Tibial Plateau Fracture Recovery

[SoccerGirl]

and... dancing is also still a bit scary with some of the movements, but I can generally enjoy it with no problem now (swing, ballroom, folk), which is awesome

It is still emotionally difficult to accept the leg and the loss of being able to freely do as I please (sports, etc.)...

I am really affected right now by the boston tragedy, wonder if any of you are too. Stirs up my own TPF trauma. So many lost their legs completely. So many of us whose bodies/ lives are senselessly changed in an instant. Heart goes out to everyone!

[Maker]

soccergirl, I had my 12 screws and 2 plates removed 9 months after my VI fracture...it was a non evident. crutches for two weeks.

I am two years out though and still cant run or walk up stairs very well though.

regarding the lump, is it on the front of your shin? If so, you shin may have herniated like mine which has nothing to do with the hardware. Think muscle poking through a sausage casing.

[krausedmb]

@nurse Nina and acwheel - I am interested to see how you do with hardware removal. I was hit by a truck while cycling last march and broke the plateau and head of femur while the thigh and calf muscles pulled the bone off. They reattached the muscles and bone with 2 screws and plated the plateau with 6 or so screws. I have mild dull pain in the knee every day and also have trouble coming down stairs. I have worked hard riding the indoor trainer and working out but it is still weaker than my right. The pain is livable, it is just annoying. I meet with my OS last week and he recommends we take it out. I am very apprehensive about going through another surgery and having to work so hard to get flexion and extension again. Now, my leg is definitely not as flexible as it used to be and I can't even kneel heel to butt without extreme discomofort. Keep us posted on your recovery and the differences between removal and original surgery. Best wishes
- Joel

[Talldoc57]

I was bike riding in Israel in July 2012 and did a foolish maneuver, crashed my bike and fractured my tibial plateau (non displaced, thank G-d.) The people there were fantastic, coming out of their homes to help me. The surgeon was excellent by giving me a removable splint and avoiding surgery. When I got home the orthopod agreed and just got me slowly back to function. It is now nine months and while I function more or less normally, my knee is very stiff and still hurts. Still can't get it to full -15 degrees hyperextension, but I keep working it with stretching, elevation (letting gravity work on it) the elliptical machine, plus leg extensions and leg presses in the gym. All of these posts where they are talking about a full year before complete return to function seem to be correct.... I only hope that it does return to function! The hard part isn't the healing of the fracture in my case.... it's lengthening the connective tissue so my leg can get to its full hyperextension. That hurts but I keep giving it hell....! Good luck to everybody !

[splat]

I was bike riding in Israel in July 2012 and did a foolish maneuver, crashed my bike and fractured my tibial plateau (non displaced, thank G-d.) The people there were fantastic, coming out of their homes to help me. The surgeon was excellent by giving me a removable splint and avoiding surgery. When I got home the orthopod agreed and just got me slowly back to function. It is now nine months and while I function more or less normally, my knee is very stiff and still hurts. Still can't get it to full -15 degrees hyperextension, but I keep working it with stretching, elevation (letting gravity work on it) the elliptical machine, plus leg extensions and leg presses in the gym. All of these posts where they are talking about a full year before complete return to function seem to be correct.... I only hope that it does return to function! The hard part isn't the healing of the fracture in my case.... it's lengthening the connective tissue so my leg can get to its full hyperextension. That hurts but I keep giving it hell....! Good luck to everybody !

Ever entertained the thought of getting some rolfing?

[Orthoski]

Still can't get it to full -15 degrees hyperextension

One of the issues that this thread raises is that, in recovering from any knee injury or surgery (which in some ways is just a controlled injury), we often focus on how far we can bend the knee. In actuality, it's getting full extension that's arguably more important and much harder to recover once the knee gets stiff. The reason it's so important is that the ability to lock the knee straight significantly decreases the energy of walking; if we're even a few degrees short of full extension, we rely on our quads to keep our legs from collapsing every time we take a step and this is a much less efficient process (try walking with your knees bent the entire time to get an idea of how significant a difference it is). Best of luck to you!

[LacyLou]

Ah, misery does love company. Found this forum and read it until 5:30 am. Hi, new girl here. Just a quick introduction. I fell from a galloping horse and collided with a fence post in October, you guessed it,TPF. I was taken to a local hospital where I was promptly stuffed into another ambulance and brought to a trauma hospital in Boston. It was determined that I had compartment syndrome and I was moved to the front of the line for surgery. Woke up with a fasciotomy and an external fixator. Had two more surgeries and was released 9 days later. One week after, I developed a fever and on Halloween was readmitted with a secondary infection of a pin site (released four days later with a PIC line). Visited OS 4 weeks later and a blood clot was found so I was put on Coumadin. That is my story and I am sticking with it.
I am now 6 months post op. Still on blood thinner but otherwise ok. Physically I am where most of you are. Stiffness, intermittent, spontanoeus pain, limp etc,... My concern is my mental state. I have dreams and flashbacks to the injury. I still have my horse and aspire to riding again but am understandably terrified after having suffered so much. A friend told me I may be suffering some post traumatic stress. Any one else have the same issues? Would love to hear from you.

[haggis]

Just found this site and its much better than any in the UK.

Broke my left TP skiing in Italy on 6th march ( 50th birthday !!)
End of day, coming to end of run, hit a very small mound which threw me off balance then caught an edge , when i landed the knee went out just like Lindsey Vonn !! No pain from two minutes after accident.
Depressed plateau by a lot plus the break, type ii shatzker, so needed bone graft.

Back in uk had to wait for swelling to go down before op.
Op was on the 18th march
Leg in plaster for two weeks then off for stitch removal
Still no pain !!
Plaster back on for two more weeks..
Plaster off and knee brace fitted, not used after two more days !!
PWB starts monday 30th april.
Not seen surgeon since stitches out, physio been light since plaster removal, start proper physio monday night. So far leg has full extension but only 50 degrees flex. Still no pain. !!
Surgeon was convinced that the op was so good he did not need to see me !!
Still amazed that i have had no pain , massage for soft tissue release has been usefull, all the other excersizes have been of little use so far. Trying to take it slowly but really keen to be up and walking quickly ..
Will post again with update.

[soonerstacy]

It's almost a year since the surgery. Plate and 8 screws still in. I'm having trouble with the fact that my affected leg is still substantially smaller than my normal leg. I keep working out and all that's happening is my good leg is getting a bigger quad. I try to do single leg presses with the bad leg but it still hurts my kneecap. My bad leg feels stronger but looks the same. Haven't yet seen the OS about having hardware removed. Kinda just wanna enjoy my summer and ignore the pain that occurs while working out. The pain is always just right on the center of my kneecap when bending or putting weight on the knee. Anyone else have that feeling? I think I can live with it though. :/

[Maker]

sooner, I had pain under kneecap for a long time after injury (and still do on leg extensions but I dont really do those). It is likely because your kneecap is not tracking straight due to quad atrophy. you have to get your VMO firing again and fix hip and glutes.

I could never gain strength on the leg press bc of knee pain. What helped was getting on a spin bike (not regular bike) and doing heavy resistance intervals....the spinning didnt hurt my knee and i started gaining strength in my quad (focusing on using the quad for the rotation). regular bike did not work very well. intervals were 1 minute off and 1 minute at heavy enough resistance where quad and hamstring were burning by end of 1 minute. started with 5 min warmup and then 15 min of intervals...now up to 40min in total.

also do not neglect the hip adduction and hip abductor machine at gym (the ones you never see guys on if you know the ones I am talking about)...you need to strengthen qlutes and hip muscles....also helps knee track straight. i spend a lot of time on those.

glute ham bridge is also good...google it. I do both leg and single leg.

that got me strong enough that i could start doing single leg press. took a while though.

also be mindful of your position on the leg press machine....foot placement should be high on the platform so you knee does not travel past the shin. and make sure you knee doesnt drift in when pushing weight....that also means you have weak hips.

i am 2 years out....i was in PT for 1 full year and didnt make the progress I have made in past 3 months on my own.

if the pain is by your kneecap I doubt it is from the hardware.

[soonerstacy]

Maker, thanks so much. I didn't have a very good physical therapist. By the time I was walking without a limp, my time there was done. This website seems to be really good for vmo strengthening. I will definitely try a spin class. And I always do the adductor/ abductor machines at the gym religiously.
I didn't really think the kneecap pain was related to hardware. Nor do I want to take a half day off work to have the doctor tell me basically the same thing you just said. Thank you again! I've attached the link for anyone needing it.
http://http://www.sportsinjuryclinic...ises/vmo-rehab

[Charlie11]

This site has been great. I want to share my story and advice.

I had a type 2 lateral break that required 3 screws. I hit a tree while snowboarding. I am 41 and very athletic. I ski, ride, swim, board, indoor rock climb and especially run (30-50 miles per week). I had almost no pain from the start. I was at 0 and 88 degrees ROM at 2 weeks. I was at 125 at 4 weeks and 135 at 6 weeks. I started PWB with only 1 crutch at 8 weeks. Some FWB at 9/10 weeks. Using a cane at 11 weeks. Next week (12 weeks) I will be without any support aids. My story/advice:
1. Get off of the pain medication as soon as possible. It is very additive and can really mess with your mind. Take Tylenol instead.
2. To sleep on your side, put a pillow in between your knees.
3. Request P/T from your doctor in the first few weeks. I started at 2 weeks.
4. Shop around for Therapists. Make sure they have experience with tibial plateau fractures. Make sure that you are going to see a certified P/T and not just a technician.
5. Start doing leg raises and bends as soon as possible. Lay on each side (left, right, front, back) and raise your bad leg 20 times per side, repeat 20 more, 3 times per day. Sit on the floor with a belt stretched around your toes on your bad leg. Very gently pull on the belt pulling your leg into towards you to work on ROM. 5 times, 3 times per day.
6. The P/T will work on (by rubbing and pushing) the tendons and muscles of your bad leg that are tight. This tightness is preventing ROM. My ROM would increase by 20 degrees from the beginning to the end of my session.
7. Use the brace only as protection. I took mine off to sleep at about 3 weeks. I stopped using it in the house at 5 weeks. I stopped using it altogether at 7 weeks.
8. Once weight bearing starts, the P/T working on the tendons and muscles of your bad leg will greatly improve your walking gait.
9. Work on your tight muscles and tendons at home with a rolling pin and/or foam roller. It will hurt when you are doing it but it will feel so much better afterward.
10. Work through stiffness and slight soreness. Do not try to work through PAIN.
11. Ice at least once a day, EVERDAY, until you are healed. I am at 11 weeks and I still ice daily. It helps.
12. Keep your leg elevated as much as possible. I have my computer box on the floor so I can put my leg on it as I sit at my desk.

Good Luck everyone. I plan to start waterskiing at 15 weeks and running at 6 months. I'll let you know how it goes. My story is only a sample size of one, but hopefully it helps. Reading about everyone else has helped me.

- Charlie

[qwerty77]

I fell off a pony in August 2010 and suffered a left tibia plateau fracture. I went home after my fall thinking i had just twisted it but the following day thought i better go get it checked out. The DRs in A&E also thought it was just twisted until it was xrayed! I had surgery and a plate and 6 screws inserted. For a long time it felt weak and unstable, and the ligament at the back of the knee was very sore. The surgeon said I didnt need physio but 4 months post op I went to see a private one to get some advice as it felt weak. 2.5 years on I still get a lot of pain, not all the time. Walking is fine, riding is ok 75% of the time but sometime i get pain using the clutch when driving, it can hurt walking downstairs, and it is agony if I knock it! I have been to my GP several times and get told this is perfectly normal and something i will have to live with. Personally i feel the screws have moved (you can feel 2 of them!) I can not bend it back 100% so things like kneeling down are impossible.
Pic before surgery- pic before surgery - pic after surgery -

[fncrutchesrnofun]

I'm 18 weeks out from a displaced tibial plateau fracture and still stuck at 4-6 degrees extension. Besides sports massage, active tissue release, and stretching I am also in a JAS brace 3-4 times a day to help gain full extension. Any suggestions??? So frustrated.. If I sit for even short periods of time and then get up it's like learning to walk again. My whole leg seems to be "jacked up" because of this abnormal gait.

[wilson737]

Awesome! Thank you so much. I am under the impression that they are leaving my screws in. I have not heard otherwise. I didnt need a plate. Here are my xrays...

Hi, Great photo's. Of real interest because I came too during my operation, when they were drilling, and could see screen (one camera's inside) and second x rays - my 2 screws look exactly like this. I had some questions and some may sound basic - fractured tibia plateau easter in Austria skiing. 2 weeks later had surgery in Italy (we live there) so I'm about 4 weeks post operative. No complaints but my Italian isn't up to technical medical speak - I'm doing some physio but see a physio tomorrow for a program. So far only able to bend knee half what I can other knee. Can't weight bear for another 4 weeks and wondered how you know how to do 25% initially? Is there some method they tell you about. Know I must really hit physio hard because want to ski next year. At moment I feel like my knee will never bend properly and if I let my foot drop to ground I feel really wonky. How quickly can you drive once you've passed non weight bearing phase? Do you think my recovery will be easier because I've only had 2 screws and most importantly (wish I had asked this). They told me they were putting screws in because the compression down on to Tibia from the Fibia meant the bone had dropped - How are two horizontal screws fixing it - presume there isn't an attachment above????? As I said lots of probably stupid questions - please forgive but I've had no real explanation from doctors here. What should I expect once weight bearing arrives? What did you find the best physio exercises? If anyone has any answers that would be great - cheers and thanks.....
Also I'm desperate to get back to playing tennis - if anyone similar how long do you think before I can get on court - sounds like a lot of people have problems running and its high impact

[wilson737]

Charlie
Love your post, love it if you could add more tips (I fractured Tibia Plateau skiing - compression down from fibia 2 screws in just below knee - currently I'm 4 weeks post op) Seeing physio tomorrow but so far haven't done much as living in Italy and language a bit of a barrier..... My physio is Swedish though and speaks English. Desperate to get back to tennis and ski-ing. Just done your physio as per number 5, so far knee about 90 degrees (slightly more if I sit on chair and slide knee on towel so it comes underneath chair).
any other tendon / muscle PT you can recommend... do you know methods to weight bear (8 weeks for me) ie. how do you know when you've put 25%down? I feel at the moment I'll never get motion back - knee so stiff, a bit swollen and if I go out get a swollen foot - any idea when this will improve? Have you tried cycling - I was thinking of buying an in house exercise bike. I let my foot rest on floor (no weight) and I feel really wonky and like I'll never be able to stand on it ? How did you find that.... sorry for all the questions, your post was so informative though and i'm feeling a bit isolated here on advice side - my fault for not being fluent in Italian. Thanks so much for putting your advice on.

[justathought]

I haven't posted here since March. My surgery was November 9, 2012. I have been full weight bearing since March. Progress has been steady but slow compared to some... My limp is gone, I walk up and down stairs without a problem and generally without using a railing. I do not run - causes pain - but an earlier injury had prevented running before this. My life is pretty much back to normal. All positives. However, it would be inaccurate to say that I am not aware of the injury. I feel it everyday. I still have swelling each night. And, unlike some here who have been able to "push" harder through the pain, my efforts to do that result in significant setbacks. I have found that for my type IV break steady but small incremental increases are the key to recovery. Six months out, every week still brings improvements. Recently, some days are good enough that I think there will come a day that I don't think about he knee. This forum and the Facebook group have provided a wealth of information and support.

[kayharley]

I just found this wonderful site .... thank you everyone.

I fell while doing something extremely stupid and I guess I was fortunate that my TPF was non displaced and only had to use an immobilizer for 6 weeks with no weight bearing and then slowly starting with PWB. At 8 weeks I was walking with a cane and my last xray showed that the fracture has closed and I was dismissed by my doctor without any PT reference. My ROM has been good because I was able to remove my immobilzer and bend my knee one week after the fracture.

I am now at 10 weeks and walking but with considerable pain and stiffness. What I find strange is that alot of the pain is in my toes and my foot not to mention the back of my knee. I am also trying to work on my gait because the limp is very pronounced but from what I'm reading here, recovery is a long process.
Any advice would be appreciated but it felt good to vent.

[Dagrin]

Found this site while googling TPF recovery, looks like a wonderful thread (only ready the first couple pages and the last page so far, I look forward to perusing it at my leisure.)

Yesterday marked the 4 week anniversary of the injury, tomorrow the 4 week anniversary of the surgery. Noy sure what degree of a TPF it was, but it was offset about 3mm, took a plate and 7 screws to repair, and, just for kicks, I broke the tip of the fibula too. WHEE!!

Luckily, pain have never been an issue for me with this injury..took a total of 4 painkillers in the hospital...mostly just so the nurses would leave me alone for a while, and 1 my first night out. Nothng since, not so much as a Tylenol...I either have a stupid pain tolerance (not likely) or have been lucky in the injury happening in a fairly non-painful fashion (more likely)

The feelings of helplessness/uselessness are the worst part of the situation (followed *very* closely by boredom), but I have to remind myself that:
a) each day is a day closer to being better, and
b) by the time I'm finished, I'm going to be better than I was before the accident happened, no matter how long that takes.

I've been working the flexion hard...probably around 125-135 degrees already, but am fighting to get extension more than a couple of degrees past 0, just something I have to keep at.

My poor calf is soooo tiny

Doing what I can with leg raises, etc to keep working the hips, and a bit of upper leg.
The amusing (to me) thing is that I can now sit up -> touch my toes better than I could before I broke myself.

Every day is a challenge to keep positive and to keep healing, but with the support of friends and family it's a challenge I keep passing.

*Hopefully* going to PWB in 4 more weeks..I'll keep scarfing my calcium and other vitamin/mineral supplements until I'm healed. One day at a time.

[gboisson]

Hey just wondering how you are doing now back to work as a firefighter??
I am at 7 months now and wanted to know as I am also firefighter with type 5 TPF so just wanted to know if you had any issues??

[Orion]

Hi,

I had my TPF April 14, I got hit by a sheep, yes.. A sheep. I entertained the ER all night with that story . I am 6 weeks post op ( ORIF arthro. Assisted ) with 2 screws and some sort of composite material to fill the gap. I've been non weight bearing since the injury, and I think I may go crazy! Not splinted, or in a brace and working on ROM ( no pt yet) was doing pretty good until this past week and seem to have a bit of swelling that is making it harder to change position... Just feels like I can't get anymore extension because of the swelling?
I also compete in dog agility, which involves a lot of sprinting, turning, changing direction.. Should I look for a PT that is more for sports injury and recovery? Thinking about walking and PT helps me not be so insanely bored and crazy!

[CLDrgon]

Hi
On May 26, 2013 I fell 20 feet off a ladder, bruised right ribs (painful but healing) and fractured my left tibia plateau. they wanted to do surgery the next day but due to the hardware already in place as well as the movement downward of the tibia the doctors felt it best to wait for 6 wks non wgt bearing. So I am off from work, doing strengthening exercises of the quadriceps and flexion of the foot. The pain is not the most baffling, it is not knowing what is going to happen after this time period but docs are not optimistic at all.
so i am hoping for a mini miracle at this point and want to remain positive. surgery was out of the question as they did not want to cost me any bone that may be needed if they have to do a full knee reconstruction.
since i had the half knee, i have been very lucky with no pain (maybe every once in a while). now after reading all of this and not hearing anything positive from doctors, i don't know.
has anyone out there had a half knee and then fractured the tibia right where the hardware is for that knee replacement. any advice would be welcomed at this point.
also have always been able to pick and choose my docs in regard to this but due to the nature of the injury i was assigned a doc. i know i can still change but want to wait until the 19th of June when my next appt is.
currently at home, with leg brace fully extended and of course non weight bearing so using crutches. i am healthy and tend to heal fast. i also worked out 3 times a week using spinner bike, ergometer for arms and shoulders plus weights and so forth.
Just wondering????!!!! if anyone is in the same situation.

[Olligator]

Orion - So sorry to hear about your injury. I had my TPF and surgery last October - plate, 7 screws and bone graft. NWB for 6 weeks, FWB 4 weeks later. I cautiously returned to agility class 3 1/2 months after the surgery and light competition a month after that. I went to a regular PT, but made sure he knew what my specific goals were. After I could walk in a straight line he watched videos of me competing so he could see what I needed to be able to do. We did tons of sidestepping, braiding, agility ladder, etc. The key to sprinting is definitely quad strength. OS suggested wearing a simple elastic sleeve to keep everything lined up and it helps a lot.
Next week will be 8 months since the surgery and I attend a weekly class with two dogs and trial twice a month plus some practice at home. I try to enter Friday and Sunday to give my knee (and my lower drive dog) a day off in between. It is working well so far and I definitely feel like I could do two days in a row now.
What breed of dogs do you have?

[Orion]

Olliegator- well that sounds promising for me! I was afraid I would be totally out of everything for a year. I have border collies( the reason I was with the sheep to begin with). Once I start pt I will make sure to layout my plans. I also play flyball, but I'm really afraid of that! Too many dogs running at once..I've seen many people go down.

[crm1978]

I found this thread today and am amazed at the information I've discovered about fractures to the tibial plateau. I fractured mine on the July 4th 2012 when my dirt bike got a little sideway and my leg git the dirt. I went from being a very active person which included running 3 miles a day to not being able to walk for six months. The day of the accident they put my leg in one of those negative pressure devices where they drill two holes in your femur and teo in your tibia an run a bar bar between them to pull the bones apart. They also made 12 inch incisions on both sides of my calf because the surgeons were afraid my leg would explode because of the fluid caused by swelling. I was in the hospital for a month waiting for the swelling to go down enough undergo surgery to repair the fractures. They sewed up one side of my leg but since it was still swollen they could not close the other side. Instead they grafted skin from my thigh onto the open wound. I also have twelve screws and two plates, one on each side of my tibia. I am running again, but not quite as long and fast as I was before and I still have a lot of pain all the time. I know it sounds superficial, but I'm just wondering if this "dent" in my leg will ever fill out. It has been 10 months since the graft. I attached photos, so anyone who has had a similar injury or knows anything about it, please post back!