Early physiotherapy after femoral fracture and intramedullary nailing; a case report.

Abubakar IA1*
1Department of Physiotherapy, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi State.
*Correspondence: Ibrahim Ahmad Abubakar; +234 8029819190; ibrahimcsskd@gmail.com

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Background: Femoral fractures are among the commonest fractures of the lower extremity that come with bleeding and pain, and require hospital admission. Patients with such injuries usually suffer long-term disabilities. This case report describes the outcome of a patient following surgical fixation of distal right femoral bone fracture and early physiotherapy intervention program focusing on early weight bearing and strengthening of thigh muscles.
Case Report: The case was a 27-year-old male student who sustained a displaced fracture of the distal right femoral bone as a result of gunshot. The patient was treated with surgical fixation using intramedullary nailing but following surgery, patient complained of reduced quadriceps strength, hip abductor strength, limited range of motion (ROM) and gait disturbance. Physiotherapy intervention focused on early muscle strengthening activities, increasing ROM with exercises for hip, knee and ankle joints.
Conclusion: Early Physiotherapy facilitates long-term success such as decreasing functional impairments and disabilities, which are achieved by early weight bearing, strengthening of the quadriceps/ hip muscles, and increasing the range of motion at the knee joint.

Keywords: Femoral fracture, Early physiotherapy, Intramedullary nailing, Muscle strengthening activities, Early weight bearing.

Cite this article: Abubakar IA. Early physiotherapy after femoral fracture and intramedullary nailing; a case report. Yen Med J. 2021;3(2):153–157.


  1. Canale ST. Campbell’s Operative Orthopaedics. 10th London, UK: Mosby; 2003.
  2. Mitchell SL, Stott DJ, Martin BJ, Grant SJ. Randomized controlled trial of quadriceps training after proximal femoral fracture. Clin Rehab. 2001;15(3),282-290. https://journals.sagepub.com/doi/abs/10.1191/026921501676849095.
  3. Wong PC. An epidemiological appraisal of femoral distal fractures in a mixed Asian population Singapore. Singapore Med J. 1967;7(4):236-239
  4. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s fractures in adults. 8th ed. Philadelphia, PA: Wolters Kluwer Health; 2015:2149-2228.
  5. Carneiro MB, Alves DPL, Mercadante MT. Physical therapy in the post-operative of proximal femur fracture in elderly: Literature review. Acta ortopedica brasileira. 2013;21(3):175-178.
  6. Brudnicki J, Kubicz-Chachurska M. Rehabilitation in lower extremity fractures treated with intramedullary nailing. Med Rehab. 2011;15(2):13-19.
  7. Khalid M, Minhas MS, Ansari I, Mehboob G, Baig N. Functional outcome of close intramedullary static reamed interlocking nail in femoral distal fracture. Pak J Surg. 2011;27(2):100-104.
  8. Helmy N, Jando VT, Lu T, Chan H, O’brien PJ. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral distal fractures. J orthop trauma. 2008;22(1):10-15.
  9. Hennrikus WL, Kasser JR, Rand F, Millis MB, Richards KM. The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old. J Bone Joint Surg Am. 1993;75(4):508-513.
  10. Kapp W, Lindsey RW, Noble PC, Rudersdorf T, Henry P. Long-term residual musculoskeletal deficits after femoral distal fractures treated with intramedullary nailing. J Trauma Acute Care Surg. 2000;49(3):446-449.
  11. Paterno MV, Archdeacon MT, Ford KR, Galvin D, Hewett TE. Early rehabilitation following surgical fixation of a femoral distal fracture. Ther. 2006;86(4):558-572.
  12. Arazi M, Ögün TC, Oktar MN, Memik R, Kutlu A. Early weightbearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure? J Trauma Acute Care Surg. 2001;50(4):711-716.
  13. Brumback RJ, Toal TR, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral distal with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999;81(11):1538-1544.
  14. Sherrington C, Lord SR, Herbert RD. A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil. 2004;85(5):710-716.
  15. Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP. Abduction strength following intramedullary nailing of the femur. J Orthop Trauma. 1997;11(2):93-97.
  16. Mira AJ, Markley K, Greer RB 3rd. A critical analysis of quadriceps function after femoral shaft fracture in adults. J Bone Joint Surg Am. 1980;62(1):61-67.
  17. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J surg. 2006;76(7):607-611.
  18. Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture. Arch Phys Med Rehabil. 2008;89(4):609-617.
  19. Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M. Effects of resistance training on lower-extremity impairments in older people with hip fracture. Arch Phys Med Rehabil. 2008;89(9):1667-1674.
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