Rehabilitation of a Patient with Knee Arthrofibrosis after Tibial Spine Fracture: a Case Report in Paediatrics

INTRODUCTION. Tibial spine fracture (TSF) is a rare injury, the incidence is higher among children. The common complication of treatment is arthrofibrosis. Early rehabilitation is important for its prevention. Guidelines haven’t been worked out. CASE REPORT. Patient A., 11 years old, was operated for TSF. When she had hospitalized in medical rehabilitation center after 4 months, knee arthrofibrosis was diagnosed. Examination: range of knee motion is 180–155°. Edema of periarticular tissues. The gait pattern is impaired. She couldn’t maintained balance in Trendelenburg test on affected leg. Psychological diagnostics: fear of knee flexion, decreased motivation. Rehabilitation aims: A. will begin to bend knee while walking after 10–14 procedures d450.3.2–d450.2.1, b7100.2–b7100.1. A. is not afraid to bend knee during exercises by the end of the rehabilitation d240.2.0–d240.1.0. Rehabilitation program: physical exercises, mechanotherapy (treadmill, ladder with ramp, continuous passive motion), electrical myostimulation, aquajet therapy, vibrotherapy, kinesiotaping, hardware massage, sessions with psychologist, magnetic laser. RESULTS AND DISCUSSION. Range of knee motion is 180–135°. Edema of tibia and hip has decreased. A. minimally bends knee when walking, hip flexion has appeared. A. can maintain balance in Trendelenburg test. The fear of bending knee has decreased according to self-assessment, but it is difficult for A. to cope with the situation of physical discomfort on her own. The aims have been partially achieved. Rehabilitation potential is low because of long period after surgery and personal characteristics. Life quality didn’t decrease, it made difficult setting rehabilitation aims. The team decided to focus on psychological work and improving motion. CONCLUSION. Teamwork and guidelines are important for rehabilitation due to variety and complexity the pathology.