Year: 2026 | Month: September | Volume: 16 | Issue: 9 | Pages: 160-166
DOI: https://doi.org/10.52403/ijhsr.20260918
Severe Knee Extensor Lag Following Mid-Shaft Femoral Fracture Treated with IM Nailing and Bone Grafting: Is Late Rehabilitation a Contributing Factor? - A Case Report
S Jeba Malar1, Anas Ahamed A2
1,2Physiotherapist, Department of Physical Medicine and Rehabilitation, Government Medical College Hospital, Tirupur, Tamil Nadu, India.
Corresponding Author: S. Jeba Malar
ABSTRACT
Background: This case report describes a 23-year-old male with a comminuted mid-shaft femoral fracture who initially received traditional bone setting followed by surgical management with intramedullary interlocking nailing and autologous iliac crest bone grafting. Structured supervised physiotherapy was initiated several months after surgical fixation because of poor adherence related to fear of movement (kinesiophobia).
Aim: To describe the functional changes following a structured supervised physiotherapy programme initiated late after surgical management of a femoral shaft fracture with nonunion, and to document the residual knee extensor lag.
Results: After 8 weeks of supervised physiotherapy, hip and knee range of motion, selected hip muscle strength, pain, swelling, weight-bearing ability and gait improved. Hip abductor strength improved from 1/5 to 3/5 and hip extensor strength from 2/5 to 3/5. Knee extensor strength remained 2/5. Active knee flexion improved from 0–90° to 0–125°. The terminal knee-extension lag improved from 60° to 45° but persisted. Knee circumference at the mid-patellar level decreased from 41 cm to 40 cm, while moderate swelling remained.
Conclusion: Late structured physiotherapy was associated with clinically meaningful improvements in mobility, selected muscle strength, pain and gait. The persistent extensor lag should not be attributed to late rehabilitation alone. Possible contributors include prolonged immobilization, knee effusion with arthrogenic muscle inhibition, kinesiophobia, late weight bearing and fracture-related factors.
Key words: Intramedullary nailing, bone graft, progressive resisted exercise, quadriceps lag, kinesiophobia