Rehabilitation After Severe Open Tibial Fractures

Abstract

Sustaining a severe open tibial fracture is a life-changing injury regardless of whether the eventual clinical outcome is amputation or limb reconstruction. Surgical treatment is only the first stage of the patient’s recovery. For the patient to achieve their maximum potential for physical, social, and psychological function, greatest participation in society, and quality of living, they require a combination of training and therapy collectively referred to as rehabilitation. After initial surgical treatment there are a finite number of possible clinical outcomes ranging from the surgical objective of infection-free bony union and healed wounds and a useful limb, to primary amputation in an unreconstructable limb. Between these two outcomes is a spectrum of limbs requiring ongoing treatment for infection and/or problems with healing of bones and soft tissues. Those that suffer with persistent complications/consequences of injury may end up with a delayed amputation. The goals for rehabilitation, however, must remain the same, namely to maximise the return of limb functionality and to help integrate the patient back into society by facilitating optimal quality of life. Aside from the limb injury, patients may well have other injuries, e.g. traumatic brain injuries or pre-existing medical co-morbidities, and therefore each patient’s rehabilitation needs will vary considerably.