Outpatient physical therapy for a patient following open reduction internal fixation due to bicondylar tibial plateau fracture

A 49-year old female patient underwent open reduction internal fixation due to a bicondylar tibial plateau fracture. She was seen in outpatient physical therapy for 20 sessions over 10 weeks. Treatment was provided by a student physical therapist under the supervision of a licensed physical therapist. Initial evaluation was conducted 2 weeks post-operation where the patient presented with swelling in the right knee and ankle, decreased knee and ankle range of motion (ROM), decreased lower extremity muscle strength, and decreased functional status. Per physician's orders, the patient was non-weight bearing for 6 weeks following surgery and ambulated using 2 axillary crutches. The patient was evaluated at the initial encounter with goniometry, manual muscle testing, Numeric Pain Rating Scale, mid-patellar girth measurements, palpation, observation, the Wells criteria, the Lower Extremity Functional Scale, the Timed Up And Go test, and patient report of status. A plan of care was established, and treatment was administered twice weekly for 10 weeks. The patient's primary goals were to decrease pain, ambulate without an assistive device, return to driving, and return to work. The interventions used were patient education, postoperative bracing, progressive ROM techniques, neuromuscular electrical stimulation, pneumatic cryotherapy, soft tissue mobilization, isometric exercises, open- and closed-chain strengthening exercises, stretching, gait training, and balance activities. At discharge, the patient showed improvements with ROM, strength, girth measurements, fall risk, gait mechanics, functional independence, return to driving, and return to work. The patient was discharged from outpatient physical therapy with a home exercise program.