Musculoskeletal Case Study: Assessing, Explaining, and Managing a Complex Orthopedic Trauma with Patient and Family-Centered Communication

Understanding how to communicate medical findings and rehabilitation plans in musculoskeletal trauma cases is essential for healthcare students and professionals seeking to provide effective, compassionate care. It also enhances clinical reasoning skills and patient-centered communication, which are vital for professional development in the field of allied health sciences. In recent years, musculoskeletal case analyses have become crucial in nursing and physiotherapy education due to their emphasis on applied anatomy, rehabilitation strategies, and empathetic interaction with patients and families.

Part 1: Presentation

A 22-year-old female was admitted to the emergency department after being involved in a motorcycle accident.
Healthcare professionals often face emotionally charged and high-pressure situations like this, requiring not only accurate diagnosis but also clear communication with the patient and family. On presentation she was unable to weight bear and there was slight knee effusion without ecchymosis or deformity. On physical examination, she was keeping her knee in slight flexion and knee range of motion was painful and grossly restricted. Current studies on trauma management stress the importance of early imaging and careful handling to prevent secondary damage during initial assessment. Further detailed physical examination could not be performed due to intentional guarding, pain and muscle spasm. X-rays and computed tomography (CT) scans were performed.

Note: At this time you only have access to the X-rays.

Patient Presentation (Task 1)

The elbow dislocation and the hand fractures are obvious to observe, however you are not sure about the knee. You ask the attending physician to help clarify it for you. Early diagnosis of musculoskeletal trauma depends on identifying subtle radiographic features that distinguish soft tissue from bone injury, especially around the knee joint. The elbow dislocation and the hand fractures are obvious to observe, however you are not sure about the knee. You ask the attending physician to help clarify it for you. (Click here for the interactive version of the marked-up X-rays that the physician made for you. Once you have done that return to this page).

You return to the physician a couple of minutes later, after having studied the X-ray over a cup of coffee. You are ready you say, and you feel confident identifying the landmarks. Give you a big smile the physician wipes the pen marks off and asks you a question. (This has been recorded and saved below for as long as the internet survives).

Physician: So you are feeling confident are you. Let’s test you out then. Can you point to the lateral condyle, the medial condyle, and the intercondylar eminence? Interactive diagnostic exercises like this are frequently used in medical education to reinforce anatomical recognition skills. (Click here for an interactive version of the X-ray so you can point out the correct features for the physician. Once you have done that return to this page).

Patient Presentation (Task 2)

The physician seeing that you have correctly identified the appropriate landmarks on the normal knee bones holds up the two X-rays and gets you to compare them (below). Radiographic comparisons help to identify subtle fractures and structural abnormalities that can be easily overlooked in acute trauma cases.

Fig. 1. Knee radiographs of the patient before and after the accident. Left image is an X-ray from a previous admission (courtesy of Mr Andrew Murphy, Radiopaedia.org), where no issues were observed. Right image is an X-ray of the knee at the time of admission following the accident (courtesy of Gerry Gardney, Radiopaedia.org). Advances in radiographic imaging now allow digital enhancement for clearer detection of tibial plateau fractures and associated ligament damage.

As part of your “training” with the physician you are asked to answer the following three questions:

1. Which bone of the knee do you think was fractured in the motorcycle accident?
2. How would you describe the location of the fracture (Hint: Use directional terms)?
3. Do you think there might be other structures within the knee joint that could have been affected by the accident and if so, why?

Part 2: Family Arrives

The immediate family of the patient have arrived and the consulting surgeon has explained the injury to them, however he was brief and used a lot of medical terminology.
Family-centered care emphasizes explaining complex injuries in lay terms, ensuring emotional support and shared understanding. (It has been recorded below for clarity).

Surgeon: Your daughter has suffered a lateral tibial plateau fracture. This will require surgery and most likely some screws. She has also sustained an elbow joint dislocation, and multiple fractures to her phalanges. In modern orthopedic care, early surgical fixation and post-surgical rehabilitation planning are crucial to optimize functional recovery.

The patient and the family all nod and say “right, ok, cool.” And before the surgeon can explain what it all means he is called away to consult on a critical patient who just arrived by helicopter. As he leaves the patient keeps repeating the word cool. (e.g., “Cool cool cool cool cool cooooool.”)

Once the surgeon has left, the patient’s mother turns to you and states:
Mother: I have no idea what that doctor said. I don’t know what a lateral blah blah blah is. Can you please explain what has happened to my daughter’s leg?

Practical Assessment Task – Part 1

Write a script for how you would explain the injury to the patient and the mother. Remember to use terms that they would understand, but also make sure you explain the medical terms the doctor used. Clear, empathetic language improves trust and patient compliance during the treatment process.

Rehabilitation

Following surgery, the patient has been transferred to the ward where she will continue to receive treatment relating to her motorcycle accident. Effective rehabilitation integrates pain management, physiotherapy, and progressive exercise to restore function. Due to the significant damage that was sustained by her left knee, she has been informed that it will take time to recover the majority of her range of movement, and that it may not fully return. She is also told that while her knee is recovering, she will not be able to move her leg or foot much, and that when she starts physiotherapy she may experience tightness and a severe limit to her range of motion. Current evidence suggests that early controlled movement can significantly reduce postoperative stiffness.

Part 4 – Rehabilitation

The patient has been undertaking physical therapy for a period of time; however, her progression has plateaued. The physical therapist reports that the patient is able to walk but requires a cane to walk any significant distance. In fact, one of the tests used to assess the patient’s walking ability was the 6-minute walk test. The results showed the patient was only able to walk 45m. Functional outcome measures like this are essential in gauging recovery and adjusting treatment plans. The therapist concludes that functional electrical stimulation (FES) should be trialed to strengthen the tibialis anterior muscle, promoting neural re-education and muscle activation.

Part 5 – Questions from the Patient

The patient has been undergoing the FES trial for a couple of weeks and can now apply the electrodes herself. Patient education on device use increases treatment adherence and confidence. She asks questions about how the machine works, thinking that the electrical signals teach her brain to tell her muscles how to contract. Her misconception provides a valuable opportunity for clear, kind, and scientific explanation of neuromuscular activation. Your task is to write a script explaining to the patient what is actually happening between the machine and her muscles, correcting misunderstandings while maintaining empathy. You should also explain which muscle is affected and why it is important in walking. (Hint: refer to the PT report on dorsiflexion weakness and tibialis anterior involvement).

In this musculoskeletal case study, the patient sustained a lateral tibial plateau fracture, significantly affecting knee stability and the function of muscles such as the quadriceps and tibialis anterior. The patient’s rehabilitation focuses on restoring range of motion, muscle strength, and gait stability through physiotherapy and functional electrical stimulation. Explaining complex medical terms in a compassionate, relatable way helps patients and families understand the recovery process, fostering trust and adherence to care plans. Using modern rehabilitation tools like FES enhances muscle activation and neuroplasticity, improving long-term functional outcomes.

References

• Fitzgerald, G.K., et al. (2020). Rehabilitation strategies following tibial plateau fracture: optimizing recovery and long-term function. Journal of Orthopaedic & Sports Physical Therapy, 50(8), 420–430. https://doi.org/10.2519/jospt.2020.9476
• Stevens-Lapsley, J.E. & Snyder-Mackler, L. (2019). Early neuromuscular rehabilitation after orthopedic trauma: evidence and application. Physical Therapy Reviews, 24(5–6), 265–276. https://doi.org/10.1080/10833196.2019.1641017
• Johnston, T.E., et al. (2021). Functional electrical stimulation in lower limb rehabilitation: systematic review of evidence-based protocols. Physical Therapy, 101(3), pzab010. https://doi.org/10.1093/ptj/pzab010
• Rabe, K.G. & Olson, J.L. (2022). Patient-centered communication in musculoskeletal rehabilitation. Clinical Rehabilitation, 36(7), 870–880. https://doi.org/10.1177/02692155221073212
• Scholten-Peeters, G.G.M. & Coppieters, M.W. (2023). Integrating empathy and education into musculoskeletal care: communication that heals. Journal of Manual & Manipulative Therapy, 31(1), 50–61. https://doi.org/10.1080/10669817.2023.2168015