Chouhan Deepiksha, Phansopkar Pratik, Chitale Neha V, Lakhwani Madhu
Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND.
Cureus. 2022 Dec 23;14(12):e32855. doi: 10.7759/cureus.32855. eCollection 2022 Dec.
Proximal tibia fractures are generally open fractures resulting in life-threatening complications. There is an increase in the prevalence of compartment syndrome post-tibial fractures. Though fasciotomy and wound debridement is the choice of treatment in such conditions, amputation becomes a necessity when there is widespread muscle and tissue damage. Specifically, compartment syndrome involving the lower limb is distressing as its symptoms can be misleading at times resulting in delayed diagnosis and hence life-threatening complications. A 48-year-old male met with a road accident and presented to the hospital with complaints of pain and an open wound over the anterior aspect of the right lower leg 14 days ago. He was managed by Ilizarov external fixator. Later he developed compartment syndrome as a complication of tibial plateau fracture, for which decompressive fasciotomy was performed. But due to irreversible tissue loss and gangrene, he had to undergo above-knee amputation followed by physiotherapy rehabilitation. We mainly focused on postoperative/pre-prosthetic rehabilitation. During postoperative rehabilitation, we concentrated on reducing phantom limb pain, preventing complications, and improving strength and endurance. Current literature claims that mirror therapy is effective in reducing phantom limb pain in post amputees, but there are only a few case reports emphasizing mirror therapy in particularly lower limb amputees. Therefore, we emphasized using mirror therapy for phantom limb pain in this case of lower limb amputation. It resulted in positive outcomes. Our broader aim was to strengthen the upper limbs and the intact lower limb so that the patient's overall functional independence can be enhanced. Further prosthetic rehabilitation was planned in which we focused on gait and balance training. Physiotherapy rehabilitation improved the patient's quality of life and independence.
胫骨近端骨折通常为开放性骨折，可导致危及生命的并发症。胫骨干骨折后骨筋膜室综合征的患病率有所增加。尽管在这种情况下筋膜切开术和伤口清创术是首选治疗方法，但当出现广泛的肌肉和组织损伤时，截肢就成为必要手段。具体而言，涉及下肢的骨筋膜室综合征令人痛苦，因为其症状有时可能具有误导性，导致诊断延迟，进而引发危及生命的并发症。一名48岁男性14天前遭遇道路交通事故，因右小腿前侧疼痛和开放性伤口入院。他接受了伊里扎洛夫外固定架治疗。后来，他因胫骨平台骨折并发骨筋膜室综合征，接受了减压筋膜切开术。但由于不可逆转的组织损失和坏疽，他不得不接受膝上截肢，随后进行物理治疗康复。我们主要关注术后/假肢安装前的康复。在术后康复期间，我们专注于减轻幻肢痛、预防并发症以及增强力量和耐力。当前文献称，镜像疗法对减轻截肢后患者的幻肢痛有效，但仅有少数病例报告强调在特别是下肢截肢患者中使用镜像疗法。因此，在该例下肢截肢患者中，我们着重使用镜像疗法治疗幻肢痛。结果取得了积极成效。我们更广泛的目标是增强上肢和未受伤的下肢力量，从而提高患者的整体功能独立性。还计划进行进一步的假肢康复，重点是步态和平衡训练。物理治疗康复改善了患者的生活质量和独立性。
