The primary treatment for distal femoral fractures is often surgical fixation (e.g., plates, screws, rods) to stabilize the bone. Physiotherapy begins very early, sometimes even the day after surgery, and is crucial for optimal recovery. The protocol will be highly individualized based on the fracture type, surgical fixation, surgeon’s recommendations (especially regarding weight-bearing status), and the patient’s overall health.

Phases of Rehabilitation

Acute Post-Operative Phase (Protection & Early Mobilization):

• Pain and Swelling Management: Ice, elevation, medication (as prescribed).
• Protection of Fracture Site: Adherence to weight-bearing restrictions (non-weight bearing, toe-touch, or partial weight-bearing as advised by the surgeon). Use of crutches, walker, or wheelchair.
• Early, Gentle Range of Motion (ROM):
  • Ankle Pumps and Foot Circles: To prevent deep vein thrombosis (DVT) and maintain circulation.
  • Gentle Knee Flexion/Extension: Often passive or active-assisted, within a protected range, sometimes using a continuous passive motion (CPM) machine.
  • Hip Flexion/Extension (within limits): To maintain mobility of the hip.
• Isometric Exercises: Gentle contractions of thigh and gluteal muscles without joint movement to maintain muscle tone (e.g., quad sets, glute sets).
• Circulatory Exercises: Deep breathing to prevent pulmonary complications.

Intermediate Phase (Progressive ROM & Initial Strengthening):

• Gradual Increase in Weight Bearing: As bone healing progresses, weight-bearing status is advanced according to surgeon’s orders. This often involves gait training with assistive devices.
• Increased Range of Motion: More aggressive knee and hip ROM exercises.
• Progressive Strengthening:
  • Light Resistance Exercises: Using resistance bands or light weights for quadriceps, hamstrings, glutes, and calf muscles.
  • Core Stability Exercises: To support the spine and pelvis, which indirectly aids lower limb function.
  • Balance and Proprioception Training: Early incorporation of exercises to improve stability and body awareness.

Advanced Phase (Full Weight Bearing, Strength, Function & Sport-Specific Training):

• Full Weight Bearing (as tolerated and approved): Progression to walking without aids.
• Advanced Strengthening: Incorporating more challenging resistance exercises, squats, lunges, step-ups, and balance exercises.
• Functional Training: Mimicking daily activities such as stair climbing, getting up from a chair, carrying objects.
• Agility and Plyometrics (if appropriate): For younger, active individuals aiming to return to sport.
• Sport-Specific Drills: Tailored exercises to prepare for return to specific sports or high-impact activities.

Manual Therapy Techniques

Manual therapy is an integral part of physiotherapy, especially in the later stages of distal femoral fracture rehabilitation to address stiffness, scar tissue, and muscle imbalances.

• Joint Mobilization
  • Knee Joint Mobilization: Gentle, specific glides and oscillations applied to the knee joint (tibiofemoral and patellofemoral joints) to restore normal movement, reduce stiffness, and improve patellar tracking. This is crucial as knee stiffness is a common complication.
  • Hip Joint Mobilization: To ensure proper hip mechanics, which affects knee alignment and function.
• Myofascial Release (MFR): MFR targets the fascia, the connective tissue surrounding muscles. For distal femoral fractures, it’s particularly useful for addressing:
  • Quadriceps and Hamstring Tightness: These large muscles often become tight and fibrotic after injury and immobilization. MFR helps to restore their extensibility and reduce tension.
  • Scar Tissue Mobility: Releasing restrictions around surgical incisions to improve skin and underlying tissue mobility.
  • Reduced Overall Thigh and Leg Tension: Releasing fascial restrictions can improve blood flow and reduce pain.
• Active Release Technique (ART): A highly specific soft tissue technique that involves applying tension to a muscle or fascia while the patient actively moves the limb through a specific range of motion.
• Muscle Energy Technique (MET): A gentle manual therapy technique that uses the patient’s own muscle contractions to relax and lengthen tight muscles and mobilize restricted joints.
  • Application: Can be used to improve range of motion at the knee and hip, for example:
    • To increase knee flexion, the patient might gently push into knee extension against resistance, followed by the therapist gently moving the knee into more flexion as the muscles relax (Post-Isometric Relaxation).
    • To address hip flexor or hamstring tightness, which can indirectly affect knee mechanics.