Impediments to the restoration of full knee function after distal femoral fracture are fibrosis and adhesion of injured soft tissues around the metaphyseal fracture zone, joint capsular scarring, intra-articular adhesions, and muscle weakness.
Once early fracture stability has been restored by the healing process, the surgeon and the physical therapy staff will design an individual program of progressive rehabilitation for each patient.
The regimens suggested here are for guidance only and not to be regarded as prescriptive.
The long leg circular cast is not intended to be a weight-bearing cast, so the patient will need to use crutches or a walker. The leg should be kept elevated, whenever possible, to prevent additional swelling.
The exercises for the patient should be explained and demonstrated. These include: flexing the toes and lifting the leg.
A major concern with using a long leg cast for a distal femoral fracture is knee joint stiffness. Therefore, the duration of treatment in the long leg cast should be as short as possible (4-6 weeks). After this period, the cast will be changed to a hinged knee brace or hinged knee cast to allow knee flexion and extension. This would be applied as soon as firm callus formation is present.
Weight-bearing would be started at approximately 6-8 weeks following injury.
There should be regular radiological review until fracture union.
Thrombo-prophylaxis should be given according to local treatment guidelines.