Tibial Plateau Fracture Recovery

[drob2342]

First of all, thanks to everyone who has shared their story. It has given me great insight to what to expect.

I had my TPF on 1-3-13 while wake boarding over the holidays. Iced and elevated injured leg for 2 days thinking it was an ACL, MCL tear. After two days, felt I could walk on it, so I did for two more days. Got home from vacation on the third day and leg was in terrible pain. Saw knee doctor one week after accident and he confirmed I had TPF but ligaments were all okay. I thought it was certainly the best of the worst. After reading this blog, I began to wonder if it was the case based on some of the challenging stories.

Well, I had surgery 2.5 weeks ago to have 10 screws and a plate installed. Virtually no pain although I was taking light pain meds in the hospital. Released the following day after surgery and haven't taken more than 2 - 500 mg Tylenol twice a day. That only lasted about 4 days. After staying on my back for the first week, which by the way was the hardest thing I have done, I had my 1 week post op check up. ROM was 90, 0 on my extension. Just had my 2.5 week appointment and I have ROM of 141 versus 146 on my good leg. I feel very fortunate and pleased with my progress. Still NWB for another 2 weeks when I will have another xray and determination if I move to PWB and possibly start riding a stationary bike. Just wanted to share my progress and again, thank everyone for sharing their situation as it certainly is comforting to know and compare what others have dealt with this fracture.

Sounds like you're making tremendous progress. Did they keep you overnight after the surgery? Are you also dealing with any of the numbness in the lower leg? I got my ROM to 100 comfortably today.

[JustDrewIt]

Well, I just passed the two-year mark since the accident.

Went to see the orthopedic surgeon: bone density is almost completely recovered, ROM is fantastic (not hypermobile when straightening though like I used to be), and strength is going really well- just gotta keep working at it. I only have to go back if I have stability issues. (I had a tibial plateau fracture, torn meniscus, and MCL was ripped off the tibia.)

The biggest change happened when I started walking 30 minutes a day at lunch break. Huge improvement over just a couple of weeks. Forced myself to take the stairs (up was fine, but down was really scary) and with persistence, that improved vastly too. There's no noticeable limp but I know the right leg doesn't straighten quite as much as the other one- I'm not too worried since it's not stopping me from doing anything. I suspect that's still somewhat of a strength issue.

Anyway, I just wanted to echo what others have said- there is a light at end of the tunnel. And it's not a train. I was so depressed by not being able to walk for so long, but just keep at it and you'll get there.

[bking210]

Drob - I left the hospital about 23 hours after surgery. I didn't really have any numbness, more discomfort in my instep of the outside of my ankle and on the outside of my lower calf. Calf muscle soreness is probably more related to the muscle being removed from the tibia to provide a clean surface for the plate. Both areas of discomfort went away after about a week. I was able to remove the TED hose yesterday and that created an even greater sense of flexibility in my knee. Really looking forward to PWB in a few weeks and ability to get on a bike or doing some form of exercise.

Congrats on the ROM to 100!!!

[justathought]

Hey - haven't posted in a couple weeks.

I am now 11.5 weeks post surgery. PWB since January 10 (only 35 -40 pounds of pressure) hoping to be FWB on Feb 7. ROM is now 0 to 120 degrees. I have gone back to work teaching (4 hours in the classroom twice a week).
I have some swelling post teaching but ROM is slowly increasing as is leg strength.

Still on the recovery journey

[smillerdvm]

Hello all,
This is an interesting forum and very helpful - thank you to all who have shared!
From my browsing, I can see that there are many degrees to a TPF. Just by browsing, I learned a lot and had many of my questions answered, but I still have a few...
I broke mine, inside left, mild displacement. 1/12/13 skiing in Utah. Surgery 5 days later with a plate and 6 screws. Instructions: 6 weeks NWB. At 6 weeks can start PWB with gradual increases. PT starting now at 3 weeks. I have a passive ROM machine at home I use 2-4 hours/day (at 105 flex and 2 extension)
I am 49 years year old and never a broken bone in my life. I originally was of the mindset that 'at least I didn't blow out my knee', little did I know...
I am a veterinarian. At work, I am on my feet 10-12 hours/day and doing all the acrobatics you can imagine dealing with animals 2 pounds to 200 pounds. I stand for hours in place doing surgery and go down on the floor 100's of times a day (up and down with every appointment.). As a Vet, it's difficult to talk about my work with MDs, they just do not understand the physicality of being a vet.
My Questions:
1. Any ideas/hints to get more comfortable at night? can not sleep more then 2 hours at a time. During the day, the mind is active and distracted - at night, all I feel is my leg. I am off narcotics and just taking Tylenol as needed. Even ambient doesn't help.
2. Anyone out there with as physical a job as I have? When can expect to work without restrictions? I know this is a difficult question to answer for anyone - but if anyone can have some input on standing for long hours post TPF repair, that would be appreciated
3. Anyone know a good scar cream?
4. What is better: an upright stationary bike better or a recumbent?
5. Anyone feel good 1,2 or 3 years out with their hardware still in? It seems to me, people are feeling much better removing hardware around 1 year?
6. Any good ideas/hints for carrying around stuff on crutches - backpack, fanny back - anything else??
Thank You!!!!

[Casper2012]

Smillerdym. Your sleeping issue is very common and many on this forum suffer the same including myself. I'm not sure why however in my experience it took me 4-6 weeks post surgery to start getting a more normal nights sleep. It's particularly difficult if your TPF requires you to sleep in a position that is not normal for you. As for physical work I'm sure you've gathered from reading posts on this forum that everyones recovery is different so there's no good way to predict. Many are NWB for 12 weeks and it's best to discuss with your OS who knows the magnitude of your injury. A website called CrutchEze has some accessories for crutches and walkers you might find useful. Good luck and best wishes for a speedy recovery.

[mosby88]

In 2009, I had a lateral tibial plateau fx while skiing in Durango. A plate, 8 screws, 8 weeks NWB later, and 6 weeks of PT later...I was pretty good. Unfortunately, I could not flex greater than 95 degrees so I had to have a manipulation under anesthesia (MUA) in order to regain ROM. 1 year later, I had another surgery to remove the hardware since the screw heads were causing issues. I still have some weakness but I am able to ski (a lot). For those of you recovering, hang in there...it will get better. As I tell my patients, (ironically, I am a PT) it is marathon, not a sprint.

[ATLRunner]

smillerdvm - I'll try to answer some of your questions. I just passed the 1 year mark and life is pretty normal for me now. I still have my hardware and am still investigating about the removal possibly this year. Fortunately, it doesn't bother me too bad, but I can feel it and I want to get back as close as possible to my pre-accident form. I can appreciate your questions as I had several of the same ones you have currently.

1. As for sleeping, I'm a side sleeper and it was killing me for the first 2-3 weeks. Keeping the leg elevated and in the brace was tough and I don't think I ever reached REM sleep which is not good for the human body. Fortunately, I was given clearance to remove my brace at night for sleeping only. Once that happened, I could turn to the side and bend my knee and get into a comfortable position. It's different for everyone, but that's what worked for me.

3. As for scar cream, I used Mederma gel. I used it routinely after showering and it seemed to work fairly well. During the summer when I was tan, I could see the scar, but it was faint. I think over time it will continue to get better.

4. As for the bike, my PT recommended that I use the recumbent bike as it put no downward pressure on my leg/knee. Initially, I only rode it for 5 minutes with no resistance, but worked up to 10 then 20 pretty quickly. I was very active pre-accident, so being stationary so long was tough. I loved once I could start riding the bike as it made my leg feel good. FYI, I ride the upright bike fairly hard now (100+ RPM ) with no pain and my leg has gotten a lot more stable.

I hope some of this helps. It does get better. Just be patient and do your best each day. Best wishes and I hope your recovery is as good as mine has been thus far.

[smillerdvm]

CASPER2012: Thanks for the reply - I checked out "Chutcheze" and ordered an accessory - never would have found the website without your tip.

[smillerdvm]

ATLRUNNER: I have read your past posts - you are very generous with your time and info - thank you.

I had my first PT session today and was underwhelmed to say the least. She answered "I don't know to half my questions". She did not even have a response when asked which type of bike may be best...I will be moving on from her. Just starting now to reawaken my quad muscle and stretching out hams/tendons. The real work starts with weight bearing in about 3-4 weeks. Hopefully I will have found a better PT by then.

Interesting, today Lindsay Von's crash hit the news (lateral TPF and torn ACL/MCL). Expectations are she'll be back in 1 year competing at the olympics. Tough to fathom, but she is young and world class - we'll see. I look forward to observing her effort/attempt!! I wish I had her medical support team around me...lol.

Will continue to work on the sleep and hoping it gets easier as time goes by.

Thanks again!

[jjohnson]

Depressed TPF 9-20-12 falling off a 14 feet roof (right knee-lateral side). Also broke my right shoulder. Male, age 55.

Once at the hospital I was x-rayed and told that I would need plates in both knee and shoulder. When the OS showed up I found out that the shoulder was indeed broke but would not require a plate. He said he was more concerned about the knee fracture and said it in such a way to raise alarms in my head. Uh-oh, how bad can a shin bone fracture be. Simple bone fracture, back to normal in six weeks, right? Wrong! I had never heard of a TPF and never in my imagination did I ever figure on having such a life altering injury.

Anyway, the deal is I spend 4 days in hospital. I hyperextended my leg when I hit the ground and fractured and severly bruised my right shoulder trying to grab a nearby tree. The pain was pretty intense and received some morphine first and then Oxycodone. The Oxy was great for helping me sleep and I received a 20mg dose every four hours.

Day four I was ready to leave the hospital and told Dr. I was out of there. Physical Therapist wanted me doing pt while there but I really wasn't in any condition to do so. (They still billed the insurance co. $1,800 for her 15 minute visit). Moving from my bed to do x-rays, MRI and surgery was extremely painful so I was not too confident about getting from my bed to my F150 pickup truck for the ride home.

It was tough but I made it into the truck, passenger front seat. The ride home was brutal as I felt every bump in my leg and lower body. The worse part was I started having severe muscle spasm in my lower pelvis area and both legs. I mean SEVERE! Once I got home I stayed on the living room couch for 4 days after which I finally moved to my bed as the couch was becoming very uncomfortable.

Being bed-ridden for days was a drag and I finally decided to begin moving aroung the house for such things as taking a bath and reading the newspaper in the kitchen just for a change of scene. Each time I moved from the bed to the wheelchair I experienced these extreme muscle spasms. These things were scary painful. The slightest movement would trigger them. Needless to say, getting on the pot to go #2 or getting into the tub for a bath was a major event with muscle spasms making the process a major effort. Initially I did not eat for at least ten days and I did not have a bowel movement for two weeks. The Oxycodone did a great job clogging the system. I was happy about this since it meant only a few trips to the pot and therefore less opportunity to trigger the muscle spasms. (I paid for that, however, because my bowel movements were very painful). I took a bath at least once a week having a towel bath daily. Each week it became easier to get into and out of the tub and thereby I was able to see some improvement in my state of affairs.

I first saw my OS two weeks post surgery. At that time he told me that I would be NWB for at least six more weeks. Since this also applied to my right shoulder, crutches and walker were out of the question. Wheelchair only. It was at this point that he also told me I would probably never use my right leg in the way I had prior to the fracture and that I would most likely get osteoarthritis in my right knee due to lateral meniscus tears. This might also require a complete knee replacement in as little as 5 years. Mentally, I think I can handle the long duration required to heal from this injury but I am not doing so well accepting the probable worsening of my right knee as quickly as he described it. I asked about the muscle spasm and asked for a muscle relaxer. He didn't think it would do much good and said the spasms I was having were pretty common and might continue for as long as 4 months. I am happy to report that the Flexeril that he prescribed took care of the spasms almost immediately.

Update: I'm doing well at week 7 in that I am getting around pretty well using only a wheelchair. My spasms are gone. Pain was giving me problems, especially trying to sleep so I was taking Oxy every six hours for a while then only to sleep and finally I quit with them about a week ago. The constipation and the bad mood that it was giving me was not worth the pain relief. My pain is manageable now even after doing regular pt for my shoulder and leg. My shoulder is killing me and stiff with minimal ROM. I've been using rotator cuff therapy and it is starting to produce good results. My leg is actually doing exceptionally well with little to no swelling even after being upright for most of the day. Flexion is nearly the same as my good leg. Extension is not so good but I'm able to match my good leg after I get up in the morning and my right leg is not swollen. Once the swelling sets in I'm about 3 degrees from being completely straight.

Scheduled to see OS in one week when he said if all is well he will give me the ok to PWB at 50%. This will allow me to use a walker and crutches and I'm expecting he will give me the OK to return to work. I am a welding instructor at a local tech college so it should be doable.

Looking forward to added mobility with the PWB. PT will be focused on gaining muscle mass back. Lost about 20 lbs, mostly muscle. Fearful of what I am going to experience when I put any weight on the knee. We'll soon see.

[leejem]

Hi all!
6 month post displaced TPF plus shin fracture. Plate and 10 screws
I pretty much have full ROM, I can touch my heel to my butt. My ankle is not quite as flexible as the other. My bad leg is 2-3 cm smaller in circumference than the good one. I have very little lateral strength and alot of muscle wastage.
I can't run. Walking hurts every step, it's just the severity that varies. Sometimes I'm almost limp free, others days are bad.
I can cycle and have made it an integral part of my rehab. I'm up to 40km rides and looking to train up for an 80km ride at the end of march. I live in the Australian "mountains" so there's some decent hill climbs around. I can't use cleats yet as I haven't got the lateral strength to unclip. I can't pedal standing up yet.
I can do yoga, slowly moving between poses.
I can swim 2km at a time. I use a fun only on the bad leg to try and build it up.
4 months until the start of our ski season and I'm really hoping I'll be back on the skis again.
I would never have thought recovery would be so long and so hard. But then I look back to where I was 3,4,5 months ago and realise just how far I've come.

[Schmoopie]

I'm 11 weeks tomorrow. Still no weight bearing, with another two weeks to go (hopefully)!! No pt has been ordered yet, only rom for the past 2 weeks. It's been a very long road. I'm really hoping for some partial weight bearing at my appointment in two weeks. Who knew a fracture could cause so much damage?

[HansNB]

When I last posted at 8 months following surgery, I had started a fairly aggressive gym workout to continue to rebuild the muscles supporting my injured knee. What developed shortly thereafter was the Rice Krispies crunching under my patella during squat movements. It was not that painful, but discomforting, so that I tended to favor the leg during even simple movements such as getting up from a chair.

I finally went back to my PT yesterday; she found that while the outside leg muscle was quite developed, the inner muscle was underdeveloped, resulting in a muscle imbalance. This apparently can cause mis-tracking of the patella, and the crunching action as it rides to one side. I was given some exercises, in the hope that the inner muscle will be strengthened, and the crunching will subside. We'll see how it works out.

On another note, I experience what some others have mentioned, including Karpiel, that the recovery is unpredictable. I still struggle with what is good for the injury vs. what makes it sore. Some days I can do a heavy resistance spin bike class with no ill effects the next day. Other times when I haven't worked out as hard, I am looking for the ice pack and Advil.

Returning to skiing for me is an uncertainty - this was the 2nd time I was hauled off a ski hill in a toboggan and had my body screwed back together. Maybe more time is needed to mentally recover. We'll see.

Thanks to all of you that put so much effort into this thread!

[fncrutchesrnofun]

I am also around your same age and had a similar brake, also my first ever. I was skiing on Dec 28th, caught an edge and heard a pop from my right leg. I thought for sure I had either an MCL or ACL injury. I was able to painfully ski to the bottom of the mountain and assuming I had ligament damage, I spent the next 2 days on the couch with ice/elevation. I also have an active job..I am a nurse anesthetist and a former runner of 5 miles daily. I was shocked to find out that I had a tibial plateau fx and had surgery on 1/1/13. I also had trouble sleeping. After 11 days the only pain med I would take was at night so I could sleep. I am resigned to the fact that I will not be able to return to work until April at least. Mederma is the best scar cream and there is one that has SPF 50 in it...definitely need SPF if applying scar cream. I am 5 weeks out now and will be another 3 weeks non weight bearing. Hoping I get the OK to do bike or anything even close to aerobic exercise! I succumbed to renting a wheelchair....it enables me to go places that are too much for crutch walking and I use it at home to carry things from place to place. The one I rented also has a leg rest that I can elevate while sitting. Best of Luck...By the way...Is there anyone out there that is running again after a tibial plateau fracture? My orthopedic surgeon thinks that I will be able to...

[smilybeck]

By the way...Is there anyone out there that is running again after a tibial plateau fracture? My orthopedic surgeon thinks that I will be able to...

I'm 6 months out and have started running in water for the range of motion. I've still got a long way to go before transferring that to land, but at least it's a start. I've been seeing a sports physio since the start, and we have been working towards the goal of running by the years aniversary.

Funny thing, the other day I forgot all about my leg, jumped off my seat at work to chase after my Director and tried to run - my ankle gave way. Oops...however, the positive side is that I'm mentality ready for running, even if I'm not physically able to yet.

[fncrutchesrnofun]

Thanks for the running info...I would be ecstatic if I could run at the one year mark! In the meantime I think spinning and the elliptical are gonna be my way to burn off some steam and I'll try the pool first when I can weight bear.

[tinka333]

Hi Tinka333,
Yes that is exactly what I was dealing with - same places same pain same inability with ROM. At first my OS said keep going with PT thinking it was all scar tissue. But I went back twice and demanded an MRI I knew something was wrong like way wrong. I couldn't do the leg lifts at all either or the stairs. After the MRI they clearly saw my meniscus was 75% torn and ripped away sticking out all over plus the scar tissue built up what a mess! My leg is still a little stiff when I do the leg lifts and it still pops just a little but without any pain. This weekend I went up the stairs without using the railing and not one at a time but really walking up the stairs. It sounds so minor but for me it's huge haha. Hope this helps my advice would be to insist on the MRI let them get a clear look at it and then they can decide what's best. Good Luck keep us posted on how it goes

Hey itsdeenah,

Thanks so much for replying. Im really in heaps of pain and just keep getting told by my PT that its a muscle imbalance or i need to back off a bit on the exercises, but even when i back off it doesn't get any better. Im so frustrated cause all seemed to be going well and then this pain... i feel like im going backwards. I'm absolutely going to request a MRI. I've done everything they have said to the T and its getting worse everyday.
Physio has me taping my knee cap to the medial side (inside) of my leg cause she says my pain is from the glute muscle being weaker on the inside of my leg, pulling my kneecap out of track but tapping doesn't seem to be helping.

itsdeenah you had a 2nd surgery for this right? Can you tell me what they did in the surgery, time frame for your recovery and how you feel now etc.
Thanks again for your reply - i was feeling a little discouraged and a bit hopeless

[justathought]

13 weeks out from a medial TPF ... Weight bearing as tolerated. Using crutches comfortably except for teaching which would be standing 4+ hours which is still too much.

Pain is very manageable but noticeable when I overdue.

[AllanahSA]

Hi, I'm 43 Mom of two and a Gr 1 Teacher Assistant. I had the first ski accident Jan 2010. ACL Surgey to Right knee. Very long and difficult recovery, with manipulation for the stiff knee after 6 months. Was skiing again 13 months later, with a brace. Another ski accident Jan 2013 - Non displaced Tibial Plateau Fracture up into the right knee. 6 weeks now in the cast...Another long road ahead. I get hope and good info from all of u. Thanx from Sunny South Africa.

[bking210]

Had my i month appt with my surgeon and PT therapist yesterday. ROM is 0-145 versus good leg at 0-148. Thrilled with flexibility and still no pain. Everything feels really good. My take away from this experience just 1 month into to it is that since I thought this was an ACL/MCL injury, I immediately began locking out my quads and flexing my knee even though it was uncomfortable. Maybe it was the wrong thing to do since it wasn't a ligament injury versus a TPF, but I do think it set me up for continued success with ROM. I also feel I had an awesome surgeon. Combination of both has contributed to what so far has been a smooth recovery.

Still on NWB for two more weeks, then PWB in two weeks. Waiting for another 7 weeks when hopefully will be released to do whatever. I appreciate all the information on this site and hope smooth recoveries for everyone!

[smillerdvm]

Hello - Update at 4 weeks post op. Ski accident - Left,Medial TPF with plate and 6 screw repair. Turned 50 years old (female) 2 days ago - not how I imaged that day to be, but perspective demands that things could easily be worse.

I had a great PT session this week with a new PT who really knew his stuff. I did NOT like my first PT who was the opposite of helpful. If you do not like your PT get a new one - ask for recommendations, ask your doctor for specific names etc. It matters.

Some PT insight I have learned that I would like to share: According to my PT, ROM is not the most important thing at this (4 weeks post op and NWB) point, it's the degree of leg extension - being able to get the leg straight and/or past or whatever is equal to the good leg. This is TOUGH PT and extensive Supine heel hangs to stretch out. Lots of ice after. The PT is going to try to get me a home electrode machine to help stimulate quad tone which is the second priority. ROM is important, don't get me wrong, but these first 2 (extension and quads) are what's going to get you walking without a limp faster. Remember heel toe is the natural walking movement. I have a passive range of motion machine (optiflex K1) at home which I still do 3 times a day and have since right after surgery - so ROM was never really lost fro me anyway. If you do not have this machine at home, ask your doctor to prescribe one. My PT is also going to try to order one of those "forward motion", non weight bearing braces to allow hands free walking. It may not work for me, but it's worth a try. Reviews are mixed. I want to get back to work and I cannot do this on crutches (I am a Veterinarian). Do upper body light weights or band work - keep those muscled toned and get the heart rate up a little every day if possible (but not too much or your leg swelling will get worse).

I can drive which is nice, but going anywhere in the winter with crutches is not fun or easy (live in Minnesota). Still get exhausted easily and the leg gets sore being upright for too long - after 30 minutes I have to get off my feet and get my leg raised.

2 weeks more and I have 6 week appointment with my surgeon with an xray - hoping for good news and the go ahead for PWB to begin. Not holding my breath as it seems. from people here, that this may need to wait until 8 weeks.

The continuing battle is sleep at night. I long for 6 hours of non-interrupted sleep. I imagine it would help with a faster recovery as well.

All for now.

[bluwav43]

Hello all, new here so bare with me...had a fracture in Oct. 2012, had keee surgery, steel plates and screws put in, got past all the bed time, cruthes, propped up leg stuff..knee is doing great...but..now my foot is swollen and will not go down no matter what I try......doctor is confused as well...anyone else run into this situation...I'm open to all replies...thanks, God Bless.

[smillerdvm]

Hello all, new here so bare with me...had a fracture in Oct. 2012, had keee surgery, steel plates and screws put in, got past all the bed time, cruthes, propped up leg stuff..knee is doing great...but..now my foot is swollen and will not go down no matter what I try......doctor is confused as well...anyone else run into this situation...I'm open to all replies...thanks, God Bless.

Hello - I had foot surgery (both feet, bunion repair) years ago (currently recovering from a TPF - see above). One specific thing my surgeon told me back then: if you get swelling and don't get it down asap with elevation and/or ice, that it can persist as a permanent condition. He made sure to emphasize avoiding and correcting swelling until fully healed and back to normal 100% (months and months). Maybe you had swelling that went unaddressed for too long. I don't know the pathology of why this would happen though - sorry.

[fncrutchesrnofun]

"2 weeks more and I have 6 week appointment with my surgeon with an xray - hoping for good news and the go ahead for PWB to begin. Not holding my breath as it seems. from people here, that this may need to wait until 8 weeks."
I just had my first PT appt last week. One of the most important things he told me is that a tibial plateau fracture, once repaired, has to have time to heal. We have one shot at getting back to "normalcy" and if we push it too hard or re injure it than we are toast. Being an active person ( I am a nurse anesthetist, mother of 3 and former daily runner) I have to keep in mind what the PT told me. Now is the time to be patient and that's difficult for people like myself. I am 7 weeks out and won't be able to drive for another 6-7 weeks. As much as it kills me to inconvenience other people to drive me around, I know that I am a liability if I get in an accident because I am driving too soon. Patience everyone...This forum is so helpful!