Fracture of tibia and fibula

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* Selected Axes

* Theoretical Framework

* Rehabilitation Kinesics

* Introduction to Kinesiology.

* Physiotherapy techniques.

* Role of Kinesiology in the specialties.

* Bibliography

Selected axes:

Axis I: Introduction to Kinesiology.


* Pillars of Kinesiologist.

* Immobilization syndrome.

* Types of rehabilitation: primary, secondary and tertiary.

Axis III: physiotherapy techniques.


* Mobilizations.

* Physiotherapy.

Axis IV: Role of Kinesiology in the specialties.


* Fracture.

* Fracture treatment.

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Theoretical Framework:

The patient Torqui Mariano Ruben 23 years of age, with a diagnosis of fracture of tibia and fibula of his left leg in the distal third caused by a traffic accident which occurred on October 21, 1996, aggravated by three nonunions and 2 ciprofroxacina bone infections treated with 500 mg.

Underwent surgery 13 times. He performed with osteosynthesis placing repairing surgeries on different occasions:

* 3 external tutors (Lazo and Ilizaro Canadel).

* Plate with screws to fix broken fibula.

* 4 bone resorption in the tibia and fibula.

* Removing soft bone graft from the left iliac crest.

* Pulling it free skin graft from the left thigh.

* Free flap back to the reason for repairing the arterial and venous circulation.

* Vascularized fibular graft taken from the right leg and placed in the left leg artery linking the anterior tibial pernea order to combat nonunion bone resorption since proved unfruitful.

The patient was always treated Kinesthetic since so many surgeries suffered muscle loss and was traveling with Canadian crutches and cane on different occasions.

He also used several casts and splints which caused him too much muscle loss and immobilization to the ankle.

On 31 December 2001 the patient was discharged concurring office for radiographic controls performed. Also underwent a diet to prevent future injuries.

Today you can perform any type of physical activity with the risk of injury that can have anyone.

Osteosynthesis: Union of the fractured bone ends or by mechanical or surgical.

Bone resorption: partial or complete disappearance of bone tissue.

Nonunion: False joint, especially one formed between the bone ends unconsolidated fracture.

Kinesics Rehabilitation:

* Care muscular ankle, knee and hip.

* Correction rotation standing and walking.

* Static mild, painless contractions of the muscles of the foot, leg and thigh.

* Resistance and mobilization against the ankle, leg and thigh.

* Assisted active mobilization tibiotarcianas painless joint, upper and lower peroneotibiales, knee and hip.

* General Gymnastics for toning both lower limbs.

* Shortwave was applied, ultrasound, electrostimulation, Laser, Magnet.

Axis I: Introduction to Kinesiology.


* Pillars of Kinesiologist.

* Immobilization syndrome.

* Types of rehabilitation: primary, secondary and tertiary.

The Kinesiologist is a member of the health team whose performance includes the evaluation, prevention, maintenance and treatment of the physical capacity of people applying physiotherapy, physiotherapy and KINEFILAXIA. (The three pillars).

In this case the clinical was as follows:

Three Pillars

Immobilisation syndrome

(Imbalance of the normal relationship between rest and physical activity).


Rehabilitation primary, secondary and tertiary.

In this case we use the secondary rehabilitation.


* To preserve patient function threatened by injury.

* Prevent secondary complications.


* Postural treatment to prevent secondary complications (vice running).

* Stimulation side unscathed.

* Optimal preservation of joint range of motion.

* Standardization proprioceptive.

* Facilitation of equilibrium reactions.

* Training of integrated activities (Transfers and standing).

* Promote running static patterns.

* Start with displacement.

Axis III: physiotherapy techniques.


* Mobilizations.

* Physiotherapy.


In this case were made to tone and restore damaged tissues, build strength, endurance, coordination, range of motion and speed.

Briefly explain the mobilization done for this particular case.

* Mobilization free – static: this mobilization was performed when the patient was placed in a cast or where external tutor had. In this movement there is no displacement. It is performed in order that the patient may contract their muscles and thereby decrease the swelling of his foot.

* Mobilization active – assisted: this mobilization was performed because the patient, following the loss of muscle mass after surgery did not complete the arc of motion. With the passage of time and once the patient is able to support the leg exercises conducted in the sidebars to complete the arc of motion overcoming gravity and avoiding complications.

* Active Mobilisation – Weathered: this mobilization was performed after the patient is evolved favorably to previous demonstrations. At this point the patient has a greater displacement and is done to increase the resistance. Performs flexion – extension, adduction – abduction exercises with equipment such as pulley, etc.


In this case we used the following physical mechanisms are:

* Shortwave.

* Ultrasound.

* Electro.

* Laser therapy.

* Magnet.

-Shortwave: Only at the end of treatment, and to help improve mobility, using the Joule effect (heat). Not so in the beginning, as this contraindicated when metal implants or osteosynthesis. Nor has effect for fracture healing.

-Ultrasound. It is used to reduce the acute inflammation and pain, not in the fracture zone, but in the vicinity with low intensities (0.5 l, 5 watts per square centimeter) and pulsed mode. The duration of treatment is 5 to 10 minutes depending on the area to be treated. In the sub phase. Acute used to produce heat in depth. (When the fracture is already consolidated) to improve joint stiffness.

-Electro: was used to promote the rehabilitation of muscular work. couple pumping promote muscle contraction and to improve muscular atrophy. For muscle re-education must take into count that the contraction should be adequate but comfortable, the pulse duration should be between 30 to 40 pulses per second. Pumping muscle contractions are performed to aid venous return and thus reduce edema.

– Laser therapy: Noted for its analgesic working it on time and scanning system. In a timely manner in the area of pain or using acupuncture points, and sweep as throughout the treatment area. Depending on the power and intensity of treatment duration varies between 5 to 10 minutes.

-Magnet: It leverages its benefactor recognized effect of fracture consolidation (since it favors osteogenesis) and tissue regeneration.

Axis IV: Role of Kinesiology in the specialties.


* Fracture.

* Fracture treatment.


A fracture is a discontinuity produced sharply. In this particular case is a fracture and the difference is that the bones to be exposed to the outside leaving the soft tissue damage.

In this case the fracture is overload as it receives an external shock and is causing the fracture.

This fracture is a fracture in the distal third diaphyseal type multifragmentary unstable with a thrust-type longitudinal displacement and internal rotation.

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(It should be noted that this is not the patient radiography which work is done)

Fracture treatment.

In this case, the method of reduction and the patient to enter the hospital underwent a continuous type traction then 15 days later put a loop Canadel external fixator. This tutor what was in place for six months and then removed him as the body began to reject it. Over the years performed treatments were unsuccessful because there were several drawbacks. Nonunion 3 who were treated with bone grafts in two opportunities, then, at the end of treatment, performing vascularized fibular graft which was successful.


I chose this topic because I vivenci and doing work on this topic I’m percent witnessing an episode that marked my life and I will never forget.

Importantly, all the time I was content by the orthopedic surgeon and the physiotherapist and they took care of my rehab and keep my mood in good condition as it is very important to be mentally to get a good rehabilitation. Also told with a good family and friends who were with me at all times and I was never alone. I stress this because to go to practice geriatric watched the people that did not have this environment and your mood was not optimal.

Another point to note is that never stopped doing my rehab overcoming many obstacles along the way but it is essential to get it right and proper rehabilitation thanks to that today I can do a completely normal life and I can play sports with risk that can be any person.

Of all my rehab all I have to criticize is that I never made kinesiologist any massage and I think it is essential to reduce the pain and increase lymphatic circulation among others.


* Study Guide: Introduction to Chair of Kinesiology and Physical Medicine of the American Open University.

* Medical Dictionary. Dr: Dox Mellioni Eisner


* Search engines:, and



Torqui, Mariano Ruben.

Bachelor of Kinesiology and Physical Medicine