Tibial Plateau Fracture Recovery

So now that I am weight bearing the physical therapist has been doing more strengthening exercises with me. I have also been working on transitioning more weight onto the bum leg. Its psychological at this point. I just don't trust the knee. At physical therapy the pt had me try to put all my weight on the bad leg. Just as I got the good one up, the ankle on my bad leg gave out. Needless to say I was surprised it was the ankle and not the knee that gave out. So now not only do I not trust the knee, now I don't trust the ankle. The never ending injury!! Who uses compression socks to control swelling? What kind and how high (above the knee or below?).

Greg33, I use the compression sock for swelling. I got it at Walgreens in the diabetic section. It's the one that goes up just below the knee.

Oh and I love it! Works sooooo well!

Thanks Skigramma, I had my first OS appointment Tuesday, 11 days post op. I have an Equinus contracture due to the imobiliser not allowing my foot to move, my leg was bandaged from thigh to toes. I was changed to a Donjoy rom brace locked at 0 extension and 10 degrees flexion. I had to get fitted for an AFO, the clowns that fitted it wanted me to bend my knee and then took the brace off and unlocked it. My husband soon put them straight, anyhow I go back to the clowns next week to get the AFO. Other than that I am pretty much the same, except the itching is driving me insane. Hope everyone is having as good a day as you can when confined to " house arrest "

well, i'm at 8 weeks now, and i actually did walk a few steps yesterday, and while my leg didn't hurt, it was just soo weird. idk i'm still gonna wait some more though, just in case bc i don't really trust my knee yet. anyway, if you any of you have a tv subscription for hbo or max, hbogo and maxgo have been holding me over bc i don't have netflix. just started season 3 of true blood!

Hi - I'm having the same troubles! ughh. The OS released me to PTW up to FWB as tolerated yest. I'm having the same trouble and I couldn't do one crutch it felt way too unstable. I feel like I'm still baby'ing it b/c I'm not sure what 50% is supposed to feel like. Tried standing too but I know I'm relying on my good leg for that as well. Are you having any progess? I was so excited and now I feel let down.

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Originally Posted by soonerstacy

Has anyone had experience using one crutch, and 50% weight bearing? Physical therapist told me it was safe, but I feel like its hard to gauge what 50% wb feels like with only one crutch. After she taught me how, I went back to two crutches. Like I feel too wobbly or that I'm doing more than 50%. Don't wanna mess it up now...

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Another new TPFX member...

What a great thread.. I just spent the last week reading through the ups and downs... very emotional

I have played regular and adventure sports for last 25 years. Thought I was kind of invincible after some nasty I tumbles on trails, snow, ice, dirt, cement, etc, so it pains me to have hurt myself this way.

Now 36 y.o male... After coaching (and scrimmaging) my daughters soccer team for 2 years, I thought I should join an Adult league. I played div 3 college ball, couldn't be so bad... chest trapped the ball, brought down, fake out defender and then tried to alter my sprint about 30° and collapsed. My right shin was far too much to the right after I tried to get up. Could only roll around in amazement.

that was Tues night at 10:30, June 6.. found myself after 2 hospitals in northern VA in an ex-fix until second surgery June 20. 2 plates around 15 pins, nwb and no brace. PT was started about July 10 and I believe I was told to go immediately. So I went.

I had never heard of anyone with this injury prior to me. But this thread has been a bit therapeutic. I totally relate to all the physical and emotional crap for the past 5 weeks.

Been working from home via laptop and BB, so very lucky to have great bosses. Went in a couple times, but was very exhausting for me on meds. Just been 2 weeks off ms contin and neurontin and very glad to be off.

-Jon

It took me about a week and a half of pt to get my muscles warmed back up a little. Then one day I felt up to the challenge of using one crutch. Some days are better than others. When I went down to one crutch I had done foot and ankle pain, but it's gotten better. Try it maybe for half a day Deena. By the end of the day I sometimes go back to two, because of soreness.
I've got one more week, then hopefully it's full weight bearing!! woohoo on Monday it will be 12 wks post op. Got back on my horse tonight for the first time. He was happy to see me :)

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Originally Posted by itsdeenah

I'm not sure what 50% is supposed to feel like.

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One of the best ways to think about 50% PWB is like when you're just standing in place pre-injury - half of your weight is on each leg. As you walk, it becomes a little trickier because any times you lift up the other leg, all your weight is on the leg that is left touching the ground. While bearing in mind what it felt like to stand in place with both feet on the ground, try to approximate that weight while walking through with both crutches (easier than one). Resist the urge to accelerate the weight-bearing beyond your surgeon's recommendation. Best of luck.

Can anyone tell me if foot swelling goes down with WB?

Extremely urgent its time for decision
I am from india
I am 24 years old male
i met with an accident one year ago on 14/07/2011
and my leg right tibia and fibula were fractured
and the orthopedic surgeon fixed
ORIF right proximal tibia with locking plate
but till now the fracture was not healed and am able to walk with the help of elbow crutches is already 12months
the x-rays were same there is little difference in the X-ray which were taken in the period of every month
some doctors were saying need bone grafting
and some doctors saying is healing
last month the doctor advised me to walk with out any support
I did the same and after 4 weeks the plate side is pain
I am not having any pain I can walk up to 2 km with out any support.
After that I anm unable to walk because of pain and met with the doctor and he taken ct scan and the ct scan report was
The radiologist given report as
Status of post operative plates and screws are noted in tibia
Old fracture proximal tibia shaft of right tibia is seen with sclerosis along the fracture borders
With 5 mm gaping noted. Minimal callus seen antero-laterally. As compared to fibula callus formation is less –suggestive of non united fracture.
The doctor said fracture was not healed and he did bone grafting
NOW ON 26/6/2012 I HAD ONE WITH BONE GRAFTING SURGERY
the same right proximal tibia
with autologus+autogenes bone graft
now I am taking rootcal tablet
doctor advied to non weight bearing for 6 weaks
my question is what is the time required to heal the fracture after keeping bone grafting
and what can be done to speeden the fracture healing
and is there any method to fasten the fracture healing

Sounds like you went on to an atrophic nonunion after your original surgery (your bone just didn't start healing across the fracture site) and therefore you required some bone graft, which I assume they took from your hip (iliac crest). That's arguably the most definitive surgery for a nonunion (taking your own bone from your iliac crest), and hopefully it'll do the trick. I wouldn't rush weight bearing (a locking plate is not a load-sharing device) and there isn't much you can do to accelerate healing beyond making sure you're taking enough calcium and vitamin D. Best wishes!

I wrote initial intro post... don't know where it is... so here is short test.

6/6 fx'd inside left TP of right leg and got ex-fix for 2 weeks.
6/20 surgery 2 plates and 10+ pins.

-jon

Hi everybody, when I had my Tibial Plateau Fracture I started reading this thread all the way back on page 1 and I have learned a ton! Now it is time for me to pay it forward. Sorry for the long posts but I have a lot I would like to share. Here’s my story:
Back in April I was in Alaska with a couple of days off so I went skiing. On the first day, first run, third turn I lost my balance and fell and rolled. In the roll the back of my ski got stuck in the snow while I continued rolling forward and the first thing that gave way was my Tibia. Result is a very typical TPF pattern: depressed Anterior Lateral fracture, Menial Meniscus damage and a partial MCL tear.

If you’re not sure what exactly is going on with a TPF, in layman’s terms my explanation: a shard broke off from the outside of the Tibia, in my case on the forward outside. Then, the next time the Femur came down it hit the top of the Tibia but just like in a house with a wall removed, the roof caved in under the pressure. In the case of the Tibia, the roof actually shatters like glass. The other side of this Tibia Plateau now has to carry the whole load and the cushion between the Femur and the Tibia, called the Meniscus, can tear from the pressure. Also the rubber band that holds everything straight running along the outside of the knee will then get stretched and tear. And that’s the MCL tear. During the surgery, the Orthopedic Surgeon will put the shard back where it belongs and secure it in place with a plate and screws. Then he’ll drill a hole into your bone from the opposite side so he can tap all those ceiling pieces back into place. Then he will backfill the hole with a putty made from grafted bone. Lastly he stitches everything back together and tells you not to stand on it for a while – a very long while!

As for the recovery, I have been very fortunate and have beaten my doctor’s expectations. For the first 6 weeks I treated my knee as if it were made of glass: avoid all pain and pressure. At the 6-week follow-up visit, the X-ray showed no sinking had occurred and there was so much new bone growth that he released me to build up to FWB over the next 2 weeks. And at the 10-week follow-up he declared me no longer disabled so I could finally go back to work. That doesn’t mean I’m back strength wise, that’ll be many more weeks but at least the bone is strong again.

Time line:
04/16 Zig, zag, crack
04/24 Surgery; plate, 7 screws, and arthroscopic meniscus repair
06/06 (6 weeks) PWB, build up to FWB over the next 2 weeks
07/09 (10 weeks) no longer disabled, back to work.

Picking an Orthopedic Surgeon (OS): I think it is very important to pick a surgeon that you trust and that has a good track record in TPF surgeries. It is your knee and you have to live with it for the rest of your life. If you pick the first guy out of the yellow pages because he’s close, you’re risking your ability to walk without a limp for the rest of your life. And besides, you will only visit him once every couple of weeks so is it really that big a deal if he’s a couple hours drive away? It’s no guarantee but hey, I’ll stack the deck into my favor any way I can. I picked mine based on recommendation from someone I know and trust and he’s a 2 hour drive away. Turned out to be an excellent decision because he did a great job, I think. In your pre-surgery interview, ask how you can communicate with him between visits if you have a question. My OS has a Physician Assistant (PA) who’s my information conduit to The Big Man. At one point I even had a FaceTime call on my iPhone with the PA, showing him my knee and ankle from a hundred and fifty miles away so he could see for himself.

Physical Therapy (PT): This person you will see much more often than the OS. Even if you don’t have insurance I think it would be wise to visit with a PT a couple of times: first about 1 week after surgery, then when you go to PWB, and again when going FWB. They can show you which exercises you can do and how to do them properly. If you call them and explain the situation, you may be able to negotiate a rate comparable to what the insurance companies pay, which can be as low as half of the walk-in rate.
I started going one week after the surgery, initially 1-2 times a week and then, when PWB and FWB 3 times a week. If you can find one with a pool than great because pool walking when you’re PWB is a great way to rebuild your strength (more about that later).

Disclaimer: Now, I am not a doctor, physical therapist, or nutritionist or anything so please talk to a professional about what you should and should not do but here’s what I did and it worked for me.

Drugs: First thing to do after the surgery is to get off the drugs and that’ll take a couple of days. If you can, replace the painkillers with Tylenol. Avoid NSAIDs like Aleve and Advil. According to my OS, they inhibit bone growth and hey, that’s why we’re here right?
Be aware of Deep Vain Thrombosis (DVT). This is a blood clot that can form where blood stagnates, like in a leg that isn’t used. To prevent this, move your ankles up and down a number of times and tightening your lower and upper leg muscles. Basically as often as you can remember to do this but at least once an hour. You can set your watch to beep every hour as a reminder, for example. You should start this while still in the hospital and continue doing it until you’re PWB. If you need to travel or sit with the leg lowered for extended periods of time, or if you’re going to fly, an Aspirin can help reduce the risk of DVT.

Scarring: Rub Vitamin E lotion on your scar daily starting at 2-4 weeks post-op to help minimize the appearance of the scar and avoid direct sunlight on the scar tissue, as it will darken permanently. But a little sun on the rest of your skin is good because it will enable your body to turn the vitamin D into bone-building material, my OS explained me. I don’t quite understand how so don’t ask.

Shower & Tub: It is OK to get the wound wet in the shower, but not to take a nice long bath or a swim until the wound has closed completely (4-6 weeks). I have a tub with showerhead and after sitting in the dirty bath water for a week I smartened up. I bought a shower stool at Amazon for $30 and a handheld showerhead. That way I could sit on the stool and shower myself down. As for going to the pool: it is a good exercise tool but again my PA warned me to wait until the wound has closed. The last thing you want at this stage in the game is an infection.

Sleep: Forget about it. Sorry, but I have read this many times on this forum and I suffered from it too. I had my OS prescribe me sleeping pills and even with these pills I was only able to sleep about 1-2 hours at a time. This can last several weeks but don’t worry, it will go over and you will be able to sleep through the night again.
And that annoying brace! Well, my PA came to my rescue here and explained that the brace is to keep the knee from twisting and to take the load if you accidentally put weight on your leg. When you’re laying in bed neither one is a problem so he OK’d me to sleep without the brace three days after the surgery. Now you see why it’s a good thing to get your OS’s email address?

Nutrition: Initially I added 4 glasses of milk per day to my regular diet but later on I replaced this with 1200mg Calcium and 5000IU Vitamin-D supplements on my OS’s recommendation. For muscle (re)building I drank 2 protein shakes per day right after exercising. I would just buy large containers of whey protein at the supermarket and mix my own, much cheaper than individual shakes.

Swelling: RICE = Rest, Ice, Compression, and Elevation. All four help to reduce the swelling. Now 14 weeks post-op, my ‘bad’ knee is still larger than the ‘good’ one and the OS told me it’ll take a couple more months before all the swelling will be gone.
Rest - Good thing the OS doesn’t allow you to put any weight on the leg, right? Rest: Check! But if you keep the leg lowered for any period of time and also later on when you are weight bearing, you can expect the knee to swell up after exercise.
Ice is your big friend. Not only does it help but it feels great too. I still ice up after my daily exercises. If you’re using ice cubes then no longer than 20-30 minutes per hour to prevent skin freezing. Ice packs usually won’t hold their cold any longer than that either. There is also a machine out there that will pump cold water around your knee that you can use 24/7, the Game Ready. Your OS may be able to write you a prescription for that. I didn’t use it myself, just passing on what I discovered.
Compression is very effective to temporarily reduce the swelling. I bought compression socks and a compression knee brace. Be aware that the fluids you push out go somewhere else. So if you only wear a compression sock, your knee may swell up. I had it with the knee brace without the sock: my lower leg would swell and it would start throbbing after a while. The compression knee brace did help me when I started to walk to help prevent knee buckling.
Elevation is my OS’s soapbox issue. After having been lectured about it Ad Nauseum: if you’re elevating, your knee should be 1-2 feet above the level of your hart for fluids to flow back into your body. Yes, feet! This means flat on your back with a large box or suitcase under your leg.
My daily routine the first six weeks: 3 x day exercise for about 1.5 hours, then 30-45 minutes flat on my back elevated, iced, and resting. That is 6-7 hours each and every day! The rest of the day I made sure the leg would be raised whenever possible. Newsflash: you are disabled. Getting back to normal is going to be a full-time job.

This is turning into a huge story so I’ll break it up into a couple of pieces. My next post I’ll tell you what exercises I did while non-weight bearing.

Anyone know how long it takes mods to approve posts? Written 2 long stories over past couple days...

Welcome to the board.

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Originally Posted by global_dev

I wrote initial intro post... don't know where it is... so here is short test.

6/6 fx'd inside left TP of right leg and got ex-fix for 2 weeks.
6/20 surgery 2 plates and 10+ pins.

-jon

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Originally Posted by peaton

Welcome to the board.

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thx, you all have been a great help to me over the past week when i found this thread. i wrote up 2 decent long posts, but they seem to have disappeared into the forum ether.

Thank you~ I took your advice Sat. morning & got up the courage to drop to one crutch..just 1/2 day like you said by around 3:00 pm it was aching. But at least some progress finally. It still feels tingly when I take the first steps but much better I can carry things now yay! Very glad to hear you rode your horse thats awesome and I bet it felt great!!
Cheers to reaching some much needed milestones!! :)

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Originally Posted by soonerstacy

It took me about a week and a half of pt to get my muscles warmed back up a little. Then one day I felt up to the challenge of using one crutch. Some days are better than others. When I went down to one crutch I had done foot and ankle pain, but it's gotten better. Try it maybe for half a day Deena. By the end of the day I sometimes go back to two, because of soreness.
I've got one more week, then hopefully it's full weight bearing!! woohoo on Monday it will be 12 wks post op. Got back on my horse tonight for the first time. He was happy to see me :)

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Where did you all find about PWB with crutches. I hurt rt leg and would have thought crutch under right arm, but that's not the case, huh?

@global_dev
My PT instructed me for PWB with one crutch - if it's your right leg you crutch under your left arm using the crutch and your right leg at the same time then swing the good foot (your left) by itself. Same thing with the stairs first up with the good foot and down with the bad foot. At least thats whats comfortable and feels safe for me. Plus I need a railing for the stairs to hold onto and provide support. Good Luck with it and keep safe!

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Originally Posted by global_dev

Where did you all find about PWB with crutches. I hurt rt leg and would have thought crutch under right arm, but that's not the case, huh?

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Soonerstacy...Congrats on getting on your horse. I am still just kissing, petting and giving treats. I hope to be light riding in the arena mid to late fall.

Keep up the good work!

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Originally Posted by soonerstacy

It took me about a week and a half of pt to get my muscles warmed back up a little. Then one day I felt up to the challenge of using one crutch. Some days are better than others. When I went down to one crutch I had done foot and ankle pain, but it's gotten better. Try it maybe for half a day Deena. By the end of the day I sometimes go back to two, because of soreness.
I've got one more week, then hopefully it's full weight bearing!! woohoo on Monday it will be 12 wks post op. Got back on my horse tonight for the first time. He was happy to see me :)

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Can anyone tell me if foot swelling goes down with WB?

Since it looks like my first 2 intros are lost... here goes again! Interior tibial plateau frx of right leg.

I'm Jon, 36 y.o. male. 6ft,210.. I've been skiing,snowboarding, mtn biking,climbing,hiking for years. Some great times and a few spills, but nothing ever serious. That's what makes this injury so ironic. Played soccer through university and then took a break and 3 yrs ago started coaching my daughters team and ran around with them no prob. Decided to join an adult league and was excited to get back into it.

First game at 10pm on Tuesday in early June and warmed up for an hour practicing tricks sprints... game finally starts, I am running around... chest trap ball, fake out a defender, zig and then zag with the ball and on the zag, heard a crunch and collapsed. Lower leg was offset from usual and couldn't move...

From first hospital to second at around 2am... woke up to an ex fix which I wore for 2 wks, internal fixation at end of June ... no brace, only bandaged. 2 plates, 10+ pins..

Working from home since then, thankfully... sent my 2 daughters away indefinitely, 3&7, since I was killing their summer and my wife's. Luckily their grandparents are awesome and have made their summer very great and memorable. This was a sad, but needed, decision to make.

Been in PT since Wk3, improving rom and muscle use... still NWB nd coming up on wk 6 tomorrow and OS appt on Friday. Hoping to get to at least pool okay from doc and maybe pwb as leg feels decent, but while I want to push through, I don't want to reinjure.

Thanks again as reading this thread has gotten me through week 4 which was a bit depressing as all settled in to how long and emotional this injury in recovery can be.

Jon

[thank you for the replay
the doctor said that one side of the bone is healed an other side is mussel formed and
i want to know that what is the healing time of the fracture after keeping bone grafting

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Originally Posted by scjohnson07

Can anyone tell me if foot swelling goes down with WB?

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Are you wearing a compression sock? If so, what mmHg type?