Postoperative Open Reduction Internal Fixation Discomfort and Rehabilitation Response: A Case Report

Rehabilitation details after open, comminuted patellar fractures in older adults are seldom published; this case maps a full 20-week recovery using a structured, criteria-based program. A healthy 56-year-old woman was unable to bear weight after a fall, with anterior knee wounds and imaging that showed an open, comminuted left-patella fracture. Six weeks postoperatively, she reported resting pain of 4/5 on the Verbal Rating Scale (VRS) and demonstrated only 40° active range of motion (AROM). The injury was classified as a Type I/II open patellar fracture. It was stabilized with open reduction and internal fixation (ORIF) with tension-band wiring plus screws. Beginning at postoperative Week 6, the patient followed a five-phase outpatient protocol progressing from immobilized isometrics to closed kinetic chain (CKC) functional drills over ≈42 visits. By Week 20, active flexion increased to 129°, quadriceps strength to 4+/5, and the Lower Extremity Functional Scale (LEFS) score to 50/80. Mid-patella circumference fell 1.8 cm, serial radiographs confirmed union, and resting pain fell to 2/5, although intermittent stiffness and mild activity-related aching persisted. A staged, adaptable rehabilitation plan can yield substantial gains in mobility, strength, and function within five months of an ORIF procedure for complex patellar fractures. Daily low-load motion and progressive closed-chain loading appear key, and patients should be advised that modest pain and strength asymmetry may linger beyond 20 weeks, warranting continued follow-up.