Post-surgical rehabilitation of a rare variant of Guillain-Barré syndrome: acute motor axonal neuropathy with distal tibial fracture

Abstract

Introduction: Guillain-Barré syndrome (GBS), particularly the acute motor axonal neuropathy (AMAN) variant, presents with rapidly progressive motor weakness and often requires prolonged rehabilitation. Orthopaedic complications in such cases are rare but can increase management complexity. Objective: To report the post-surgical rehabilitation of a patient with GBS/AMAN complicated by a distal tibial fracture and to highlight the effectiveness of a structured, interdisciplinary rehabilitation approach. Methods: A 31-year-old male with AMAN/GBS, complicated by respiratory failure requiring ventilatory support, sustained a right distal tibial fracture during rehabilitation. The fracture was surgically managed via closed reduction and intramedullary nailing. A 12-week structured rehabilitation program was implemented, beginning with early respiratory exercises, pain management, and passive joint mobilization, followed by progressive weight-bearing, muscle strengthening, proprioceptive training, and functional gait practice. The final phase incorporated resistance exercises, dynamic balance, and task-specific functional activities. Functional outcomes were assessed using the Barthel Index, Functional Independence Measure (FIM), and Berg Balance Scale (BBS). Results: The patient achieved substantial functional improvement. Barthel Index increased from 16 to 90/100, FIM from 59 to 106/128, and BBS from 4 to 15/56. He regained independent ambulation with minimal assistance, improved postural control, and could perform most activities of daily living safely. The outcomes demonstrate that early mobilization and progressive, individualized rehabilitation can overcome both neurological and orthopaedic limitations. Conclusion: This case highlights that structured, multidisciplinary rehabilitation program can achieve meaningful functional recovery in GBS complicated by orthopaedic trauma, emphasizing early mobilization, strength restoration, and balance training.