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

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, 4 days/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.