Continuous Passive Motion in the Rehabilitation of a Comminuted Patellar Fracture Following Delayed Physiotherapy Initiation - A Case Report

Sep 28, 2026

Uploaded by Jasmine

Comminuted patellar fractures are challenging injuries, and delays in post-operative physiotherapy markedly raise the risk of arthrofibrosis and long-term disability, especially in resource-limited environments. A 40-year-old man with multiple comorbidities presented 53 days after ORIF with severe knee stiffness and profound dysfunction: flexion 10°, VAS pain 8/10, Kujala 19/100, and Lysholm 7/100. A 4-week supervised CPM program plus structured home exercise, with CPM progression guided by VAS tolerance, produced rapid gains to 110° flexion, pain 0/10 at rest and 3/10 with movement, and major score improvements (Kujala 69/100; Lysholm 76/100).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Key Clinical Message

Continuous Passive Motion in Post-Operative Rehabilitation

Barriers to Use in Low-Resource Settings

Case Report Rationale and Clinical Interest

Clinical Case Reports CASE REPORT OPEN ACCESS Continuous Passive Motion in the Rehabilitation of a Comminuted Patellar Fracture Following Delayed Physiotherapy Initiation: A Case Report Mohammad Ali1,2 | Timothy Miller2 1Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh | 2Doctor of Physical Therapy Program, College of Health, School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA Correspondence: Mohammad Ali ([alibup2018@gmail.com](alibup2018@gmail.com)) Received: 15 July 2025 | Revised: 8 December 2025 | Accepted: 23 December 2025 Keywords: case report | continuous passive motion | knee stiffness | patellar fracture | physiotherapy | post-operative rehabilitation ABSTRACT Comminuted patellar fractures are challenging injuries, and delays in post-operative physiotherapy significantly increase the risk of arthrofibrosis and long-term disability, particularly in resource-limited settings. A 40-year-old male with multiple comorbidities presented 53 days after open reduction and internal fixation (ORIF) for a comminuted patellar fracture, suffering severe knee stiffness. Initial assessment revealed profound functional impairment: knee flexion limited to 10°, a Visual Analog Scale (VAS) pain score of 8/10, a Kujala score of 19/100, and a Lysholm score of 7/100 . A 4-week rehabilitation program consisting of supervised Continuous Passive Motion (CPM) (1 h/day, 4days/week) and a structured home exercise program was implemented. CPM parameters were progressed based on pain (VAS ≤4) and tolerance. After 4 weeks, the patient achieved 110° of knee flexion, pain reduced to 0/10 at rest and 3/10 with movement, and functional scores improved dramatically (Kujala: 69/100; Lysholm: 76/100). This case demonstrates that a combined CPM and home exercise protocol can yield substantial functional recovery even when rehabilitation is initiated late following a complex patellar fracture. It highlights a feasible and effective intervention model for resource-constrained environments where delayed rehabilitation is common. 1 | Introduction Patellar fractures represent a particularly disabling form of knee trauma because they directly disrupt the extensor mechanism, which is essential for weight-bearing, walking, and stair climbing [1] . These injuries often result in significant functional limitations, particularly when they are comminuted, meaning the bone is broken into three or more fragments [2] . In such cases, both bony reconstruction and soft tissue repair become more complex, increasing the risk of prolonged immobilization, joint stiffness, and delayed recovery [3] . In LMICs like Bangladesh, road traffic accidents are a leading cause of patellar fractures among the productive population [4, 5], contributing significantly to the regional burden of disability [6] . This underscores the critical need for effective, accessible rehabilitative strategies. Following surgical management of patellar fractures, especially complex types involving multiple fragments, the focus of care shifts toward rehabilitation to regain joint mobility and functional independence. Among the various techniques available, early physiotherapeutic intervention plays a critical role in preventing complications such as contractures, peri-patellar adhesions, and reduced range of motion (ROM) . Early mobilization is typically initiated within days of surgery to stimulate synovial fluid circulation, maintain cartilage health, and reduce the risk of intra-articular fibrosis [7] . This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. Clin

FAQs

Why are delays in post-operative physiotherapy particularly risky after comminuted patellar fractures?

Delays significantly increase the risk of arthrofibrosis and long-term disability by contributing to prolonged immobilization, joint stiffness, and delayed recovery.

What rehabilitation approach was used in this case report?

A 4-week program combined supervised Continuous Passive Motion (CPM) (1 hour/day, 4 days/week) with a structured home exercise program, with CPM parameters progressed based on pain tolerance.

What outcomes were achieved after 4 weeks of CPM plus home exercise?

Knee flexion improved to 110°, pain decreased to 0/10 at rest and 3/10 with movement, and functional scores rose markedly (Kujala 69/100; Lysholm 76/100).

Sep 28, 2026

Uploaded by Jasmine