Early Touchpoint, Lasting Impact: Comprehensive Orthopaedic Physical Therapy from Emergency Department to Return-to-Sport

Faculty Mentor

Joel Sattgast, John Wehrer

Presentation Type

Poster

Start Date

4-14-2026 9:00 AM

End Date

4-14-2026 11:00 AM

Location

PUB NCR

Primary Discipline of Presentation

Physical Therapy

Abstract

Background and Purpose: Traumatic ankle injuries involving dislocation and fracture require coordinated, multidisciplinary care. Physical therapists (PTs) are uniquely positioned to influence outcomes across the continuum of care – from initial triage in the emergency department (ED) to rehabilitation and return to function. This case report describes the comprehensive management of a displaced fibular fracture with talocrural dislocation sustained during a recreational event at CSM 2025. The purpose is to illustrate a phase-based, evidence-informed approach to orthopedic trauma care, emphasizing the value of early PT involvement and individualized rehabilitation.

Case Description: A healthy student PT sustained a traumatic ankle dislocation with a displaced distal fibular fracture during a glow-in-the-dark dodgeball game at CSM 2025. The patient underwent open reduction and internal fixation (ORIF) within 12 hours of injury. Due to the involvement of PT pre-operatively, critical errors were avoided, and early post-operative management was enhanced. Rehabilitation was structured into three phases:

  • Phase I (0-6 weeks): Emphasis on protection, pain management, edema control, safe mobility, and maintenance of proximal strength and capacity.
  • Phase II (6-12 weeks): Initiation of weight-bearing, progressive ROM and strength training, and neuromotor retraining.
  • Phase III (12-24+ weeks): Advanced loading, functional testing, impact preparation, and return-to-sport training.

Rehabilitation was guided by tissue healing timelines, performance-based criteria, and psychological readiness. Shared decision-making informed return-to-sport planning.

Outcomes: The patient returned to daily and recreational activities by 5 months without complication. High psychological resiliency was maintained, measured via the Brief Resilience Scale. Key outcomes demonstrated progressive improvements in function, mobility, and strength: Date LEFS Figure-8 DF (knee to wall test) PF AROM INV AROM EV AROM PF Force (lbs) PSFS* IE 22/80 58 cm 0 cm 48 10 13 DEF 0/50 4/8/25 47/80 58 cm 4.5 cm 48 40 15 192 4/50 5/28/25 51/80 n/a 6.5 cm 54 38 17 251 n/a 6/16/25 61/80 n/a n/a n/a n/a n/a 332 25/50

*PSFS activities = running, biking, hiking, weightlifting, and soccer

Discussion:

This case underscores the impact of PTs across all phases of musculoskeletal trauma care. Early involvement in the ED can optimize initial management and prevent missteps in triage, plan of care development, and discharge planning. Throughout the rehabilitative plan of care, integration of objective performance measures, functional testing, and psychological support ensures a comprehensive patient management approach. This case further supports contemporary evidence that PT-led, individualized care from acute traumatic injury through sport reintegration can enhance and promote safe return-to-sport following complex ankle injury.

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Apr 14th, 9:00 AM Apr 14th, 11:00 AM

Early Touchpoint, Lasting Impact: Comprehensive Orthopaedic Physical Therapy from Emergency Department to Return-to-Sport

PUB NCR

Background and Purpose: Traumatic ankle injuries involving dislocation and fracture require coordinated, multidisciplinary care. Physical therapists (PTs) are uniquely positioned to influence outcomes across the continuum of care – from initial triage in the emergency department (ED) to rehabilitation and return to function. This case report describes the comprehensive management of a displaced fibular fracture with talocrural dislocation sustained during a recreational event at CSM 2025. The purpose is to illustrate a phase-based, evidence-informed approach to orthopedic trauma care, emphasizing the value of early PT involvement and individualized rehabilitation.

Case Description: A healthy student PT sustained a traumatic ankle dislocation with a displaced distal fibular fracture during a glow-in-the-dark dodgeball game at CSM 2025. The patient underwent open reduction and internal fixation (ORIF) within 12 hours of injury. Due to the involvement of PT pre-operatively, critical errors were avoided, and early post-operative management was enhanced. Rehabilitation was structured into three phases:

  • Phase I (0-6 weeks): Emphasis on protection, pain management, edema control, safe mobility, and maintenance of proximal strength and capacity.
  • Phase II (6-12 weeks): Initiation of weight-bearing, progressive ROM and strength training, and neuromotor retraining.
  • Phase III (12-24+ weeks): Advanced loading, functional testing, impact preparation, and return-to-sport training.

Rehabilitation was guided by tissue healing timelines, performance-based criteria, and psychological readiness. Shared decision-making informed return-to-sport planning.

Outcomes: The patient returned to daily and recreational activities by 5 months without complication. High psychological resiliency was maintained, measured via the Brief Resilience Scale. Key outcomes demonstrated progressive improvements in function, mobility, and strength: Date LEFS Figure-8 DF (knee to wall test) PF AROM INV AROM EV AROM PF Force (lbs) PSFS* IE 22/80 58 cm 0 cm 48 10 13 DEF 0/50 4/8/25 47/80 58 cm 4.5 cm 48 40 15 192 4/50 5/28/25 51/80 n/a 6.5 cm 54 38 17 251 n/a 6/16/25 61/80 n/a n/a n/a n/a n/a 332 25/50

*PSFS activities = running, biking, hiking, weightlifting, and soccer

Discussion:

This case underscores the impact of PTs across all phases of musculoskeletal trauma care. Early involvement in the ED can optimize initial management and prevent missteps in triage, plan of care development, and discharge planning. Throughout the rehabilitative plan of care, integration of objective performance measures, functional testing, and psychological support ensures a comprehensive patient management approach. This case further supports contemporary evidence that PT-led, individualized care from acute traumatic injury through sport reintegration can enhance and promote safe return-to-sport following complex ankle injury.