![]() ![]() This is a case of a 52-year-old female patient with right-handed dominance, a teacher by occupation at a school. The combination of restricted active and passive range of motion, decreased muscle strength, altered proprioception, and pain as a result of the fracture and treatment necessitates a specialized rehabilitation program that includes exercises for ankle mobility, strengthening, weight-bearing, and balancing. Rehabilitation begins after surgery or the removal of a plaster cast. In order to restore the lower limb's natural supporting function, the applied exercise therapy's goal is to repair the ankle joint as functionally as possible. The Mulligan idea of mobilization with movement (MWM), a form of manual therapy, involves the therapist using a gliding force while the patient performs an active movement. One of the techniques available in physiotherapy for regaining range of motion is joint mobilization. Following treatment, patients usually encountered some kind of sequelae, like joint stiffness, traumatic arthritis, walking instability, and joint deformity. The reduction and treatment of this kind of fracture remain a major challenge in the medical field. This might be caused by osteopenia or osteoporosis, which may be found in this vulnerable patient group. One study found that females had a higher prevalence of trimalleolar fractures, with 77.78% of participants being female. Females experience incidence at a 2:1 higher rate than males do. ![]() High energy trauma is to blame for these fractures. ![]() It is the least common kind and only appears in 7% of all ankle fractures. A bimalleolar fracture plus a posterior malleolar fracture make up the trimalleolar ankle fracture (TAF), a kind of complex ankle fracture. These fractures could be unimalleolar, bimalleolar, or trimalleolar, depending on the number of malleoli involved. The treatment showed improvement in the range and strength of the lower limb.Īnkle fractures are the most typical type of fracture in the lower limbs. Strength training of lower limb muscles, proprioception training, and gait training was given to the patient. A Mulligan’s movement with mobilization was prescribed to increase the range of ankle dorsiflexion, and ultrasound was used to improve scar mobility. The patient attended physiotherapy treatment. This prolonged non-weight-bearing phase caused muscle wasting of the right leg, and reduced ankle dorsiflexion range and strength. Due to fear of pain, she was not bearing weight on that limb. ![]() Ten months post the operation she saw pus discharge from the scar site, she was re-operated for implant removal and physiotherapy was advised. Due to this, there was a delay in the weight-bearing phase. There was pus discharge from the suture site post-operatively. She was managed with open reduction and internal fixation using rush nailing and canulated cancellous screws. She was brought to the hospital for investigation and was diagnosed with a trimalleolar ankle fracture. In this case report, we present a 52-year-old female patient who met with a road accident 15 months before presentation. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. The trimalleolar fracture of the ankle is the least common type of fracture among ankle fractures. ![]()
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