Home-based physiotherapy after femoral shaft re-fracture in a 4-year-old patient: A case report

Background: There are no reports on home-based physiotherapy after femoral shaft re-fractures in children. Here we report a case involving a child who sustained a femoral shaft re-fracture and returned to kindergarten after 2 months of home-based physiotherapy.

Case: A 4-year-old girl presented at an emergency hospital with severe pain in the right lower limb and the inability to walk after falling at home, 15 days after discharge following treatment of a right femoral shaft fracture at the same hospital. Radiography was performed and she was diagnosed with a right femoral shaft re-fracture. Following her second discharge, she underwent home-based physiotherapy 3 days/week (40 min/day). She experienced muscle weakness in both lower limbs and a decline in the ability to stand on one leg. Consequently, she required walking assistance because of anxiety and fear of falling. Her walking ability, activities of daily living, pain, bone deformity, leg length discrepancy, anteversion of the femur (Craig's test), range of motion of both lower limbs, the circumference of the thigh and lower leg, muscle strength of both lower limbs, and standing balance (standing on one leg) were assessed.

Outcomes: No severe adverse events were associated with home-based physiotherapy. The patient could walk independently without pain or fear of falling and returned to kindergarten 118 days after the re-fracture.

Conclusions: For paediatric patients with femoral shaft fractures, home-based physiotherapy is recommended to improve motor functions and activities of daily living and to facilitate return to kindergarten or school.