Tibial Plateau Fracture Recovery

[Steff87]

Hi everyone, just found this thread and looking for advice.
I am 26 and I shattered my tibial plateau which has been plated and pinned. I am now almost at the 3 month mark. I have started weight bearing and doing all the exercises my physio has been telling me to do, and trying to resist the urge not to overdo it!
I had a bit of bad news when I went to see my Orthopaedic doctor Thursday, instead of being told that I could continue to work towards full weight bearing they said this could just be the beginning.
The tilt of my plateau instead of going downwards is now going upwards which he said could cause instability in my knee and therefore need more operations.
Before I was told this I have been telling my physio that when I straighten my leg is seems to over-straighten and also I feel like my knee will collapse at any time. We both put it down to lack of muscle strength but after the news from the x-rays its seems otherwise.
Just wondered if anyone has experienced a similar sensation and if it improved upon building the muscles back up?

Really appreciate the comments, and its nice to be able to speak with people who knows how difficult, frustrating and sometimes depressing it can be.

[ileneroberds]

Hi everyone, just found this thread and looking for advice.
I am 26 and I shattered my tibial plateau which has been plated and pinned. I am now almost at the 3 month mark. I have started weight bearing and doing all the exercises my physio has been telling me to do, and trying to resist the urge not to overdo it!
I had a bit of bad news when I went to see my Orthopaedic doctor Thursday, instead of being told that I could continue to work towards full weight bearing they said this could just be the beginning.
The tilt of my plateau instead of going downwards is now going upwards which he said could cause instability in my knee and therefore need more operations.
Before I was told this I have been telling my physio that when I straighten my leg is seems to over-straighten and also I feel like my knee will collapse at any time. We both put it down to lack of muscle strength but after the news from the x-rays its seems otherwise.
Just wondered if anyone has experienced a similar sensation and if it improved upon building the muscles back up?

Really appreciate the comments, and its nice to be able to speak with people who knows how difficult, frustrating and sometimes depressing it can be.

I had a similar issue, but not with overdoing it in PT. The upper left part of my fracture wasn't placed correctly the first time I had surgery. I had to have surgery redone 2 weeks later. Although the surgery has been redone correctly and I am nearly 7 months in recovery, it still feels as though my knee is going to give out at any time. Not to mention I still have a limp when the weather is cold. I have learned to cope with it, but I'm not sure if that's the right attitude to have. I'm curious to see what your doc says. I don't see my doc again until April, but maybe I will need to go in sooner...

[ileneroberds]

I'm 7 months in recovery. I wonder if I'll ever feel normal again. Still can't bend my leg very far and kneeling is totally out of the question. My ankle still swells on a daily basis, not horribly, but swelling is constantly there. I walk around and still hobble everywhere I go. Anyone out there have a little insight as to how long this recovery will take? The cold weather in Utah certainly isn't helping either. UGH!

[kmrrdb]

ileneroberds
I am 15 months from my surgery. I had a displaced and depressed TPF. Was NWB for 3 months and wasn't really walking comfortably until month 4. I still am making progress but have had a few steps where my knee feels unstable and then the next day it feels strong as ever. I have chosen to leave my hardware in, doesn't seem to bother me even on cold rainy days. I was told this is a 2 year recovery before you feel "normal". For me I just compare it to my good leg and it still isn't close but I think is mostly strength differences. I don't get swelling at all anymore. In my 13 month, I played 36 holes of golf two days in a row without swelling or significant pain so it gets better, just takes a while. Continue PT, get to the gym and if possible get in a pool and build strength back that way.

[kmrrdb]

If any one is frustrated with standard crutches. I switched to Mobilegs Crutches during my 3 months of NWB. They were great and took away a lot of the aches and pains. Still have mine but don't need them anymore and willing to sell at half the price. Private message me if interested. Thanks,

[Cass.]

Hi All, have seen this thread before and it's fantastic to see everyone's experiences with tp fractures and their post op recoveries. I thought I would share my experiences as I'm now 2 and a half years post injury....

It all started back in June 2011 when my horse fell on top of me on a bitumen road. I received a depressed crush fracture of my medial tibial plateau (I think it's a grade IV fracture) and obviously fractured my fibula as well. Was in hospital for a week before surgery then it was plated and screwed. They were concerned that there was laxity in my joint so did warn me that they would probably have to do a recon down the track. Sure enough I had gross instability and had the hardware removed 6months post op followed by an Acl reconstruction, meniscus repair and they noted at this stage that there was also laxity in my pcl but didn't repair it as they generally aren't required.

During this time I had developed a few side effects. Obviously the common one which is loss of sensation down the centre and outside of my calf, unable to kneel and can't squat low but the random one was the sympathetic nervous system damage. This started a few weeks after my first surgery when the foot on my damaged leg would swell, go blue and tingle. This would then spread up my leg. I had scans which cleared me of clots and they suggested it was just a normal post op problem. This resolved and was fine until about 7-8 months after the injury when both feet started going blue and swelling. I had a lot of work up done just in case but they put it down to sympathetic nervous system damage which may or may not resolve.

About 12months post op they were surprised by how much instability I had and I was obviously still limping quite badly. He was sure I'd ruptured my pcl so that needed to be reconstructed and he was concerned that I'd redone my Acl so with that it was off to another surgery! About 16months post injury they did surgery#4. For this they did a pcl recon but left my Acl alone as it was only partially torn thankfully. So lots more physio and hard work to go.

Now a recap on where I'm at and the issues I'm having now. I'm back to normal with my horse riding (I do endurance riding), I'm working hard on my running and have recently stepped up to running 10km which I am so so happy about. I cant run 2 days consecutively which is fine but also cant go for more then a week without running or I lose my muscle mass and control. I still can't kneel or squat but you can get around that ok. I am mostly pain free and only now and then get pain. I still have the problems with my feet, so can't wear heels of strappy shoes. All in all I'm extremely happy with where I am at. It does get better and as frustrating and painful as it does get you do need to know that it will get better. You just have to make sure you do the work. I'm still repairing and working on my leg, learning new things about my abilities all the time but never thought I'd get back to this so I'm stoked

[Alidavi]

I fractured my medial TP on November 2 playing softball! Had surgery the next day involving fixation with 4 screws. I was in a plaster cast for two weeks and in a lot of pain, especially at night. I was then fitted with a fiberglass cylinder cast from my thigh to my ankle and that was absolute hell also. At 6 weeks post surgery I had the cast removed and was placed in a ROM-T brace set at 0-90 degrees and told to start physio to increase my ROM. Isometric exercises and lots of strengthening of the quads. Very stiff knee! Seems like a mountain to overcome but I am diligent with my home exercises and have an appointment in 4 weeks to follow up with surgeon. Hope to have PWB at that time. The physio really helps I must say. I still have a hard time sleeping at night due to the pain in the problem area. My ROM is scaring me but from what I read it will come in time. I hope so. I appreciate all the advice in this forum.

[TPFxPilot]

Can you please describe this issue in more detail? I wonder if I don't have the same problem. I'm 10 months out and all along a characteristic pain has been at the top of my calf/outside of my knee. My plate is right at the very top and outside of my tibia.

Eurotrash - Sorry I didn't see your post earlier. It's possible that you're experiencing a similar issue, and it may be worth making an appointment with your OS to discuss what you are experiencing. Your plate is in a different spot than mine, so it's difficult to compare. Mine was located on the inside top of my left tibia, in the vicinity of where the hamstring attaches.

The report from my appointment with the OS in October says "The fracture has gone on to heal, but the patient is still experiencing pain medially directly over the hardware and some limitations with deep flexion." Essentially I had no pain when at rest, and usually none while walking at a normal pace. But other activities, even simple ones like putting on my pants that required lifting my leg higher or significant bending at the knee, were painful. The pain wasn't in the knee, but seemed to be associated with the tendons or muscles around the plate. Interestingly, I only experienced this pain with active flexion, not passive flexion. In other words, I could use my hand to pull my left foot up to touch my rear end with no issues. But if I l tried to lift my foot toward my rear under its own power, I would feel a steadily increasing pulling around the plate area. The pulling sensation would quickly turn to pain that made it impossible to flex further.

Anyway, I definitely encourage you to talk about your situation with your doc and see if hardware removal might be the answer.

[TPFxPilot]

As a follow up to my last post a couple months ago (read it here), my hardware removal surgery was successfully completed on Friday morning - 1 year and 8 months after it was installed. I was wheeled into the Operating Room at about 7:30am, and I was on my way home by 9am. I think the actual procedure was about 20 minutes. The anesthesiologist actually gave me a choice whether I wanted to be just numbed or put to sleep. I thought he was kidding at first, but I soon realized he was serious! I still elected to be put to sleep - the other option was a spinal epidural, and I wasn't keen on the idea of fiddling with my spine.

Overall, my experience so far has been similar to what Amoparker described in her post (read it here). The surgery was out-patient, and I was full weight bearing immediately - I walked out of the hospital! The pain is nothing like the original surgery - in fact, I never filled the prescription they gave me for Percoset. It's too early to tell whether the hardware removal will take care of the pain I was experiencing during flexion, but I'll update on that as I progress. Right now, the leg is wrapped to keep the incision covered, the incision site is sore/tender, and my ROM is reduced as a result. I'm walking around quite well and going up and down stairs, though I used railings to help out at first on the steps. Every day has been noticeably better already.

So far, the hardware removal has far exceeded my expectations. I really expected crutches again for a couple weeks - the last thing I imagined was walking to the car after the procedure! I'll continue to update as the healing and rehab progresses.

[Steff87]

Hi ileneroberds,

I saw my doctor, the top of my tibia is not tilting in the wrong direction its out by around 15 degrees which can cause instability. He said this can't be addressed at the moment as I have to wait for it to heal before they repair it, if they decide to do this. He said it is because when they operate they have to remove tissue from the bone and the tissue supplies blood to the bone as it is a living part, surgery again at this stage would mean removing more tissue and he said you can end up with having dead bone.
However I am now waiting for an MRI scan to check my MCL and see if this is contributing to the instability I have.
I also have too much hyperextension which is also making it difficult to walk as where my knee should be stopping to be straight its bending too far.
Just another long wait for the scan now... Will keep you posted.

[Medicstu]

On Sept 21 I fell 25 feet and received a TPF on my Right knee and a Dislocated and broken Left foot. The hospital I went to which is a level 1 trauma center ended up saying I did not need surgery. I then went to My hospital which I work at as a Paramedic, and my surgeon said I needed surgery, I had the TPF fixed but they needed to use donor bone to fix it, and they also fixed my left foot and put it in a cast, I was no weight bearing, 2 weeks later on a Dr follow up the xray of my foot was still or got dislocated again and then I was back in and they pinned it in place and casted it. six weeks later the left cast was off, the whole time my TPF knee was only in a thigh to foot knee brace. I was only rolling around in my wheelchair and not walking, now I'm on week 14 and for the last few weeks I have been using a walker for short distance and just around the house. My pain is minimal more on my foot, My knee is weak and my thigh muscle is about gone. I want to start the elliptical on the 8th after my Dr appt, and am trying to be back to work feb 1st, so we will see. it has been a long and hard time so far.

[Adoc86]

Hi all,

I fractured my tibial plateau after getting into a car accident on December 10th. The bone shattered, but stayed together (if that even makes sense) - like a puzzle, so my surgeons felt that surgery was not necessary or the best route. Is anyone here recovering from this injury without surgery? I've been told to wear my brace for 16 weeks and that I will start to gradually bend my knee soon. All of the posts I've read have been from people that had surgery so I just wanted to see if there is anyone out there that was in my situation.

Thanks!

[redlegofficer]

Hi All,

Well most of you seem more knowledgeable about terms and types of the fracture than I am.
My story starts on 05 Dec 13. I was minding my own business crossing a street in a crosswalk and I had the signal. I was half way through the crosswalk and an oncomming car made a left turn into me. Needless to say the car won. It seemed I had some initial bad luck with regard to the hospital I was brought to. The ER took an x ray and game me meds for pain but ranted ot relaease me> Ok so friends picked me up and brought me home. I should have realized that when the hospital called me the next day and told me there was an anomoly in the x ray that it was going to be bad. Ulitmately I had my corrective surgery on 16 December 13. The doctor said he was very pleased on how the surgery went but said " I dont want to mislead you but this was bad, roughly 1/3 of your pleatau was turned into kibbles and bits". I had what looks like 2 plates and what looks like 3 or 4 screws installed. I had my stiches out on 27 Dec 13 as well as being put in a 0/90 degree articulated brace and told to bend the knee regularly but zero weight bearing for 12 weeks. I do have a follow up on 30 Jan 14. Finding this site has been a help. sorry for the circumstances but glad to meet you all.

[Neil56]

I found this thread while laying in bed after my injury, frankly after reading many posts I was too depressed to post anything myself. I finally decided that everyone is different and that my injury may not have been as severe as many others here. Now at the 3 month mark I decided that maybe I can encourage a few.
I joined the TPF "Club" on Oct 6, 2013. I was raking gravel out of the bed of a truck, not noting where I was, my left foot caught air, and right caught on the tailgate. I landed with a thud and was in the worst pain I have ever experienced. My wife and son drove me to the hospital and I found out about the fracture. I had my surgery the next day. 1 plate and 6 screws. I left the hospital a week later. I was put in an adjustable brace and told no weight on it for 6 weeks. I admit probably the most miserable time in my life. Side note, at the one week mark I was having a huge problem with being way too hot or too cold. Turns out the foam goop they give you to use since I couldn't use the shower built up in my hair and was not letting heat escape. One quick buzz haircut and all was well again. I started physical therapy for ROM but could not do much because of no weight bearing. I did find that I was bending my knee more that the Surgeon wanted during my sleep. Once I was released to full ROM I started out a 70 degrees and rapidly improved from there. At the 6week mark I was released to being FWB gradually, 10 lbs the first week then 25, 35 and the 4th week FWB. PT has been going great. I started December using a walker, quickly began using crutches, then a cane. By the day after Christmas, I was able to greet my therapist by carrying my cane. (most of the way) I still use it as needed. I have been able to move around my small home without using anything but it is a bit awkward. Today Jan 4th I walked around a bit outside with my son and his Father-in-law with no cane and only a slight limp. I know it will get more painful through out the day and the cane will return, but I am really happy with how I am improving. I was released yesterday by my Surgeon and told I no longer need to use the knee brace. I hope this is encouraging to those of us with the more minor injury and also hope that I have not depressed anyone who is not having things go so well. P.S. ROM Thursday at PT was 142 ! matching my left knee. I still have a good amount of stiffness when first getting up after sitting or sleeping but it improves quickly.
Lest I not forget, I had great support from my wife, I almost would not let her out of my sight for many weeks as I have never been so helpless. I truly do not know what I would have done without her.

[Julialynnb]

I joined the club on dec 10th in a car accident. Luckily not my fault so I will get all the pt that money can buy without worrying about cost. My surgery was dec 27, 2 weeks ago , I have 6 screws and one small plate, not a horrible fracture. A depression fracture with one small crack down the tibea, sorry for my lack of details , I am waiting on a copy of the surgical report. Many thanks to all of you for the great information on here. I am experiencing very painful nerve feelings, like pins and needles from hell. The start right under my knee and shoot down my shin. They just started a couple days ago and are more painful than anything I've dealt with so far. My dr says its normal and we will keep a watch on it , had anyone else had these ? Thanks ! Julie

[forouhar]

Hello Treemaker; The rate of recovery is individualized and depends on severity of fx and degree of displacement ( severe in your case ) and other things. Therefore, it would not be a fixed period! A follow up MRI should be helpful in determining the degree of completion of healing. Also, and perhaps more importantly, your symptoms. If pain gets worse and slight swelling develops, you must take it easy and continue with PE and low impact activity such as stationary bike, swimming, quadriceps knee roll starting with low weigh high rep gradually increasing it with no weight on tibial plate, hamstring roll, foot raising, calf exercises in low wight bearing position. Running and jumping are VERY high impact, they should be avoided until healing is complete based on clinical symptoms after exercise. It would take many more months. Being patient will pay of later with lower risk of osteoarthritis in the future. Best of Luck!

[forouhar]

Hi Julia; If you have plate and screw, you have had displaced subcortical fx. You symptoms indicate additional soft tissue injury perhaps including bursa. Nothing NEW! You should be off that leg as I am sure you are. This type of Fx takes a lot of time to heal. PLease be patient!

[forouhar]

Hello; you apparently did have "displacement"! Very lucky. Therefore, you should heal well. But, NO WEIGHT for 12-16 weeks. Surgery is not necessary. Don't do anything that may turn it into a displaced fx or then surgery would be necessary and the rate of complication would go up. Good Luck!

[forouhar]

I broke mine last June. From what I've learned in the last 11 months is that the answer to your questions are all "it depends". It seems like a particularly nasty part of the leg to break. It seems like the outcome depends on how badly you broke it to start with, how well your surgeon put it back together, and how well you follow a good rehab routine. Results can go from full recovery all the way to knee replacement.

I feel like I'm doing alright with mine after almost a year, but I wouldn't even consider running and won't for probably another year. I skied for the first time this year just a few weeks ago and didn't feel real confident or strong. It still hurts and I feel it all the time, but it is still getting better. I can do things without pain today that I wouldn't even be able to do just a few months ago. For me, the recovery has been a slow, steady experience.

Your knee is something that you'll use for the rest of your life, so don't do something stupid right now that will mess it up forever. Take it easy and let it recover.

I second that.

[forouhar]

I was glad to find this site. I was getting so depressed reading all the info on my fx. I am a 60 y.o. active retired expat (originally from Colorado and now in the Dominican Republic) who was on vacation in Hilton Head SC and was on a bike and was hit by a car. I had a depressed plateau fx repaired with plate and screws then two weeks of rehab at Univ. of Ga. Now back home here in the DR and continuing with PT. It is really going to be hard to stay "down" for another 1-2 months. My PT here wants to start some Pool excercises. Has anyone done and PT in a pool for this injury?
Thanks
Bob K

It wouldn't matter, what kind of low impact exercise you do. pool is good because it takes the weight off.

[forouhar]

A couple of questions for those of you who have gone through this:

1. Is developing fluid around the knee common, and will it resolve with out tapping the knee??
2. It is now 6 weeks from surgery and still having increasing ankle swelling as the day goes on. Is this normal at this stage of recovery? My ankle is basically normal size in the morining and 3x normal by evening.

Thanks

Bob K

fluid is going from your knee area down to your ankle. 3X is a lot. if the plate is restored it should heal with reduction in edema and pain. make sure the anatomy of tibial plateau is restored, then do PE with gradual weight bearing.

[sid66a]

Hi All, I was just 25 when I broke my leg - generally fit, a keen runner and cyclist. As I’m sure you’re all aware, Tibial Plateau Fracture is particularly bad, and I think you probably have to except that its going to be a couple of years before you’re back to your previous level, if it’s even attainable.

Nov '12 - broke tibial plateau fracture type 2, through hyperextension whilst playing football on astro-turf.

Nov'12 - Trauma surgery - open reduction internal fixation with 6 screws and a plate - 3 months non-weight bearing, 6 weeks in hip-to-ankle cast, 6 weeks in don-joy hinged brace - with incremental range of movement increase - very painful and frustrating time, just got to get through it, research good diets and do upper body work to keep fit - months on crutches gives you killer triceps!

Feb '13 - started physiotherapy, this was with NHS - saw some privately as well, the key is to do it religiously within pain limits, pain is there to protect but it also will be hyper sensitive in the area of damage as the brain over protects...progression is slow. The key for me was stretching, quads, hamstrings etc. My muscle mass diminished and still isn't fully back as the metal has limited what I can do. Another important area to consider is the glutes (bum) and hip as this is the mechanism that makes you walk properly, the knee just follows what's above it!

May'13 - off crutches and walking more freely, some limited cycling and swimming. Carrying on physiotherapy, although not as religiously, which was a mistake, I've still not been able to jog, can't wait for that day!

Oct'13 - back on crutches, perhaps due to cold weather in UK and more walking, went back to pyshiotherapy...I needed to push it harder, but it's difficult as my metal work really protrudes out the side of my knee and has inhibited soft tissue growth - a constant problem since the op - Doc said it will need to come out at some point, which I had no doubt about doing. My patella tendon always hurts when doing my shallow squats, and there is probably cartilage damage which makes my knee click?

Jan'14 - metal work out, been trying to get it done for a while, but the key is not to remove to early, the bone has to heal first, docs recommend 18 months certainly no less than a year. One week post op now and healing well. The op was under general anaesthetic, they went over the original incision, managed to remove all the metal, there is a risk that where bone has grown around/over the screw heads and it becomes tricky. The risk is low but worth considering. Orthopaedics are always worried about the risk of infection of another operation - i.e. metal removal. It already feels better, which is amazing, I'm still on crutches but can weight bear, and walk OK-ish, it's just my quads and hamstring that are aching as they've been out of action, plus general soreness around op, stretching again will help!

Next steps are to heal up and get to physio to do more strengthening, I should be able to progress onto body weight squats within a couple of months I hope, then I'll try jogging. I will swim and cycle (in gym) as soon as I can.

Overall, it's been a very hard 15 months, depressing and frustrating, especially when I should be in my physical prime. However, there is light at the end of the tunnel and I hope to get back skiing next winter. On reflection, the key is to look after your body the best you can through nutrition, sun (very difficult in UK), exercise what you can i.e. swimming (I used to go in shallow end and lunge and kick etc), Physio is crucial for recovery...the exercises are not complex, and physios will tell you the same exercises, just need to do them! Physios for me are very underestimated, they’re practice can fix all manner of ailments and injuries, the docs are just there to get the bone back together without infection…they don’t see or really worry about the rehab etc.

Good luck all and if you can approach your condition positively, it puts other things like work challenges into perspective and you’ll be able to achieve anything!

Questions:

Has anyone been through this and come out the other end with 100% recovery i.e. back to where they were before? I’m hoping I will be able to run again, as I’m only 26. Is skiing OK? Any tips on recovery from here on out?

Feel free to ask for any tips?

Cheers, James

[Julialynnb]

I was 17 days from date of fracture until surgery and at home, which was not horrible but all that time not bending my knee has caused me some issues. I am 3 weeks from surgery, 5 from accident and can only get 50 degrees on the bend in my pt , it feels stuck , they are assuming scar tissue and I still have some swelling. I am going to pt 3 times a week and doing everything they ask . For anyone new and just reading and not posting ( that was me for many weeks) they are right here. Everyone is different , just keep plugging along , the days will go by and you will improve with each one. I have found creative ways to be useful, i cook and do my dishes, it's the little things to help you feel you still have some control over your life ! Julie

[mrlinderley]

Hi all,

I fractured my tibial plateau after getting into a car accident on December 10th. The bone shattered, but stayed together (if that even makes sense) - like a puzzle, so my surgeons felt that surgery was not necessary or the best route. Is anyone here recovering from this injury without surgery? I've been told to wear my brace for 16 weeks and that I will start to gradually bend my knee soon. All of the posts I've read have been from people that had surgery so I just wanted to see if there is anyone out there that was in my situation.

Thanks!

I am in the same boat as my fracture didn't require surgery either. I was told the fracture across my TB was about 1mm wide and not displaced. The bone was quite badly displaced down the side of the tibia but was told this wouldn't cause any issues. I was none weight bearing for 13 weeks with a full leg brace on for this time. From 8 weeks I could gradually open up the angle I could bend the joint. I was discharged from hospital 8 weeks ago and have had 5 sessions of PT. I have been to the gym nearly every day and done lots of swimming and been road biking again. I still walk with a limp and my knee is painful some days and not others. I would like an MRI scan to see if there is any cartilage damage but getting one on the NHS is proving difficult so I may go private. Thinking of mountain biking again soon (how i did it) as the PT said the bone will be as strong as before and my ligaments are intact. Being from the UK my treatment may be free but I felt rushed through the whole process and found it difficult to get any answer from the consultants. I saw a different consultant every time i went back to hospital and got conflicting information on recovery time and when I could mountain bike again. Sod it, the sun is out for once, i'm off on my bike.

[skiplct]

Hi All, had hardware out Jan 14: plate and 11 of the 13 screws. Meniscal scope at the same time. Recovery not going well so far: Lots of pain along the plateau line, swelling, instability, and a worrisome red painful spot on outer ankle well below bottom incision (phlebitis??.. infection??.. )

Neuropathy is worse even than before surgery which was pretty bad. I really feel like a permanent cripple now. Struggling with despair. I don't do FB so please post here!- or e-mail me direct for support, suggestions, advice, company.