Physiotherapy Rehabilitation Strategies for Post-operative Trimalleolar Ankle Fracture: A Case Report

The trimalleolar fracture of the ankle is the least common type of fracture among ankle fractures. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. In this case report, we present a 52-year-old female patient who met with a road accident 15 months before presentation. She was brought to the hospital for investigation and was diagnosed with a trimalleolar ankle fracture. She was managed with open reduction and internal fixation using rush nailing and canulated cancellous screws. There was pus discharge from the suture site post-operatively. Due to this, there was a delay in the weight-bearing phase. Medications were given for relief. Ten months post the operation she saw pus discharge from the scar site, she was re-operated for implant removal and physiotherapy was advised. Due to fear of pain, she was not bearing weight on that limb. This prolonged non-weight-bearing phase caused muscle wasting of the right leg, and reduced ankle dorsiflexion range and strength. The patient attended physiotherapy treatment. A Mulligan's movement with mobilization was prescribed to increase the range of ankle dorsiflexion, and ultrasound was used to improve scar mobility. Strength training of lower limb muscles, proprioception training, and gait training was given to the patient. The treatment showed improvement in the range and strength of the lower limb.