Phase I: Protection and Early Recovery (0–6 Weeks)

Precautions:

• Weight bear as tolerated with walking aids as required

• Avoid impact activities

• Avoid prolonged standing and excessive loading during the early recovery period

• Progress activity according to pain and swelling

Therapy:

• Oedema management and elevation

• Gait retraining

• Active knee and ankle range of motion

• Quadriceps, gluteal and calf activation exercises

• Straight leg raises and lower limb control exercises

Criteria to Progress:

• Wound healed

• Pain controlled

• Independent mobilisation

• Improving knee and ankle ROM

Phase II: Restore Motion and Progressive Loading (6–12 Weeks)

Precautions:

• Continue weight bearing as tolerated

• Avoid impact and pivoting activities

• Progress walking distance gradually

• Avoid overloading if pain or swelling increases

Therapy:

• Progress knee and ankle range of motion

• Closed-chain strengthening

• Balance and gait retraining

• Functional lower limb strengthening

Criteria to Progress:

• Functional ROM

• Minimal swelling

• Improving lower limb strength

• Independent gait

Phase III: Strength and Functional Recovery (12–16 Weeks)

Precautions:

• Progress loading according to clinical and radiographic healing

• Avoid running and impact activities initially

• Avoid abrupt progression of training volume

Therapy:

• Progressive strengthening

• Balance and proprioception exercises

• Functional lower limb rehabilitation

• Endurance exercises

Criteria to Progress:

• Clinical and radiographic progression toward union

• Functional ROM restored

• Improved strength

• Normalising gait

Phase IV: Return to Function and Endurance (4–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into impact loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation

Criteria to Progress:

• Radiographic union achieved

• Functional strength restored

• Full lower limb ROM

• Return to unrestricted activity

General Recommendations

Work:

• Office and sedentary work may resume after approximately 2–4 weeks depending on comfort and mobility

• Manual labour is commonly delayed until approximately 3–6 months depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Upper-limb exercise and non-impact activities may resume as comfort allows.

• Progressive return to gym and functional lower limb activities from approximately 8–12 weeks.

• Running, jumping, pivoting, contact sport, and impact activities are typically introduced from approximately 3–6 months or longer with full recovery and surgeon clearance.

Thromboprophylaxis

For this procedure, routine postoperative pharmacological thromboprophylaxis is not generally required. In selected cases, A/Prof Ernstbrunner and his medical team may consider prescribing thromboprophylaxis based on the individual patient’s risk factors and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.