Comprehensive rehabilitation of a patient with consequences of a gunshot wound to the lower limb and neurotrauma: a clinical case

Gunshot comminuted fractures of the tibia are often accompanied by delayed orthopedic, neurological, and vascular-trophic complications, leading to persistent pain syndrome, limited mobility, and reduced functional capacity of the lower limb. Optimizing comprehensive rehabilitation programs for these patients remains an urgent clinical challenge.Objective. To evaluate the clinical and functional effectiveness of an individualized physical therapy program combined with bioregulatory therapy in a patient with delayed consequences of a gunshot comminuted fracture of the tibia, in combination with sequelae of closed traumatic brain injury and acoustic trauma.Materials and Methods. We present a clinical case of a patient with post-traumatic involvement of the left knee and ankle joints, chronic pain syndrome, limited range of motion, and impaired gait. The comprehensive rehabilitation approach involved bioregulatory medications, stepwise autohemotherapy, autologous plasma therapy, intra-articular ozone therapy, and kinesio-taping. The rehabilitation program included mobilization techniques, exercises to restore range of motion, muscle strengthening, balance training, and neurodynamic techniques.Results. After completing the rehabilitation course, there was a reduction in pain intensity, decreased swelling, increased range of motion in the knee and ankle joints, and improved neuromuscular control and gait function. The comprehensive approach was associated with clinically significant positive changes in functional outcomes.Conclusions. Combining individualized bioregulatory therapy with physical therapy may be considered a promising approach in the rehabilitation of patients with delayed consequences of gunshot fractures of the lower limbs, combined with sequelae of closed traumatic brain injury and acoustic trauma. These results require confirmation in further controlled studies.