Progressive Rehabilitation After Intramedullary Nailing of a Proximal Femur Fracture: A Case Report

Abstrak

Background: Proximal femur fractures may cause pain, restricted range of motion (ROM), muscle weakness, and impaired weight-bearing capacity. Progressive physiotherapy may address these impairments following surgical fixation.
Objective: To describe changes in pain, ROM, muscle strength, and thigh circumference following progressive physiotherapy after intramedullary nailing for a proximal femur fracture.
Methods: This case report involved a 46-year-old man with a displaced oblique fracture of the proximal third of the left femur following a slip and fall. Intramedullary nailing was performed on October 3, 2025. Approximately one month postoperatively, he received four physiotherapy sessions twice weekly, comprising therapeutic exercise, progressive strengthening, balance and weight-transfer training, gait training, knee joint traction, and transcutaneous electrical nerve stimulation. Outcomes included Visual Analogue Scale (VAS) pain, hip and knee ROM, manual muscle testing, and upper-thigh circumference.
Results: After four sessions, VAS scores decreased by 1 point for resting, movement-related, and pressure pain. Left hip and knee flexion increased by 5° and 10°, respectively. Hip muscle strength improved from 3/5 to 4/5, while knee and ankle strength remained 4/5. Upper-thigh circumference remained unchanged at 38 cm. No inferential statistical analysis was performed.
Conclusion: Progressive physiotherapy was accompanied by improvements in selected pain, ROM, and hip strength measures. These descriptive findings do not establish treatment efficacy or causality.