Physiotherapy Rehabilitation in an Above-Knee Amputee Following Compartment Syndrome in Post-tibial Plateau Fracture: A Case Report

Abstract

Proximal tibia fractures are generally open fractures resulting in life-threatening complications. There is an increase in the prevalence of compartment syndrome post-tibial fractures. Though fasciotomy and wound debridement is the choice of treatment in such conditions, amputation becomes a necessity when there is widespread muscle and tissue damage. Specifically, compartment syndrome involving the lower limb is distressing as its symptoms can be misleading at times resulting in delayed diagnosis and hence lifethreatening complications. A 48-year-old male met with a road accident and presented to the hospital with complaints of pain and an open wound over the anterior aspect of the right lower leg 14 days ago. He was managed by Ilizarov external fixator. Later he developed compartment syndrome as a complication of tibial plateau fracture, for which decompressive fasciotomy was performed. But due to irreversible tissue loss and gangrene, he had to undergo above-knee amputation followed by physiotherapy rehabilitation. We mainly focused on postoperative/pre-prosthetic rehabilitation. During postoperative rehabilitation, we concentrated on reducing phantom limb pain, preventing complications, and improving strength and endurance. Current literature claims that mirror therapy is effective in reducing phantom limb pain in post amputees, but there are only a few case reports emphasizing mirror therapy in particularly lower limb amputees. Therefore, we emphasized using mirror therapy for phantom limb pain in this case of lower limb amputation. It resulted in positive outcomes. Our broader aim was to strengthen the upper limbs and the intact lower limb so that the patient's overall functional independence can be enhanced. Further prosthetic rehabilitation was planned in which we focused on gait and balance training. Physiotherapy rehabilitation improved the patient's quality of life and independence.

Graded motor imagery and its phases for individuals with phantom limb pain following amputation: A scoping review

“…In 84% of works, no information about the race or ethnicity of participants was reported. [28][29][30][31][32][35][36][37][38][39][40][41][42][43][44][45][46][47][48]50,[52][53][54][55][56][57][58][59][60][63][64][65][67][68][69][71][72][73][74][77][78][79][80][81][82][83][84][85][86][87][88] Some works included participants within a narrow age range (e.g. 20-30 years old…”

“…Fifty-six works (92%) used only one of the phases of graded motor imagery, [28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]74,[76][77][78][79][80][82][83][84][85]87,89 and only two works (3%) used all three graded motor imagery phases. 36,86 Figure 5 summarizes the number of works using each phase.…”

“…36,86 Figure 5 summarizes the number of works using each phase. Most works (84%) used the mirror therapy phase of graded motor imagery, with 75% using traditional mirror therapy 28,29,31,[33][34][35][36][38][39][40][41][42][43][44][45]49,50,52,53,56,57,59,[63][64][65][67][68][69][70][71][72][73][74][75][77][78][79][80][81][82][83][84][85][86][87][88][89] and 11% using virtual reality as mirror therapy. 47,…”

“…Positive results through a reduction in phantom limb pain after graded motor imagery intervention were reported in 89% of works. 29,30,[32][33][34][35][36][37][38][39][41][42][43][44][45][46]48,[50][51][52][53][54][55][56][57][58][59][60]62,[64][65][66][67][68][69][70][71][72][73][74][76][77][78][79][80][81][82][83][84][85][86][87]…”

“…36,49–51,59,64,76,88 Most commonly used outcome measures were the visual analog scale for phantom limb pain (48%), 28–31,33,35,37,38,40,42,44,45,50,52,53,56,57,59,64,70,72,79,81,82,85–89 numeric rating scale for phantom limb pain (33%), 39,41,43,46–48,50,51,54,61,62,65,67,69,71,73,75,78,80 Brief Pain Inventory (11%), 32,33,36,39,59,76,77 and Short-form McGill Pain Questionnaire (8%). 37,…”