Background: Distal femur fractures represent complex lower-limb injuries associated with significant functional impairment. Delayed initiation of physiotherapy following surgical fixation can lead to prolonged disability, joint stiffness, muscle weakness, and reduced quality of life.

Case Presentation: This report describes the rehabilitation of a 32-year-old male patient who sustained a comminuted distal one-third right femur fracture following a road traffic accident. The patient underwent open reduction and internal fixation (ORIF) with plates and screws. However, physiotherapy was not initiated immediately post-operatively, resulting in pain, swelling, restricted knee range of motion (ROM), and muscle weakness. The patient was referred for structured physiotherapy rehabilitation approximately two weeks post-surgery. On initial assessment, the patient presented with pain intensity of 4/10 on the Numeric Pain Rating Scale (NPRS), active knee flexion of 30°, passive flexion of 50°, and muscle strength graded at 2+ for the quadriceps and hamstrings.

Intervention: A four-week, progressive, outcome-based physiotherapy program was implemented, incorporating pain management modalities, continuous passive motion (CPM), joint mobilization techniques, progressive strengthening exercises, and functional retraining. Treatment was structured in weekly phases targeting specific goals including pain reduction, ROM improvement, muscle strengthening, and functional independence.

Results: Following four weeks of rehabilitation, significant improvements were observed. Pain intensity reduced to 1/10, active knee flexion improved to 100° and passive flexion to 130°. Quadriceps and hamstring strength improved to Grade 4. The Lower Extremity Functional Scale (LEFS) score improved from 28/80 to 65/80, indicating enhanced functional independence. The patient progressed from being bedbound to performing bed mobility independently, sitting unsupported, and initiating weight-bearing activities.