Case Study - Patient with a fractured thigh bone

DS is a good amateur level endurance cyclist. He was cycling to work in central London in July 2016 and was involved in a collision with a motorist. After x-rays were taken at St Thomas’s hospital it was established he had a complete fracture to his right femur (thigh bone). Surgery was completed to fixate the fracture with an intramedullary nail (IM nail), which is a metal rod forced into the medullary cavity of the broken bone. The rod is then usually fixated at both ends with special screws and provides a strong fixation upon which the patient can usually weight bear and with time the fractured bone can reunite.

Post operatively DS was suffering thigh and knee pain. Swelling was reducing the range of motion through the knee, he had reduced weight bearing capacity and muscular weakness. After starting regular outpatient dry land physiotherapy, he additionally began attending Aqua-Physio. Communication was established between both practices to ensure the sessions were complimenting each other and were working jointly towards his short and long term goals.

DS’s long term goal is to participate in the Race Across America Cycling Challenge (RAAM) in June 2017, where he aims to compete in a team of 4 cyclists relaying across America, West to East Coast. This is a combined 3000 miles of cycling across 12 states with over 170,000 vertical feet of climbing. Teams will ride 350-500 miles a day, racing non-stop, and most finish in about seven and a half days.

Initially DS was walking with elbow crutches due to pain and weakness in his limb and his early pool sessions aimed at restoring knee range of motion, reducing swelling and restoring a normalised gait pattern. Later sessions were aimed more at higher level exercise such as jumping, hopping and higher level balance work (see video attached).

DS is now starting to spend more and more time on his bicycle and in the gym as his strength is improving. He is looking forward to some skiing trips in the new year and building up his fitness towards attempting the RAAM event in 2017.   

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