Utilization of Skilled Aquatic Physical Therapy in the Treatment of a Postoperative Traumatic Femur Fracture with Intramedullary Nail: A Case Report

Background: Intramedullary nails are frequently used in the treatment of traumatic femoral fractures and there is yet to be a standardized postoperative rehabilitation protocol. Physical therapists ordinarily use soft tissue massage, joint mobilization, and exercises to treat typical postoperative patients. Another potential intervention is aquatic therapy to provide early intervention, maintain weightbearing restrictions, normalize gait patterning, and strengthen in the closed kinetic chain. Thus, the purpose of this case report is to demonstrate the use of aquatic therapy rehabilitation in a patient recovering from a traumatic femur fracture with intramedullary nailing. Case Description: The patient is a 47-year-old male presenting to outpatient physical therapy following a motorcycle vs motor vehicle accident with multiple injuries including rib fractures, vertebral fractures, elbow fracture, femur fracture, and skull fractures. Requiring the patient to maintain 25% weightbearing of the right lower extremity. Intervention: The patient participated in skilled aquatic physical therapy 2 times a week for 4 weeks focusing on gait training, lumbar stabilization, and lower extremity strengthening in the water while maintaining 25% weight bearing. Once the patient received clearance for weight bearing as tolerated, physical therapists slowly transitioned patient to land based physical therapy 2 times a week focusing on lower extremity resistance training, gait, steps, and balance. Outcomes Measures: Outcome measures utilized include gait observation, manual muscle testing, range of motion measurements, and Lower Extremity Functional Scale. Discussion: The patient demonstrated improvements in all outcome measures over 4 weeks leading to ability to progress to land-based therapy. The patient significantly benefited from intervention using aquatic therapy and underwater treadmill, however further high-quality research is needed to compare aquatic therapy vs. land-based therapy for post-operative patients with specific lower-extremity weightbearing restrictions.