Physiotherapy Management After Flexible Intramedullary Fixation in Tibia-Fibula Fracture With TBI: A Case Report

Abstrak

Background: Open tibia-fibula fractures caused by high-energy trauma may coexist with traumatic brain injury (TBI), creating concurrent orthopedic and neurologic rehabilitation challenges. Detailed physiotherapy reports in this clinical context remain limited. 
Objective: To describe the clinical course and early outpatient physiotherapy management of a young adult with an open middle-third tibia-fibula fracture and concomitant TBI after a traffic accident. 
Methods: This single-patient case report followed the CARE framework. An 18-year-old man underwent staged orthopedic and neurosurgical procedures before four outpatient physiotherapy visits from 12 to 22 September 2025. Outcomes included pain, ankle range of motion, muscle strength, limb measurements, the Lower Extremity Functional Scale (LEFS), and anxiety. Treatment included education, infrared, ankle pump exercise, passive and active range-of-motion exercise, resisted exercise, balance training, and non-weight-bearing gait training with crutches. 
Results: Movement pain decreased from 2 to 1. Ankle dorsiflexion-plantarflexion changed from S 10°-0°-10° to S 40°-0°-21°, and inversion-eversion changed from T 18°-0°-30° to T 43°-0°-35°. Hip and ankle muscle strength remained 4/5. Anxiety decreased from 21 to 17. LEFS was 22/80 at baseline and was not repeated. By the fourth visit, the patient progressed from two crutches toward one crutch, although the criteria for progression were not documented. 
Conclusion: The four-visit rehabilitation period was accompanied by descriptive improvements in movement pain, ankle range of motion, anxiety, and observed mobility. These changes cannot be attributed specifically to physiotherapy or generalized beyond this single case.