Tibial Plateau Fracture Recovery

[peaton]

Hi everyone, I haven't posted in a few weeks, but have been lurking.

I have been FWB since Sept. 4th., still doing therapy 3x week. I am walking pretty good, no complaints there. I am still having pain in the joint area, medial, mid-line and lateral. It is always a different type of pain from achy to sharp radiating pain. I am still on a wait and see mode with the OS, because of the severity of my injury he doesn't want to disturb the joint again until I am a full year out from surgery 5/30/12.

I am very ready to start loosing some weight but with limited exercise it is tough. My therapist has me on a stationary bike and the elliptical so I have been taking advantage of my time on them.

I am amazed at the number of people that have signed up since my injury. For this being a very low incident fracture, there are many.

For those of you who are new, be patient, don't push it or over due it. Things will start to progress and move in a more positive direction.

Good Luck!

[ejk725]

Hello! I'm new to the block. Ran across this forum searching for exactly this type of thread on google.

I am currently recovering from an e-bike accident on November 5, 2012 in which I sustained a type 2 tibial plateau fracture. The depression into my tibia was about one inch and my kneecap split apart (I don't have the more technical terms and a whole list of what they did yet because I have to have the paperwork with that information mailed to me still). I had surgery on November 6th... they filled me full of synthetic bone, pins, and plates. My OS said that he was able to repair the damage to within a millimeter, which makes me hopeful.

So, I'm almost 2 weeks post-op... I'm in a zimmer splint and am NWB for the next little while. I'm hoping that I can recover quickly, as I've had to move out of my apartment where I lived alone and move in with my grandmother. I'm really, really hoping that by January that I'll be able to be back into my own space again.... even if that means someone has to drive me to get groceries!

I live in Ontario, Canada... and I was admitted to the hospital that I work at. It was an interesting admission, since I knew all of the surgeons and nurses taking care of me from a co-worker perspective. They had me in the hospital for 7 days, as I had pain control issues.

I was discharged with no home supports, except for phsyio which is going to come in and check on me 2 times in the next 3 weeks. After that, I'm apparently on my own. I'm glad I have insurance so that I can get real physio when I'm able to do more. At home, I'm currently doing active-assistive knee bends using a garbage bag and a towel on my bed. It's going well... good days with that and bad days. I am noticing that every day I get a little tiny bit more range.

Anyway, suppose that's long enough... hehe Just trying to stay positive and I'm glad that I found this thread to help me with that. Hope my post wasn't too disjointed, still on a pretty good dose of dilaudid. Wishing everyone else well!

[dnabike]

Hi ejk725, welcome aboard the TPF train. Fair warning this is a slow train with no stops, but you are already on so you might as well enjoy the companionship. This is just about the only place where you can find a lot of people who are going through the same experiences as you. Please share your progress and anything that is working well for you. You can also share your trials and tribulations, the ups and the downs as you will have plenty. Being on your own is pretty tough with this so don't be too quick to go it alone.

[Olligator]

Hi, I am new here. Fractured my right lateral tibial plateau on October 12. In the ER they told me it was not depressed, sent me home in an immobilizer, said to not put any weight on it and see an OS on Monday. Got to the OS and when he looked at the films he just kept saying "This is bad" over and over. It was depressed 12mm! Had surgery the next day, plate and seven screws. Because of old back and hip injuries I had terrible problems with muscle spasms and cramping from hip to ankle. This caused me to be very unstable on the crutches and I fell twice in the first few days. Luckily I don't seem to have done any damage. It took four weeks of strong muscle relaxers every eight hours for me to be able to move around on crutches or even sit in a chair.
They had me in a cpm as soon as I got out of recovery and at 60 degrees when I left the hospital. OS wanted me at 90 by my 2 week visit. Only got to 85 because the bandages were so tight I thought my kneecap was going to explode. He read me the riot act and threatened to do a manipulation if I didn't try harder. I am now at almost five weeks from surgery. My goal for my 6 week visit was 105 on the cpm, 90 on my own. This week I got to 120 on the cpm (OS told me to send it back which is good because insurance wouldn't pay for it) and 91 on my own. He moved my visit from next week to this week and said we will discuss weight bearing. I am a little worried that it is too soon, but I trust him to decide if it is healed enough.
I want to thank everyone for this thread. It has helped me deal with the slow pace of recovery and to find joy in reaching even the smallest milestones.

[peaton]

I would question your OS if he allows you any percent of weight bearing at this early stage. If you read past posts from people on here with depressed type injuries most of them are 8 - 12wks of NWB.

Hi, I am new here. Fractured my right lateral tibial plateau on October 12. In the ER they told me it was not depressed, sent me home in an immobilizer, said to not put any weight on it and see an OS on Monday. Got to the OS and when he looked at the films he just kept saying "This is bad" over and over. It was depressed 12mm! Had surgery the next day, plate and seven screws. Because of old back and hip injuries I had terrible problems with muscle spasms and cramping from hip to ankle. This caused me to be very unstable on the crutches and I fell twice in the first few days. Luckily I don't seem to have done any damage. It took four weeks of strong muscle relaxers every eight hours for me to be able to move around on crutches or even sit in a chair.
They had me in a cpm as soon as I got out of recovery and at 60 degrees when I left the hospital. OS wanted me at 90 by my 2 week visit. Only got to 85 because the bandages were so tight I thought my kneecap was going to explode. He read me the riot act and threatened to do a manipulation if I didn't try harder. I am now at almost five weeks from surgery. My goal for my 6 week visit was 105 on the cpm, 90 on my own. This week I got to 120 on the cpm (OS told me to send it back which is good because insurance wouldn't pay for it) and 91 on my own. He moved my visit from next week to this week and said we will discuss weight bearing. I am a little worried that it is too soon, but I trust him to decide if it is healed enough.
I want to thank everyone for this thread. It has helped me deal with the slow pace of recovery and to find joy in reaching even the smallest milestones.

[msilks64]

I have not gotten a single answer to any of my questions posted on page 45. Please, anyone who is further along in the healing process. Have a look. Thanks.
And to all of you who are suffering through the non and partial weight bearing phase, good luck, keep your chin up, and do whatever your doctors and physical therapists tell you to do!

[kmrrdb]

I agree with Peaton, that doesnt sound right. Maybe my doctor is conservative. I had a tpe II left lateral TP depressed fracture. He originally told me 6-8 weeks for partial weight bearing. At week 7, he approved 25lbs for 4 weeks, then approved 50lbs for 2weeks. I am in the 2nd week of the 50lbs PWB. Most of the weight I am putting on my leg is in physical therapy. Also putting partial weight on it when on crutches, in pool or on stationary bike, but that this about it. Next Friday will be 13 weeks and I was told to go full weight bearing at my comfort level. At first I thought that would be tough, but with each day I get a little more back so it seams more feasible now. I was told by both Ortho and Physical Therapist that I am ahead of schedule than most people they have seen with this same injury. In the last week I went from 120 flex to 128, so everything seems to be moving along. At 5 weeks out I was no where near ready for PWB. The last thing you want to do is start over again.

[karpiel]

I have not gotten a single answer to any of my questions posted on page 45. Please, anyone who is further along in the healing process. Have a look. Thanks.
And to all of you who are suffering through the non and partial weight bearing phase, good luck, keep your chin up, and do whatever your doctors and physical therapists tell you to do!

All I have to offer is at 3 or whatever years out from mine, get used to the pain, it's not going anywhere. I'm still in PT off and on and my left leg has about half the muscle mass as my right. Get used to people thinking their injury, whatever it is, can somehow be compared to yours. Get used to being annoyed at people with mild sprains limping around, bitching non stop about the pain, thinking their injury is worse cause some low rent doc told them they need to wear a brace.

Even most doctors seemingly have no clue what it means to have a tib plateau injury.

[itsdeenah]

Hello msilks64,
I believe most people experience nerve damage or loss of sensation in any scar area. Mine is that way as well. It feels numb all around the area. My OS said it would never feel normal again due to cutting deep through the tissue & my plate area feels like that too since it's pushing on my interior leg muscles. It's creepy trying to shave I usally push down harder and quicker just to get it over. (shivers). I used advanced Maderma for 4 months so my scar is flat, thin & white but the sensitivity is gross. Good luck and hope it gets better for you.

Date of Injury 4/20/12
Surgery 4/27/12
Type IV TPF with 1+" communited depression of the plateau surface
1 - Fx's Tibial Shaft
Shattered medial meniscus

I got hit by a car on Oct 8, 2011. Had surgery on 10/20/11, so it's been a little over a year for me. My knee is mostly functional, although I won't even consider trying to run. Not that I was much of a runner to begin with. I do find myself walking funny in the morning when I first wake up. I can tell the weather forecast without turning on the news. My best physical therapy has been bike riding. Once I was able to get back on a bike, I felt normal again. (that's a moving bike, not the stationary one at PT. LOL)
Here's my question for anyone who had surgery over a year ago. Does the area around the scar ever feel normal again? My scar frequently feels like a fresh wound, even though I put lotion on it every day. And the skin on the lower side of the scar, where I'm assuming the metal plate is, is SO sensitive! I can't stand shaving my leg.

[smilybeck]

Interesting to know. My doc assumes that my fracture displaced so far to the right that I strecthed the peroneal nerve, which has caused me the drop foot that I have. I'm going to mention this mirror exercise to my PT and give it a shot. Sounds like we are on the same page, as the drop foot has been more debilitating then the TBF. I am scheduled for a EMG today. I have no dorsiflexion in my foot, but I do have plantarflexion and can move my toes, but cannot lift big toe or other toes. I am walking with the help of a Ritchie style brace and have a custom carbon fiber brace coming in through a prosthetics company.

See if your PT can dry needle you (similar to acupuncture, but they "seek out" the trigger points). My PT has been doing this to help release my calf muscles and I have noticed in the last week great improvements on the pain in my foot. All I'm getting now is a tingly feeling not the burning sensation. It might help with your peroneal nerve.

[dwood92]

Hi all, uncovered the thread while searching for information about TPF. I'm 20 and fractured my right tibial plateau on the 23rd July after falling from a 30ft roof and landing on a metal fence, external fixation the same day, 1 plate and 10 screws 7 days later. 15 days in started using a gutter zimmerframe as I'd badly broke my left thumb aswell. Another 7 days later started using one normal crutch and a gutter crutch. Was released from hospital on the 17th August and am now just over 16 weeks NWB following my final operation. I have another x-ray on the 29th, fingers crossed i'll be able to start weight bearing then. I just wanted to know if anyone else was in the same boat as me because there doesn't seem to be that many people who have gone over the standard 12 weeks NWB.

Forgot to mention, my TPF is type VI and I needed a muscle flap taking a third of my calf and then a skin graft from the top of my right leg

[HansNB]

I have been lurking here for months...nearly cried the first time I came upon this forum. Reading about all of your experiences certainly put things in perspective. It has been almost 8 months since my surgery (skiing accident; active 55 year old male; left leg TPF Type 2 depressed; bone graft, plate and 6 screws; FWB after 11 weeks; released from PT at 6 months).

I feel quite fortunate that I am back to most physical activities (spin bike class twice weekly; other gym work-outs 2 or 3 times a week including execises dedicated to the recovery, sporadic road and mountain biking). Tried running a few times, but didn't feel very comfortable so have dropped it for now. It took a lot of time and work, but managed to get all ROM back (160 degrees+). I still feel every step that I take...not pain, but a tightness like there is a big rubber band around my knee; also a "clunking" when moving through a deep squat (this may be diminishing; my PT said this may go away as the muscles are re-built). I tend to overdo the exercising from time to time which makes the knee tender and a bit swollen, so I have to back off for a couple of days (this, too, is may be occurring less frequently).

Not sure if this will be as good as it gets; as one of you have stated, "it depends" on a number of factors; we all would like nothing more than to be back to "normal"....

Any runners out there who have suffered this injury, but were able to get back into running?(Or should I listen to my young nephew, who stated "You're old, forget about it!")

[tinka333]

Hi Everyone!
If i could give you all a huge hug for the weeks of support and hope you have all unknowingly given me i would!!

Quick intro, I got my TPF on the 22nd of october when i was going for a nice gentle jog along the beach with my dog when a doberman (yes, out of all the dogs on the beach it had to be the doberman!!) ran into the side of my right leg, it's shoulder and my knee. I went down, doberman carried on as if nothing had happened.
I knew it was wrecked the second it hit but as you do, I tried to get up anyway. Well that didnt work!
Waited 2 days at home "hoping it was nothing" and then realised it was time for hospital.
Surgery that day and left 3 days latter with a plate and 7 screws holding my knee together. No idea on the scale what fracture it was (will ask this next apt) but told 6mm depression, NWB for 6-8 weeks and stuck in the zimmer brace.

Im now 4.5 weeks out:
Brace is off, Allowed to move back and forward as much as i can- currently only 75 flex and 10 ext. OS said no physio yet but i have been going once a week anyway just to work gentley on ROM.
Next OS apt on 27th, going to the pool after this whether OS says i should or not - I filled up the bath last night and let my leg float and it was fantastic so cant wait for pool!!

Anyway, I feel like i know you all already from reading everyones stories. You might not have known it but you all have all been my closest friends/support over the last week or two and i send you all positive thoughts and best wishes every day for your recoverys

Will let you all know how the apt (and POOL!!) goes on tuesday.

[leejem]

16 weeks post break and surgery. Got the all clear from the surgeon this week "we don't need to see you again". Woohoo.

Found out that not only had I had a displaced TPF I also had a vertical break through my shin. Maybe they told me when I was zonked out on drugs but I swear I never knew.

Anyway, all healed well. Walking with a slight limp. Alot of stiffness and tight muscles and ligaments. Not so many sharp pains anymore.

Rode my bike for the first time last weekend which felt fantastic. Swimming 3-4km per week.

For the first time ever I can see an end in sight. And I've started to realise that its just 4 months out of my life.

Now I need to work towards running again, and the biggie, getting back on skis next June.

[kmrrdb]

Tinka333, similar story, but my depressed TPF was the result of a 50lb boxer running full speed, its shoulder and a direct hit into my left knee. I am 13 weeks out from surgery. I was originally told 6-8 weeks NWB, but it turned out that meant 6-8 weeks for the bone to heal. Today is my first day cleared for FWB. I was PWB week 9 thru week 13. Even though I am cleared for FWB, the muscle isnt strong enough to support walking but gets better every day. I think next week I will be taking my own steps. Flex is 130 and 4 ext. Keep going to PT and the pool works great.

[texanfan4life]

Hey guys 2weeks ago was given fwb really didn't think I was ready (20lbs to fwb) orig.surgery Aug 27&29 2plates12screws tpf 11day hospital stay anyway THE LIGHT IS AT THE END OF TUNNEL on a cane I have pain but am mobile keep working hard with PT&OS it will work out keep your head high!!!

[Hardman82]

been reading this forum thought i would join in i broke my tibial plateau on 3/8/12 was unloading a truck and dropped a 250 lb generator on my left knee, had surgery the same day, had a bone graft wire a plate and 7 screws on the lateral side.
Was NWB for 14 weeks i think i got rid of the crutches in June or July was seeing the OS every 4 weeks since the surgery problem is its a 2 hour drive each way for a ten min visit he would not listen that i was still having a lot of pain.
It is a workers comp claim so i was able to switch doctors once and i am glad i did say the new dr in sept, he took a bunch of xrays looked at the original ct scan told me holy crap i messed it up really bad and was surprised that it was able to be put back together,
But he also sat down with me and explained what the pain was i was experiencing i have arthritis in the knee where it broke got me on meloxicam and put me in a unloader brace
Since then the pain has gone down but still hurts under my knee cap and i can not bend my knee with any weight on it, so going down stairs it just drops makes it very difficult going up stairs has gotten a lot easier but still hurts. just seen the dr last week will not approve me to go back to work, i see him again in Jan and he told me if it has not improved anymore by then that i will not be able to go back to work.

I work construction and have been off work for almost 9 months i want to go back but between workers comp and the drs i really have no say i have to follow their rules to be covered for future surgerys and time off,
The dr also told me i will have to have the plate taken out and within 2 years i will be having a partial knee replacement very frustrating

[msilks64]

Sometime after my accident I was doing internet research on Tibial Plateau Fractures, which is how I found this message board. Thank God for this board. Anyway in my research, I found that this type of fracture is also known as a "Bumper Fracture". Something I find somewhat amusing, because it seems I'm the only one here who actually got hit by a car. I'm thinking maybe they should consider calling it a "Running Dog Fracture" LOL.

Deenah, Thanks for your comment. Although, differently from you when I am shaving my leg, I go very quickly and lightly over the metal area, and hope and pray I did a good enough job. It just feels so nasty!! http://tetongravity.com/forums/image...es/cussing.gif I used Mederma for a while too. Now I just use regular lotion. I've got a nice thick Nivea that feels good.

Hello msilks64,
I believe most people experience nerve damage or loss of sensation in any scar area. Mine is that way as well. It feels numb all around the area. My OS said it would never feel normal again due to cutting deep through the tissue & my plate area feels like that too since it's pushing on my interior leg muscles. It's creepy trying to shave I usally push down harder and quicker just to get it over. (shivers). I used advanced Maderma for 4 months so my scar is flat, thin & white but the sensitivity is gross. Good luck and hope it gets better for you.

[tinka333]

Tinka333, similar story, but my depressed TPF was the result of a 50lb boxer running full speed, its shoulder and a direct hit into my left knee. I am 13 weeks out from surgery. I was originally told 6-8 weeks NWB, but it turned out that meant 6-8 weeks for the bone to heal. Today is my first day cleared for FWB. I was PWB week 9 thru week 13. Even though I am cleared for FWB, the muscle isnt strong enough to support walking but gets better every day. I think next week I will be taking my own steps. Flex is 130 and 4 ext. Keep going to PT and the pool works great.

Well kmrrdb boxers and dobermans are not far off each other in size and weight!!
Love Msilks64's idea of calling it a "running dog fracture" lol
Congrats and good luck with the FWB!! Let us know how it goes.

I feel i will be the same when it comest to weight bearing, with the muscle loss its hard to imagine my leg will support me. Im doing heaps of leg lifts, isometric quad exercises and glute raises hoping to give myself the best chance i can at having enough muscle when the time comes.

I've also noticed i seem to have "forgotton" how to actualy walk!! I was trying to just go through the motion last night without putting any weight down and realised i dont know when the leg/ankle should be straight/bend in order to walk. I had my BF "demonstrate" a few times but just couldnt get it? Hopefuly it just comes back to you, Like ridding a bike!

Just a little trick i learnt when dealing with severe depression and anxiety back in my early 20's.
Allow the depression/anxiety to come but put a time limit on it. Say to yourself "ok, you have got 10mins to feel all the sadness you like and then we're moving on" Let it come, Feel it, and when times up.... Get up and go (even if you just do a lap around the house, moving forward at the end of 10 mins forces your brain to restart and move forward instad of getting "stuck" in the depression)

Hope it helps at least someone This injury seems to be a huge test of ones physical and MENTAL ability to cope and I for one am refuseing to alow it to change me!!!

Love, best wishes and a whole heap of good luck to all.

[peaton]

Sorry to say, Welcome!

I have the same problem with stairs up & down and lots of pain in the joint and under the knee cap. Feel your pain!!!

been reading this forum thought i would join in i broke my tibial plateau on 3/8/12 was unloading a truck and dropped a 250 lb generator on my left knee, had surgery the same day, had a bone graft wire a plate and 7 screws on the lateral side.
Was NWB for 14 weeks i think i got rid of the crutches in June or July was seeing the OS every 4 weeks since the surgery problem is its a 2 hour drive each way for a ten min visit he would not listen that i was still having a lot of pain.
It is a workers comp claim so i was able to switch doctors once and i am glad i did say the new dr in sept, he took a bunch of xrays looked at the original ct scan told me holy crap i messed it up really bad and was surprised that it was able to be put back together,
But he also sat down with me and explained what the pain was i was experiencing i have arthritis in the knee where it broke got me on meloxicam and put me in a unloader brace
Since then the pain has gone down but still hurts under my knee cap and i can not bend my knee with any weight on it, so going down stairs it just drops makes it very difficult going up stairs has gotten a lot easier but still hurts. just seen the dr last week will not approve me to go back to work, i see him again in Jan and he told me if it has not improved anymore by then that i will not be able to go back to work.

I work construction and have been off work for almost 9 months i want to go back but between workers comp and the drs i really have no say i have to follow their rules to be covered for future surgerys and time off,
The dr also told me i will have to have the plate taken out and within 2 years i will be having a partial knee replacement very frustrating

[Hardman82]

I was/am still getting a lot of pain in the joint on the lateral side it was a 12 mm compression fracture I have been wearing a brace but lately I have been getting more pain as I walk on the interior side of my knee, dr said he doesn't know exactly what is going on without an MRI is this pain normal 9 months after surgery i have tendonitis in my calf now and detached skin on my shin seems like every time i start getting better something else starts to hurt I've been going to pt for over 8 months haven't felt it improve for at least 2

[kimzz53]

Haven't been on in awhile but just saw the "scar&shaving" note- it's like you folks anticipate my questions.

One answer I can't seem to find: did anyone feel like they were regressing at the pwb stage?

I was feeling good (all things considered) with hardly any pain from surgery although hamstring giving some trouble in pt. Got some of my calf back, having difficult time with quad muscle memory. Pwb started on 11/13, 2 months to the day after surgery. Also finagled os to let me drive short distances.

Did great for a couple of days and then pain and swelling that won't go away. Swells up like weeks 3/4. Wakes me up at night. Pt switched to water last week (HEAVEN -- although I feel like Shamu at a marine mammal stranding center being lowered into the pool by that chaise contraption). I am getting pretty good rom and flexibility and was able to to 10 min on stationary bike with full rotation 1 pt session after pwb clearance

Because of pain and knee instability which may be psychosomatic I have spent the past 2days in the recliner fending off some insidious depression.

I absolutely know this is going to be a long haul but I have been lucky with progress..x-rays are good, os conservative.. and wonder if I am doing something wrong now. Os expected to clear me to fwb and stairs first week of December but I can't see my leg being strong enough without a walker.

Stats
Injury 9/7
Surgery 9/13 : S3, plates, screws, bone graft
Pt started 10/23
Pwb 11/13

[smilybeck]

One answer I can't seem to find: did anyone feel like they were regressing at the pwb stage?

Think of it this way...before the TPF if you were to workout i.e. weight training or cardio your muscles would ache for the next couple of days. It was my husband that reminded me of this. He would also get me thinking about the progress I had made each week...even if it was small.

Now that I'm on one crutch moving off them, my ankle is swelling. I haven't had that issue for 5 weeks. However I look at it this way, last week I walked 2kms to see Coldplay in concert, I survived the 3 hours with my leg down. I went Christmas shopping on the weekend by myself. I managed to get on the train to go home from work. I also managed to get in and out of our spa for the first time without help.

Also, don't worry about your leg being strong enough...in a weeks time (as long as you're doing the exercises) you'll be amazed at the muscle and strength gain you've made. Ok - you might not be FWB for the entire day, but at least it's a start.

[kimzz53]

I so appreciate your response -- it's hard to remember physical exertion hangovers from when I was more ablebodied. And you sound like you are doing very well...keep it up!

Yes, I've driven myself to pt and work, wrangling with walkers and wheelchairs, vacuumed and cleaned from the wheelchair, and today hung laundry outside on the line (put the basket on the walker and held it on with a bungee cord). Making plans for some holiday decorating too. Just not sure if I am doing too much or not enough. Pain can happen either way.

And it may be that some level of pain is the new normal as os said this was the golden ticket to instant arthritis...not that I had far to go at my age and activity history.

Don't think I could do a 2k even for a great concert, but do hope to do stairs soon...I live in a multilevel and as bed and bath are on the 3rd level feel a bit imprisoned. Using the steps is rough on the good leg

[Schmoopie]

Hello All,

I had the unfortunate luck of having a 100 pound malamute run directly into the outside of my right knee. As soon as it happened, I heard a lovely, but disgusting sound and was on the ground. Walking proved difficult as my knee wanted to go left. I was at the ER within 30 minutes, and within one hour, one doctor was saying it was a sprain, and a surgeon said it was more serious. I had surgery that evening and a plate, as well as screws and bone was inserted into the knee. Surgery was completed this past Thursday evening, and I was released from the hospital yesterday. I am now non-weight bearing for the next 3 months. I have my leg in a zimmer splint.

I'm looking for any info on what I can expect the next few weeks. I am using a walker around my three level home as I do not fare well crutches. After non-weight bearing, how long should I expect to be partial weight bearing?

I found the pain before the surgery was much worse than now, however the pain now is different. It's almost as if I can feel the bone rubbing on the plate and screws in my knee. I declined the morphine and percocet and am surviving now on extra strength tylenol. There are moments though when I think that the pain is literally going to kill me. I go back in 2 week to get the 40 staples out. I'm currently on daily injections of blood thinners to prevent blood clots.

Any help or insight would be greatly appreciated.

Thanks!