Abstract
Background: Fractures of distal end of tibia associated with soft tissue injuries and fracture of distal fibular end are very complex and forms a total of 1-2% of all fracture of lower limb. These fractures are widely termed as plafond fractures.
 Case Presentation: A 26- year-old male, a follow up case, gave a history of road traffic accident following which he underwent corticotomy and application of external Ilizarovring fixator. At present due to non-union of the fracture segments patient got readmitted after a year. Further management through a three-step surgical approach was carried out. Rehabilitation program began from post-operative day 1 and was continued for a period of three weeks.
 Investigations: On the day of examination, the patient’s pain was severe on movement with presence of disuse trophy of lower limb musculature of the affected extremity. Ranges on the right lower limb at all joints were reduced due to pain. The X-ray showed presence of 9-hole recon plate fixed distally over talus and proximally to tibia.
 Management: Physiotherapeutic intervention began with educating the patient and the caregivers about the condition, the precautions to be taken, the expected time of healing and extent of healing. The exercise program was based on the principles of variability and individuality. The protocol was changed weekly with the observed progression in the patients range, muscles strength and ability to perform more challenging in bed activities.
 Conclusion: Early rehabilitation in complex cases of tibial plafond fracture facilitates the process of healing as well as maintain the patients level of functioning by maintain muscle properties. Post-operative complications are also reduced.
Highlights
IntroductionTibia and fibula are the long bones of the lower limb, forming a tibiofibular syndesmosis
Tibia and fibula are the long bones of the lower limb, forming a tibiofibular syndesmosis. Fracture of these long bones due to high energy axial compression is known as tibia plafond fractures and can have an associated soft tissue involvement and extension of fracture into fibula [1]
Another study suggests that most of the patient were treated through two stage, where fist stage involved external fixator application for a period of few weeks to months depending on severity followed by open reduction internal fixation
Summary
Tibia and fibula are the long bones of the lower limb, forming a tibiofibular syndesmosis. Fracture of these long bones due to high energy axial compression is known as tibia plafond fractures and can have an associated soft tissue involvement and extension of fracture into fibula [1] These fractures are rare and account for only 1-10 % of total fractures of lower limbs. The type 3 fracture of this is the most severe with multiple fracture fragmentsand metaphysical impaction [2] These fractures are managed surgical in 4 phases, beginning from restoration of fibular length, followed by autologous bone graft for filling the defect and ending by insertion of buttress plate on distal aspect of tibia [3,4].
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