fracture of the condyles of the tibia lasts up to 5-6 months, while immobilization is 1-2 months. Due to prolonged immobility, there is a need to develop the joint, increase muscle tone and volume. Exercise is the main tool for recovery. In the process of physical rehabilitation, muscle strength and motor control are increased, contractures are prevented, and the stability of the knee joint is increased.