Treatment and Rehabilitation of Complicated Fractures of Both Lower Limbs: A Case Report.

Introduction: Few studies have reported the treatment and rehabilitation of combined fractures of the femur, tibia, and ankle in the same lower limb.

Case report: A 69-year-old man presented to our hospital with a fall injury due to high-energy trauma after falling from a 5 m ladder while painting and landing on both feet. Examination revealed right femoral supracondylar; left tibial plateau; right calcaneal; left ankle crush; first and third lumbar vertebrae burst; sacral; C7, Th1, and Th9 compression; and bilateral acetabular fractures. External fixation of both femurs and tibias was performed on the day of injury. After the patient's general condition had stabilized, a two-stage operation was performed on the 8th day after injury for osteosynthesis of the left tibial plateau and right calcaneus fractures and ilizarov fixation of the left ankle crush fractures. In addition, the right femoral supracondylar fracture underwent osteosynthesis on day 15 after the injury, while the burst fractures of the first and third lumbar vertebrae underwent posterior fixation on day 24. The sacral fracture; C7, Th1, and Th9 compression fractures; and acetabular fractures were treated conservatively with a brace and no weight-bearing until the ilizarov apparatus was removed and gait training started. The ilizarov apparatus was removed 90 days after application.Mild passive and active assist rehabilitation on both toes and knees was started the day after the injury. Wheelchair transfer training was started 51 days after the injury. On day 60, trunk stability and swaying were eliminated and strength training in the sitting position was started. On day 107, the patient transferred without assistance (supervised). On day 121, weight-bearing and short-term standing training (right lower limb only) was started. On day 141, weight-bearing on both lower limbs was started. On day 148, the patient walked approximately 100 m using a walking aid. On day 176, the patient walked twice on parallel bars and 4 m with Lofstrand coupling while wearing a patellar-tendon-bearing orthosis. At 212 weeks, the patient walked long distances and use the Lofstrand for 100 m. The patient could also change direction smoothly.

Conclusion: This study reports the treatment and rehabilitation of an elderly patient with bilateral compound fractures of the lower leg. The patient underwent long-term rehabilitation on the floor using the ilizarov method; however, with appropriate rehabilitation, he recovered to the point where he could walk.