Tibial Plateau Fracture Recovery

[Mr. David]

Maker, thanks for sharing a lot of wisdom here. Just wondering: in what area was your osteotomy perfomed? (ie: lateral tibia, medial tibia, or elsewhere?) Like you, I ended up with a depressed lateral plateau and valgus deformity. Our timelines/issues look similar, with mine going like this:

-July 2011: TPF: NYC bike accident: schatzker type 6 ("crushed ice", the surgeon said)
-July 2011: TPF Fix: 2 plates, 12 screws (initially was told Ex-Fix, which I wish they'd have done so I could have shopped around: unless you're having a baby, stay away from Lenox Hill!)
-May 2012: Hardware removal with scope to pinpoint problem (HSS)
-Sept 2012: Osteotomy (California)
-December 2012: ACL reconstruction (couldn't be done in concert with osteotomy, for a couple of reasons)
-Pending, March 2014: Osteotomy hardware removal (elective, due to increased irritation under skin/fascia)

To folks newly arriving here, as skipict says a few posts back, this forum need not be depressing: When I arrived, the athletic, recovery-minded people posting here provided a huge source of support for what can be an isolating recovery period. To anyone discouraged, I just want to emphasize something that I think gets missed with the minimal info one gets at the hospital: the range of TPF severity is enormous, ranging from "I had to stay off it for a while" (see Lindsey Vonn last year) to the rarer, "I may not run, or comfortably climb stairs, again".

Mine is at the extreme end (with some docs blaming a poor initial surgery) but a majority of folks will be back on skis, or running, or gardening, or whatever it is they do, without a bunch of extra surgeries to get them there. Be sure to attack whatever exercises you're given to minimize atrophy (or ask Doc/PT for some direction if they haven't told you what to do). And be patient: even the easier TPFs mean many months of downtime, but the typical "year long recovery" that everyone seems to promise you upfront is a short span in the scheme of things.

I know firsthand that it's BS to tell someone to "look on the bright side" with this, but it was a knee, not a skull, that got crushed. -I appreciate this more and more as life, and life's events, have carried on

If you're on the extreme end and still struggling after months of dedicated post-weight-bearing rehab, just don't give up: in addition to quality PT (just as valuable as a good surgeon, IMO), make sure you are working with the best physician you can. Trust your gut about docs, and get another opinion if necessary.

Due to a cross-country move over the course of my treatment, I can recommend excellent docs in CA (northern and southern), and, oddly, in Switzerland, if anyone is having a hard time finding one in those areas. -Maker's doc, Dr. Wickiewicz at HSS, was one of the best I met, and, blessed with wife's good insurance, I would have worked with him had we stayed in NY. The "Head of Trauma" over there was less impressive/thoughtful for me, especially relative to the fellow who "fixed" me in CA.

Wishing a smooth & speedy recovery to all in this "elite" club.

[Skiobsessed]

Hi everyone. Im so glad to have found this thread.. I love skiing more than anything in the world and 2 weeks ago I got a Lateral Tibial Plateau Fracture in a "dumb" fall.. I am VERY worried now that I may have made a mistake in not getting surgery. My OS gave me the option as he said he was on right in the borederline of whether I "had to" have the surgery or not. I was terrified about getting the metal plate and screws put into my knee, which is what he was going to do.. But now that I have been reading Im not sure if I should have backed out of the surgery. My joint depression is between 4mm and 5mm. Apparantly they say anything above 5mm has to have surgery and anything below (as long as the knee is "stable") can chose to be treated non-surgically.
Has anyone on here has a similar injury (lateral tibial plateau) with a 5mm depression and NOT had the surgery??? I would really love to know how your recovery has been if so. I am just super bummed that I will be off of my leg for so long, 2 1/2 month of no weight baring..at only 2 weeks in I am having a lot of trouble even imagining not being able to walk for that long and I am dying to do some type of workout. Mainly I am terrified that my skiing might never be the same.. Please if anyone has any knowledge or experience with my situation please let me know!! I would really appreciate it so much! Thank you all and good luck to everyone on your recoveries!!!!!!!!

[Skiobsessed]

Do you know how much of a joint depression you had? Mine is depressioned about 5mm (which they say is borederline for a must have surgery) So I chose to go the non-surgical route because I was terrified about having metal plate and screws in me.. But now scared it may have been a mistake not to go ahead with the surgery.. Im trying to find anyone who has had the same/similar injury with the joint pressed down 5mm and did not do surgery. I would love to know what to expect?! Thanks so much in advance for any info

[Skiobsessed]

Oops I meant to post that as a reply to one of the people who didnt have surgery. Im sorry guys I dont know how to do this thread thing

[Mr. David]

If you're only two weeks out, I believe it's not too late to change course, but you need to make a decision asap, like this week. If all your ligaments are intact and not lax, you'll likely ski again regardless of the course of action, but as I understand it, a depression can cause what's known as pseudolaxity, depending on the shape of the depressed area.

If you like your surgeon, I'd explain your concern to him right away. If you're unsure about him, find a good (top notch, as TPFs are one of the more complex fractures) ortho trauma doc in your town, call and tell them you have a fracture. That should get someone talking to you about it anyway.

Take action now so you don't 2nd guess your choice later. Best of luck.

Hi everyone. Im so glad to have found this thread.. I love skiing more than anything in the world and 2 weeks ago I got a Lateral Tibial Plateau Fracture in a "dumb" fall.. I am VERY worried now that I may have made a mistake in not getting surgery. My OS gave me the option as he said he was on right in the borederline of whether I "had to" have the surgery or not. I was terrified about getting the metal plate and screws put into my knee, which is what he was going to do.. But now that I have been reading Im not sure if I should have backed out of the surgery. My joint depression is between 4mm and 5mm. Apparantly they say anything above 5mm has to have surgery and anything below (as long as the knee is "stable") can chose to be treated non-surgically.

[SkiTurtle]

My joint depression is between 4mm and 5mm. Apparantly they say anything above 5mm has to have surgery and anything below (as long as the knee is "stable") can chose to be treated non-surgically.

SKiobsessed, what method did they use to look at your depression? For me, the x-ray showed very little in the way of a fracture. The MRI (also checking ACL and stuff) showed a 5-6 mm depression. My doc then ordered a CT scan since he said it is more reliable than a MRI. The CT showed 8-10 mm as well as a previously unseen vertical fracture on the side. The CT scan was the deciding factor.
If you are on the bubble, I would insist that they get the most accurate films possible.

Good Luck!

[Skiobsessed]

David thank you so much for your reply!! Luckily my ligaments are all fine (there is a small tear in the meniscus but it was one that looks likely to heal) My acl and mcl are both good and my OS did a "stability test" where he kind of pushed and pulled leg from side to side gently and he said the knee felt stable.
I do like and trust my OS. My biggest problem is that I am TERRIFIED of surgery, completely terrified of having the metal plate and the screws, scared of anesthsia and just the whole thing is so very scary to me. My OS actually told me that if it were his knee he would fix it, but that he truly thought I would do fine either way, he said there was probably a 7- 10% difference in the outcome I would have with surgery vs without.. So the main reason we decided against the surgery was because I had such a high level of anxiety about the proceedure.. Now its like even tho the thought of surgery scares me to death, the thought of never getting my skiing back to the same level scares me just as bad. Im not sure which is worse!
I have a call into my OS to ask him one more time if he is sure this is not a mistake.. What really worries me is that his original recommendation was to fix it but then based on how scared I was, along with my size (only 5ft and 98 pounds) he said I would probably be fine without it.. Knowing that dent is going to stay in my bone just scares me and all of the stories I have read about people having such a hard time coming back from this. I think Im still shocked and overwhelmed at the time frame amd everything.. Idk. Thank you again so much for you response and please let me know if you think of anything else! Thanks

[Skiobsessed]

SkiTurtle, I have gotten both a CT scan and an MRI. The CT shows a depression between 3.2 and 3.8 for the largest area of the fracture and then a smaller portion of the fracture which goes up to a depression of 6mm. The MRI shows the depression to be between 4mm and 6mm (with the biggest portion being under 5mm)

I have had it read by 2 different Drs and both have said they would probably fix it if it were their knee but that it might heal just fine on its own and because I am so nervous about surgery in general they think it would be ok if I let it heal... But then I just go back thinking that the only reason Im not getting it fixed is because I am too scared of the surgical risks, and maybe (probably) everything would go fine which means it might be a bad idea not to fix it. Then again, if its true that there will be little difference between fixing or not fixing then Id much rather avoid surgery. Its just hard not knowing what will happen and more than anything I want to be able to ski as aggressively as I did before this happened!! I have also heard horror stories about these surgeries going wrong and about people having problems with the "hardware". I just dont know what to do..

[tam0558]

Has anyone's injury been due to negligence on someone else's part? My friends and family are screaming "attorney", wanting to make sure that I'm taken care of long term. Anyone have experience when it comes to liability and insurance?

[lph]

When a physician says 'if this is my knee, I would have it fixed' it shouldn't require a lot of thought on your part.

surgery sucks. no doubt about it. the risks, however, are very low.

get a second opinion.

CT is the most accurate test for determining degree of distraction and depression.

[Skiobsessed]

IPH, yes I agree in some part but his entire statement to me was "If this were my knee I would have it fixed but I am a surgeon and I like to fix things, this is a borederline case and I believe you will heal and do just fine without the surgery" I asked him "well why would you fix yours then?" and he said "if it were me I would want the joint line as perfect as it can be but you may feel very little difference overall whether we decide to fix it or not".

I got 2 other opinions, one said it was non-surgical and the other said it was.. It just seems so down the middle to me based on everything the doctors have said and that is why the desicion has been so difficult.

[Maker]

Mr David.

Lateral TPF and lateral osteotomy. I had a schatzker 5 or 6 as well. I think when you get to that end of the spectrum it is just hard to put back together. Mine had broken into 12-13 pieces so they had to use a bunch of bone filler and crap like that to reconstruct it. I am not surprised that it didn't heal right.

[lph]

IPH, yes I agree in some part but his entire statement to me was "If this were my knee I would have it fixed but I am a surgeon and I like to fix things, this is a borederline case and I believe you will heal and do just fine without the surgery" I asked him "well why would you fix yours then?" and he said "if it were me I would want the joint line as perfect as it can be but you may feel very little difference overall whether we decide to fix it or not".

I got 2 other opinions, one said it was non-surgical and the other said it was.. It just seems so down the middle to me based on everything the doctors have said and that is why the desicion has been so difficult.

Then it sounds like you have done all you can. At this point, you should probably stick with your decision and hope for the best. keep in mind this is no guarantee that fixing your depression is gonna make everything better. the damage to the cartilage has been done. you are very light, which does help, less stress on the cartilage over the course of your life.

[SkiTurtle]

SkiTurtle,

I am avid golfer and golfed 7 months following surgery. At 13 months I went on golf trip and played 36 holes two days straight. It was a little sore after that but compared to everything you are going through right now it wasn't that bad. My TPF injury was on my left leg, which for a right handed golfer, is the leg all your weight lands on and it was manageable.

Can anyone explain what the holdup to recovery is after the bone has healed? I understand that there needs to be 6-12 weeks for bone healing. I also can visibly see the atrophy and know I need to rebuild muscle to be back to normal.

However, I also have a plate, screws and a bone graft on a collarbone, and after the bone healed, I was doing everything I wanted right away. What sort of problems exist post bone healing that cause folks to say they aren't back to normal months or even years after the bone has healed?

I guess I've always been a "get back on the horse right away" kind of guy, and it is depressing to hear about extended recovery without really understanding what will be causing the pain or the delay.

[powdork]

ok so what i thought was two screws and a bone graft ended up being more. total of nine screws and the big plate/bracket Clicking on the picture will take you to a blog post that also includes several pictures taken during the surgery. Didn't want to post them here as they are extremely graphic

[Skiobsessed]

Iph, thanks.. Yeah I think I am going to just stick with decision and hope for the best like you said. The Dr also told me the same thing you did about how lifting the depression is no gaurantee that it would be better. (Another reason I was so reluctant to risk the surgery and plates and screws). It seems like either way you go this is just a crappy injury but I am going to work very hard on rehad and do everything possible for PT. I think if I focus on PT I can have a good chance of getting it back. It is just very hard to hear when a dr says that "it will never be the same" either way, Thanks for your help

[Skiobsessed]

ok so what i thought was two screws and a bone graft ended up being more. total of nine screws and the big plate/bracket Clicking on the picture will take you to a blog post that also includes several pictures taken during the surgery. Didn't want to post them here as they are extremely graphic

Hey Powdork, Just curious did your doctor tell you why you needed to have the plates and screws? I saw from your xray on blog it looks similar to mine I think and you said the depression was 2.5mm? Was urs the lateral tibial plataeu? I had same thing I think but depression was between 4-5mm. My Drs all said that under 5mm surgery was not necessary just optional.. Was wondering if ur Dr told you anything different?

[powdork]

the 2.5 mm was from someone (a professional in the field) reading from one pre xray picture I posted. He mentioned he would need different views to know. I didn't get the actual figure from my doc.

[Skiobsessed]

Oh cool, thanks.. I wanted my backflip this season too

[Mr. David]

SkiTurtle, I had similar confusion when the E.R. doc told me I had a TPF, which I'd never heard of, delivering the news very apologetically. I replied, "yeah, I figured I broke my leg...so I'll be out for the summer then??"

The short answer to your question is: though yes, bones heal up on a predictable timeline, a tibial plateau fracture is unlike a cracked collarbone or a typical mid-shaft broken bone (like if you broke your arm, mid-forearm). A TPF can leave a knee with residual challenges after the bone has solidly healed.

Long answer:
Where a broken arm often just needs to be "set" and that arm's function can fully restore with healing (even if the set was imperfect), the knee is radically more complex with radically higher demands placed on it. It's a moving joint, and is the largest, most complex joint we have. It's said to be inherently imperfect for bipeds (ie: we've evolved faster than our knees have) and it carries a massive load. -There's a laundry-list of factors for pain-free, sturdy load carrying function of the knee: Smooth, functioning cartilage surfaces & menisci, strong, intact ligaments, muscle & tendons, and near-perfect joint geometry/spacing (like any "bearing" surfaces, they need to be aligned well to work well, and knee alignment includes multiple bearing surfaces on three bones)

So, with the more substantial TPFs ("bicondylar", "severely comminuted", "avulsed/torn ligaments", are some of the terms used to describe them), the odds of each of those factors being fully restored, or fully restorable, are reduced. Adding to the challenge is the fact that your tibial plateu is made of cancellous, not cortical, bone. The cancellous bone is a bit like honeycomb candy (Violet Crumble, anyone?) so when it's broken in a TPF-causing accident, it doesn't always shatter clean and leave perfect puzzle pieces like a broken coffee cup; the material can compress in ways that make near-perfect restorations impossible.

That said, before you decide that this forum is as depressing as you initially feared, there are lots and lots of people here who've returned to sports, it just depends on many factors. People with life-altering injuries (me included) are more likely to sign on and browse and report back years later (I'm inspired this week because I'm about to get hardware out and am looking for others' stories on that).

-Folks whose lives are back to normal are likely to move on and report less.

With milder TPFs (a depression on one side, for example) there is much more left intact in the knee overall, and in turn, more probability of a great outcome. Your motivation and positive attitude will certainly improve your results to some degree, and I've found that surgeons generally underpromise, so if your surgeon is mildly optimistic, you could be in fine shape.

Can anyone explain what the holdup to recovery is after the bone has healed? I understand that there needs to be 6-12 weeks for bone healing. I also can visibly see the atrophy and know I need to rebuild muscle to be back to normal.

However, I also have a plate, screws and a bone graft on a collarbone, and after the bone healed, I was doing everything I wanted right away. What sort of problems exist post bone healing that cause folks to say they aren't back to normal months or even years after the bone has healed?

I guess I've always been a "get back on the horse right away" kind of guy, and it is depressing to hear about extended recovery without really understanding what will be causing the pain or the delay.

[Skiobsessed]

Does anyone have any major success stories like you got back to completely normal knee function quicker than you thought or even better than before? Any surprising comebacks or did better than Drs expected?
Also still wondering on anyone who healed it without the surgery and did well? Would love to hear some good news!!

[powdork]

Also still wondering on anyone who healed it without the surgery and did well? Would love to hear some good news!!

i have friend who did well without surgery. here is a message he sent me

I was told I was very lucky not to have to have surgery. I also torn my MCL. I seem to remember it happening in January and skied som groomers in late april or may just before Heavenly closed. It was the MCL though that took the longest and kept my knee unstable for awhile. Do they know if you have Ligament damage also?

[Skiobsessed]

Thats awesome bout ur friend! Luckily I do not have any ligament damage. I have a tear in the meniscus but my ACL and MCL are both fine!!! My main problem is just the fracture and that 4-5mm depression in the joint. Im just worried about what its going to be like with that dip in the joint surface.. Wondering how much that really changes things once its all healed? Thanks so much for any info

[lph]

skiobsessed talked to one of my favorite ortho's who does A LOT of these.

he said if MCL is not torn and you don't have to remove any of the lateral meniscus, most people do well. (i did not ask him surgery vs non surgery), i was actually asking him about the 'bad' ones.

[kmrrdb]

SkiTurtle, my research is right in line with what Mr. David explained above. I would also like to add that after 19 months my "bad leg" is pretty much fully functional. When at the gym I have no discomfort when doing leg presses or extensions. It definitely feels different than my "good leg" but I believe most of it is just strength differences. It doesn't hurt or swell, it just feels different. I find it hard to build its strength back to equal the other. There are probably also differences and issues that I create mentally, just the fact that I call it my bad leg. I can say I don't trust it 100% like I do the other. That probably is more of a "me" problem than a leg problem. Do as much exercising with your injured leg as possible (obviously in line with your Dr's requirements). I got in a pool as soon as the incision healed and did kicking exercise, squats etc. that helped a bunch and minimized the atrophy.