Tibial Plateau Fracture Recovery

[krausedmb]

I have a question for someone who is able to do strengthening on their leg. I am almost to 4 weeks post op and I still have the restriction of only bending my leg to 40 degrees. I am not able to do any strengthening yet. My leg has lost most of the muscle. Has anyone started strengthening and are you seeing/feeling any results? How long have you been doing it? For someone who is further out, how long did it take to get your leg back to a normal size? Thanks!

[SueBee]

NICE WORK! Thank you East Mtn

I've made a feeble start on an FAQ, setting up and adding one page at http://tpf.wikia.com/

If anyone would like to pitch in, please go ahead. If interested in helping with administration, send me a PM with your email address.

[Nurse Nina]

It all depends on your fracture location, extent and whether or not you had it surgically repaired. Are you seeing a PT? They would have a better idea of what you should do. On the other hand leg lifts to strengthen your quads and foot flexing shouldn't be much of a problem. Just take it easy cause the muscles are weak and they get tense and go into spasm. That hurts me more than the bone pain.

[Nurse Nina]

[QUOTE=krausedmb;3629314]I have a question for someone who is able to do strengthening on their leg. I am almost to 4 weeks post op and I still have the restriction of only bending my leg to 40 degrees. I am not able to do any strengthening yet. My leg has lost most of the muscle. Has anyone started strengthening and are you seeing/feeling any results? How long have you been doing it? For someone who is further out, how long did it take to get your leg back to a normal size? Thanks![

The muscle atrophied because you are not using it. Once you start PT and especially when you start walking on your leg the muscle will come back within a few weeks. I started PT one week after surgery and I have very little muscle atrophy, although I still have some swelling particularly around the knee. You can try some leg lifts to work on your quads and ankle flexion to work on the anterior tibialis, but please check with your doc and ask for PT. it will speed up your recovery. I am planning to see a personal trainer once my PT runs out if I can afford it.

[liamy]

I have a question for someone who is able to do strengthening on their leg. I am almost to 4 weeks post op and I still have the restriction of only bending my leg to 40 degrees. I am not able to do any strengthening yet. My leg has lost most of the muscle. Has anyone started strengthening and are you seeing/feeling any results? How long have you been doing it? For someone who is further out, how long did it take to get your leg back to a normal size? Thanks!

Hi. I'm almost 11 months out from a grade-6 TPF. My leg still does not look like the good leg. My OS and PT and an a former patient told me that it may likely never look the same. It is not uncommon to get full strength back but not get the mass back.
When my PT compares the strength between legs, he can't tell a difference. The only time that I can tell is when I'm standing and walking for long periods of time at work. My bad leg tires faster.
After atrophy, it takes about six weeks for muscle fibers to START to regenerate.
It all depends on how severe your injury was and how long you were unable to weight bear. You can only do so much to prevent the atrophy when you're unable to bear weight.
Just like everything with this injury, it's slow!
Work hard and don't stop!
amy

[tibfibxib]

I had my 12 week checkup with my surgeon today. After studying my X-rays and saying he was really pleased with the way my bones were mending... He told me I was cleared to walk on both legs with two crutches and work my way up to one! No 10% weight bearing nonsense... No working up to hobbling over the next 3 months... I was blown away.

Naturally I spent a lot of time after my appointment walking on two crutches. My leg is terribly weak from disuse, but it works! I can walk reasonably (though very slowly) with what seems like a somewhat natural motion. I'm actually finding the limiting factor in my walk to be the ROM in my ankle. In fact it was my ankle and foot that hurt while walking, my knee felt fine.

On a side note my leg is now pretty swollen from all of the activity. I will likely go back to wearing compression socks until my leg is less prone to swelling up. I did try walking with one crutch... I couldn't resist. It's definitely too much too soon. I can walk, but it's with a horribly strange limp. A lot of that is my ankle ROM, which should improve now that I can put weight on it. I am also able (and allowed) to stand on both legs now. I can do this with only a little discomfort and I'd be lying if I didn't say that it feels great just to stand.

I have a long way to go and a lot of PT ahead of me, but there's some light at the end of the tunnel finally. Hopefully everyone here either sees it or will get to see it soon.

[ZGHighlands]

I have a question for someone who is able to do strengthening on their leg. I am almost to 4 weeks post op and I still have the restriction of only bending my leg to 40 degrees. I am not able to do any strengthening yet. My leg has lost most of the muscle. Has anyone started strengthening and are you seeing/feeling any results? How long have you been doing it? For someone who is further out, how long did it take to get your leg back to a normal size? Thanks!

Krausedmb,

I think I'm a couple of weeks ahead of you in the recovery phase (surgery was 3-10) and my severity was a little less than yours. I'm an avid cyclist, and I'm completely horrified by the amount of muscular atrophy. That being said, I've been spinning on my trainer and gradually increasing in terms of wattage and duration. Not pushing so hard that I have post spin pain, but definitely breaking a sweat! The good news is that I'm seeing improvement in the muscle mass and I'm feeling stronger everyday. I have a friend who went through this same injury last June, and he is almost back to 100%. You can still see a difference in his legs but it is a subtle difference.

The caution, however, is that if you get too aggressive too early in the rehab phase, you may be setting yourself up for knee replacement down the road.

Good luck!

Travis

[ZGHighlands]

Krausedmb,

I think I misread your post, as your going to need to be more than 40 degrees to get on the trainer. They gave me a series of Isometric flexes and presses to begin the strengthening. When they clear you for these, do them as much as they will allow you. They feel weird at first, and boring too, but they will really help when you start moving the legs again. Also, when they clear you onto the stationary bike, go easy for the first several sessions. Being a competitive cyclist, your muscles, ligaments and tendons are used to activity. Post accident, they have been getting tight and they will be sure to remind you of this when you start to use them again. Turning the pedals is a huge psych boost, just don't get too crazy with it.

Travis

[krausedmb]

Thanks for the info everyone. I saw the surgeon today for the 4 week checkup. Great News! I am able to finally bend as much as I can tollerate and will be able to start partial weight (25%) next week. Of course, if there is pain or swelling its back to toe touch. I have been in PT since a week after surgery 3x a week (message and working on extension). Have had a compression sock on since surgery that has really helped get swelling down. I have pretty much been laying on the couch with it elevated except for pt and the home pt seshes and one road trip to fort collins. It is now my goal to get above 120 degree so I can get on a trainer. First day without restriction I am at 70-80 flexion. It is tight but doesnt hurt.
injury background - tibia plateau fracture (plate 7 screws), avulsion fx femur (2 screws) - calf and groin muscles pulled off with bone from femur. Healthy (other than injury) 31 and don't smoke anything.
There is hope of riding and walking sooner than I thought.

[SoccerGirl]

I've made a feeble start on an FAQ, setting up and adding one page at http://tpf.wikia.com/
If anyone would like to pitch in, please go ahead. If interested in helping with administration, send me a PM with your email address.

great going! It has begun! Asap i hope to get on there and contribute! (it's been on my to-do list for several days to help get this going!)

Krausedmb -- about when can we start stengthening/ gaining back mass -- i'm at 11 weeks (down to one crutch/ none for short distances) and wondering the same! To date, PT has refused to let me do weights (leg machines, etc.). She said at this stage, it could lead to tendonitis and other such pleasantries.

Well... A few days ago, i tried signing up with a personal trainer. I wanted him to help me gain back core/ upper body/ aerobic conditioning at least.

(Has anyone else had experience getting a personal trainer in conjunction with Therapy during early stages of recovery?)

Well... I now offer a word of caution about trainers! (another possible topic for the new Wiki pages!) I thought this trainer was well prepped to work in conjunction with PT (therapy) guidelines, as we discussed things beforehand, my PT gave me permission, and he was reputable. So when, to my shock, he surprised me by putting me onto a couple leg machines (hip/ extension/ flexion), I put aside my doubts/ the P.T.'s words, SOOO excited to "lift some weights" for 1st time after 3 months.

Well... ever since then, i've regretted it. Pain. Not muscles, but the fracture-site. That awful bone-aching-throbbing that makes keeps you up at night and makes you reach for the Tramadol or your pain killer of choice.

So now i'm all worried that i've caused the still-soft-bone to depress further, or what have you.

So... yeah... it may be wise to not jump into weights/ machines until the Therapist ok's it

Like y'all, I'm just aghast/ grieving my wasted hamstring/ quad. Looking with longing at those weight-machines (whatever you call them!)

thanks for the person who left the tip about taking 6 WEEKS for muscles to START to regenerate. Good grief!

[Painful]

Hello I'm new to this forum but glad I found it!

3/18/12- Rolled my 4-wheeler and ended up with Tibial plateau fracture with displacement and over 1 cm of depression that had to be lifted back up into place and extra bone added to fill in.
3/30/12(2 weeks after breaking it)- Had surgery. Locking plate and 8 screws. Pain after was excruciating! Thank goodness for Delaudid!! Now cant put any weight on it for 3 months.... which is driving me nuts!!!!

[97r82]

great going! It has begun! Asap i hope to get on there and contribute! (it's been on my to-do list for several days to help get this going!)

Krausedmb -- about when can we start stengthening/ gaining back mass -- i'm at 11 weeks (down to one crutch/ none for short distances) and wondering the same! To date, PT has refused to let me do weights (leg machines, etc.). She said at this stage, it could lead to tendonitis and other such pleasantries.

Well... A few days ago, i tried signing up with a personal trainer. I wanted him to help me gain back core/ upper body/ aerobic conditioning at least.

(Has anyone else had experience getting a personal trainer in conjunction with Therapy during early stages of recovery?)

Well... I now offer a word of caution about trainers! (another possible topic for the new Wiki pages!) I thought this trainer was well prepped to work in conjunction with PT (therapy) guidelines, as we discussed things beforehand, my PT gave me permission, and he was reputable. So when, to my shock, he surprised me by putting me onto a couple leg machines (hip/ extension/ flexion), I put aside my doubts/ the P.T.'s words, SOOO excited to "lift some weights" for 1st time after 3 months.

Well... ever since then, i've regretted it. Pain. Not muscles, but the fracture-site. That awful bone-aching-throbbing that makes keeps you up at night and makes you reach for the Tramadol or your pain killer of choice.

So now i'm all worried that i've caused the still-soft-bone to depress further, or what have you.

So... yeah... it may be wise to not jump into weights/ machines until the Therapist ok's it

Like y'all, I'm just aghast/ grieving my wasted hamstring/ quad. Looking with longing at those weight-machines (whatever you call them!)

thanks for the person who left the tip about taking 6 WEEKS for muscles to START to regenerate. Good grief!

Soccergirl
I would avoid a personal trainer. Get a better PT if necessary? You can't rush this recovery too much. I am @ 7 months now. Working my long shiifts (12hrs) but it takes everything I have most days. The best thing I did was double up on the exercises they had me do @ therapy 3 times a week on my off days. Once he released me to ride the trainer bike I spent up to 30 minutes 2 times a day on that. Don't let your good leg lose muscle. my bad leg is bigger than the good leg now. I should have done the same exercises with the good one. Hang in there as someone said on this forum it sucks to be me for now. Enjoy the downtime I should have waited another month to go back to work but I am over the hump now.

thanks
jesse

[97r82]

Hello I'm new to this forum but glad I found it!

3/18/12- Rolled my 4-wheeler and ended up with Tibial plateau fracture with displacement and over 1 cm of depression that had to be lifted back up into place and extra bone added to fill in.
3/30/12(2 weeks after breaking it)- Had surgery. Locking plate and 8 screws. Pain after was excruciating! Thank goodness for Delaudid!! Now cant put any weight on it for 3 months.... which is driving me nuts!!!!

Welcome Painful
Delaudid was my friend for a couple weeks after morphine did touch the pain. Get ready for a long recovery. It will drive you nuts. Find something you can do to kill the boredom and get a good PT as soon as possible. They have lots of little exercises to battle the atrophy to prepare you for walking again. The massages from the PT are just as important as the exercises early on. If they don't work with you fire them and get another one. I was 11 weeks NWB (2 plates 22 screws). Walker and shower bench (not chair) Crutches were too awkward for me until I was weight bearing. Removed the bathroom door. Let your friends and family help you thru this rough patch. You need some company from time to time. This forum is a valuable source of knowledge. These guys have lived thru some terrifying ordeals and will talk about it.
Hang in there. Take you pain pills before therapy so PT can work you enough. Tramadol is a good choice if you can't stand the codine effects?
thanks
jesse

[seanwieland]

15 Days post op, 24 days post injury. One day at a time is leading to one week at a time. My swelling has subsided considerably, my range of motion is 10 degrees fully extended to 80 degrees. Interestingly, my doc (Dr. Khoehane at Mt. Tam Orthopedics) is of the view to wait three weeks post surgery before doing "real" PT, but in the mean time to fill the time with moving the joint to the point of resistance and just past using "active" force (ie, just muscle). This runs counter to what many of the protocols say (ie, Brigham & Womens), but he is a knee doc for the U.S. ski team, has done hundreds of these, and I'm not one to question his instructions. Thigh atrophy is pretty significant at this point (after only 3.5 weeks), it's amazing how fast the muscle goes. For pain meds, I was originally on 10mg Oxcontin 2x/day, 5-10mg Oxycodone every 4-6 hours, plus 800 mg Ibuprofen as needed, and a femoral nerve block for the first 4 days post surgery. The femoral nerve block came out, I've dropped the Oxycontin, and I'm now only taking 5 mg of Oxycodone once in the middle of the night because I wake up with lots of pain. Oh, I'm also taking Ambien to get as much sleep as possible. During the day I'm taking 800mg of Ibuprofen 3x/day (with meals). It's not pain free at this point, but it's tolerable. I'm looking forward to pushing it harder and starting PT at 21 days post-op (next week). I say that now, but after all of your reports of how painful that is, maybe not.

Here's a snapshot of the CT of the fracture - image quality is stunning. Nobody can believe that this is actually my knee!



Thanks for the great posts, keep the info flow coming, it's inspiring to read the recovery stories of others!

Sean

[Nurse Nina]

Hi everyone,
I had my 6 week post-op visit with x-rays. Everything is progressing steadily, no shifting of the plate and screws although I can feel and see on the x-ray the two screws that went through the tibia and out the other side. He said that those can be removed in a year or so if they bother me. Well, they are bothering me now, but the thought of another surgery and waiting for those holes and new scars to heal is giving me second thoughts.
I was cleared for flat foot partial weight bearing, because I also managed to sprain my right ankle inside the ski boot, I need to take it slow. The upside is that it feels great to be able to at least balance myself while standing near a counter or bed and I can manage to try to prepare dinner and maybe rinse a dish or something. The down side, is that my ankle now hurts and the knee and ankle becomeswollen by the end of the day despite the compression stocking. Needless to say I am back to icing and will reach for the tramadol if necessary. The pain isn't so bad, it's the knee and ankle that are stiff and tight. Especially in the morning. It wakes me up as I shift in my sleep.
PT came this morning and noted that because of the weeks of "standing" on the left leg, I am off "balance" when I stand on both feet. So now I need to work on lowering the right hip and trying to lean toward the right side. Hard to do while partial weight bearing. My goal is to get to full weight bearing in four weeks when I see the OS again and start outpatient PT.

[TPFxPilot]

Well... A few days ago, i tried signing up with a personal trainer. I wanted him to help me gain back core/ upper body/ aerobic conditioning at least.

(Has anyone else had experience getting a personal trainer in conjunction with Therapy during early stages of recovery?)

I don’t have any experience getting a personal trainer, but I am very interested in getting back into a weight room starting next week. I’m only about 3 weeks post-op and still NWB, but I don’t see any reason I can’t try working out a bit from the waist up on the machines to keep the rest of me in some kind of shape. I’m sure the gym will want me to work with a trainer, or at least have some form of doctor approval, before letting me step foot in the place for liability reasons, though. I'll let you know my experience.

Like y'all, I'm just aghast/ grieving my wasted hamstring/ quad. Looking with longing at those weight-machines (whatever you call them!)

Aghast is the perfect term! I seriously can’t believe how quickly my calf went from toned to flat tire! And I can almost wrap my two hands around my thigh and have my fingers touch (5 weeks post injury)...I'm almost more worried about rehabing the muscles than the knee itself.

[TPFxPilot]

Don't let your good leg lose muscle. my bad leg is bigger than the good leg now. I should have done the same exercises with the good one.

Absolutely agree with the idea of doing the same exercises for both legs when possible to try and avoid lossing mass on the good leg. I've rapidly learned that although I'm relying heavily on my good leg to get around, I'm certainly not giving it enough activity to compensate for my usual activity, so I'll likely lose some muscle mass on the right leg too, just not as glaringly obvious, unless I do something proactive to prevent it.

Speaking of exercises...I'm due. Time to go lay on the floor for awhile, and move the legs around!

[SueBee]

Hi All!

7 weeks post op follow up on Tuesday. I was cleared for partial weight bearing up to 20% gradually increasing to 50% + in 3 weeks!

I am assured by many whom I trust that the muscle will come back with work. My big challenge is ROM. OS says I have 3 weeks to improve it and if I do not the will put me under to 'manipulate' it for me. Gack! I have a PT appointment tomorrow and he is going to have to give me more exercises and I am going to be working in earnest. What are the best ROM exercises you all have used? (although it's hard for me to picture what you mean with the written description sometimes)

Feels great to have two feet on the ground! I'm definitely slow and tentative. But I am on the path to recovery. (as are we all) I have appreciated all of your wisdom.

03/10 TPX
03/13 plate and 4 screws NWB 8 weeks
05/01 (7weeks post op) PWB approx 25%

[Painful]

97r82..... Thanks so much for your reply. Crutches definitly have not worked for me....five days after injury and before surgery i was using crutches and fell backwards and of course before falling all the way down I ended up stepping with broken leg which did not work....fell into a door and wall....that was very discouraging! Didnt try crutches again until about a week post op and almost fell backwards again but luckily my hubby was right behind me and stopped me....using walker now and yes using shower bench also and bathroom door has been removed.

I have 4 daughters(ages 18,17,13,11) still living at home and am very involved with their lives...or was until this....it just kills me not being able to jump and go to do things we want or need to do like I always have.
Melissa

[ZGHighlands]

Hi All!

7 weeks post op follow up on Tuesday. I was cleared for partial weight bearing up to 20% gradually increasing to 50% + in 3 weeks!

I am assured by many whom I trust that the muscle will come back with work. My big challenge is ROM. OS says I have 3 weeks to improve it and if I do not the will put me under to 'manipulate' it for me. Gack! I have a PT appointment tomorrow and he is going to have to give me more exercises and I am going to be working in earnest. What are the best ROM exercises you all have used? (although it's hard for me to picture what you mean with the written description sometimes)

Feels great to have two feet on the ground! I'm definitely slow and tentative. But I am on the path to recovery. (as are we all) I have appreciated all of your wisdom.

03/10 TPX
03/13 plate and 4 screws NWB 8 weeks
05/01 (7weeks post op) PWB approx 25%

Hi SueBee,

Sounds about identical to my injury. Accident and surgery on 3/10, plate and 4 screws. I will say that my OS has been great in terms of progressing my recovery. He works with lots of pro skiers and other pro athletes (which I am not) so I'm confident in his judgement and recommendations. At 5 1/2 weeks, He cleared me to pwb up to 35lbs, with slow progression to 50% and use of 1 crutch. Yesterday I was allowed to make the transition to 1 crutch and it was great! I do have a slight hang up in the ROM flexion, which my PT has me working on 3-4 times a day for no more than 5 minutes. The exercise is simply sitting on the floor w my back against a wall, flex my leg from fully extended (flat on floor) to maximum flexion (knee bent)...I have to pull the lower leg with my hands, through the final 3 or 4 inches of flex. What I have found with most of my issues, is that as I become more active, the quicker the issues take care of themselves. As my PT says,"Motion is lotion." The biggest key is doing it without pain. If it hurts, stop. Best of luck to you as you move froward!

As for anyone considering a personal trainer, please be very cautious. While most are highly professional and well trained, they are not as well versed in this recovery as your OS or PT. The potential for a massive set back is considerable. Just remember that this is your knee, and you have to live with it 24/7 until you die.

Good healing to all!

Travis

[seanwieland]

Hi SueBee -

I'm curious what your ROM is at 7 weeks. I'm 16 days today, haven't started "formal" PT yet, as my doc wants to wait until 21 days to do that, but has encouraged me to push to the resistance and back again. I've gotten it to about 10 degrees (extended) and 70 degrees (bent).

Thanks,
Sean

[TPFxPilot]

Hello:

I have been thread spying for 5 weeks and thought I would finally chime in. First let me say trying to find information on this injury has been quite a challenge.

Greetings snowmobile...looks like both of our intro posts got buried a bit since the moderator needed to approve our first posts - probably a good thing for everyone, considering how much we both wrote! Anyway, for you and anyone else looking for a pretty comprehesive overview of tibial plateau fractures, here are a couple of articles I found soon after my injury. They really helped me understand the injury and options, especially since there was some debate whether surgery was necessary in my case. It's definitely not light reading - virtually everything is covered from mechanism of injury, classification, surgical procedures and techniques, hardware, prognosis and recovery - so they can double as a cure for the insomnia we all seem to experience in the early stages! Both articles are co-written with Dr. Joseph Schatzker, for whom the whole classification system has been named, so I assume they are quite reliable sources of info:

http://olc.metrohealth.org/SubSpecia...rauma/ch56.pdf

http://://health-7.com/Skeletal%20Tr...au%20Fractures

[TPFxPilot]

Interestingly, my doc (Dr. Khoehane at Mt. Tam Orthopedics) is of the view to wait three weeks post surgery before doing "real" PT, but in the mean time to fill the time with moving the joint to the point of resistance and just past using "active" force (ie, just muscle). This runs counter to what many of the protocols say

I'm actually growing very concerned about this as well...in my case, my doc hasn't allowed any "real" PT at all, and I won't see him again until May 16 (5 weeks post-op). No ROM work, just hip and ankle exercise to keep them active while I stay in an immobilizer. Everything I've read says I need to get my knee moving if I want to regain full ROM. To tell the truth, I'm not entirely following the doc's orders at this point...each night when the brace comes off for my shower, I've taken to bending the knee a couple times through as much range as I can without any resistance or pain. I find that I don't quite get full extension, and maybe 70-75 degrees flexion, but virtually no pain - just the resistance from the residual swelling of the knee (I think) which causes me to stop. Other than that brief cheating, I do keep it immobilized for the remaining 23 hours and 58 minutes of the day, but I'm really starting to worry that the lack of motion will spell trouble for my long term recovery.

BTW Sean - I was able to check out your CT on flickr, and the image is astounding...my CT definitely did not look like that in either image quality or severity!

[East Mtn]

I'm actually growing very concerned about this as well...in my case, my doc hasn't allowed any "real" PT at all, and I won't see him again until May 16 (5 weeks post-op).

You don't need to wait for an appointment. Call his office and ask for a callback to discuss.

BTW Sean - I was able to check out your CT on flickr, and the image is astounding...my CT definitely did not look like that in either image quality or severity!

Wow, that is beautiful (or horrible)! That photo appears to be set in Flickr as not being shared, so it didn't embed properly in TGR's forum. You should be able to get to it in its own browser window here.

That image was generated by TeraRecon's Aquarius Workstation software. I just signed up for a trial account on their new cloud offering, so I'll see if they can post-process my DICOM data, or if I can get raw CT data from the hospital.

CT creates a 3-D, volumetric data set, and it's a shame that instead of using it to produce an intuitive 3-D visualization, it's usually reduced into formats such as the standard DICOM CD's, where it's made to look like the century-old technology of x-ray "films". Medicine is terribly technology-phobic at times.

All, please help edit the TPF Wiki!

[seanwieland]

I'm no doctor, but listen to what your body is telling you. I think if ROM feels good, doesn't hurt, and you don't push it too much, ice it afterward, then any progress that is made now just gets you further down the curve. My doctor wants to see the "paint dry" (ie, bone heal) before I see a PT, but he encouraged me to take the brace off and work it. At 17 days post op, I have 70-80 degrees flexion. I'd call your doctor and challenge him/her on it. The Brigham & Women's care protocol for this injury says to start PT right away, with the goal of 90 degrees within the first four weeks.