Functional Recovery Following Intensive Multidisciplinary Rehabilitation after Right Gamma Nail Fixation: A Case Report

Abstract

Proximal femoral fractures are a major cause of morbidity and functional decline, with an incidence of approximately 200 per 100,000 individuals per year and mortality rates of up to 30% in elderly patients. Surgical intervention is mandatory for treatment, preferably within 24 hours according to the Federal Joint Committee (GBA). The gamma nail is recommended for unstable intertrochanteric fractures, but systematic postoperative rehabilitation is poorly documented, although it has an important impact on functional outcomes. We report the case of a patient treated with gamma nail fixation for a right proximal femoral fracture and intensive multidisciplinary rehabilitation, who was admitted approximately 18 days postoperatively with significant limitations in range of motion, muscle strength, balance, and ambulation — specifically, a Berg Balance Scale score of 6, a Functional Status Test score of 45, Visual Analog Scale pain scores of 8/10, and inability to ambulate independently. A comprehensive individualized rehabilitation protocol was implemented over a nine-week period, consisting of active and active-assistive range of motion exercises, progressive resistance training, static and dynamic balance activities, and progressive gait training with weight-bearing as tolerated. Sequential objective assessments were completed at baseline, week 2, week 4, week 6, and week 9. Repeated assessments showed significant and incremental gains in all domains: Berg Balance Scale score increased from 6 to 50, Functional Status Test score increased from 45 to 90, Visual Analog Scale pain ratings decreased from 8 to 0-2, and independent ambulation with a walking frame for 30 meters was achieved, with progressive recovery of range of motion and manual muscle testing grades. This case demonstrates the importance of early, intensive, multidisciplinary rehabilitation following gamma nail fixation and reveals that major functional improvement may be accomplished within nine weeks when rehabilitation is guided by sequential objective assessments, personalized progressive weight-bearing protocols, and comprehensive treatment that simultaneously targets balance, strength, range of motion, gait, and functional independence.