Tibial Plateau Fracture Recovery

[Steff87]

Hi Everyone,

I am now at 5 months from my original fracture. Just had a second operation 2 days ago, they removed a couple of screws that were causing discomfort and swelling and checking one of the 'shock absorbers' which they thought was torn but luckily is not! Yay!

Unfortunately I have excessive hyperextension so walking is very difficult. I have been working hard with phsyio, been a few times in the pool and really enjoying cycling as I feel normal (unlike when I try to walk). My doctor is now referring me to a specialist to have the bone rebroken and re-set. Its frustrating to say the least having come 5 months down the line and struggling and working hard, now I am due for another huge set back.

I am trying to remain positive, I am planning to head to Alaska in July and ride my motorcycle to Argentina. I am sure that the hard work will pay off and if I start this process again with a bone where it should be I am positive all will be well.

Believe me - anyone who is reading this. When I found this thread the first time in desperation for answers and an idea of time frames etc I cried for hours. Despite my major set back I am feeling more positive than ever. Of course I have days that I get down, its only natural. The thing to remember is that everyone is different - all the breaks are different and we all heal differently. It may take a long time to recover from this - but YOU WILL RECOVER!! When I get down I just think of people who are going through a lot worse, sometimes it helps sometimes it doesn't. Be strong, work hard and try to be positive. Wishing you lots of luck. xxx

[skiplct]

Hi Steff,

Glad to hear from you as I too am in the struggle. 1.6 years post fx and 1 month out from all hardware removal. The removal was a gamble, I knew, since many people experience more difficulties rather than less after hardware removal but I deliberated over it for 6 months and finally decided to take the gamble. It looks like I may be one of the ones for whom it was not a good idea, as I am much more crippled now than I was prior to removal but I am trying not to complain or whine since I it was after all my decision and elective procedure. I totally get what you mean about feeling "normal" on the stationary bike and not when weight bearing. Also trying to think positive that maybe my recovery will improve, and my leg will learn how to realign itself. I've been considering getting a pair of forearm crutches since I feel like they would allow me to move more quickly and nimbly than a cane, or 2 canes, or nothing. Please keep posting and keep thinking positive thoughts.

[powdork]

uggh! i just joined the club last week and this thread is a bit depressing, although i'm guessing the success stories don't make it in here as much.
here's how it went down - http://www.powdork.com/2014/theres-n...ng-a-backflip/

not much to report on recovery yet since i'm only 2 days post op. i pooped today which is is a start at least. baby steps.

[Tye 1on]

Aww man, bummer! Heal well!

[tam0558]

Wow! I never expected this amount of info here. I am appx 6 weeks post op from my TPR. Car wreck on January 6th. Surgery on the 7th. 9 screws and a plate. I'm in a brace at 0 and 30, just starting PT tomorrow. Heading back to the surgeon on Friday. I'm crossing my fingers that the x-rays will look good and I'll be able to start walking. After reading these posts, I feel like I may be being a bit optimistic, but I'm still hoping for the best.

[skiplct]

hi Powdork,

Listen-- The thread is not depressing as you will find in the months to come; it is actually the opposite: about the best-- sometimes the only-- source of hope, encouragement, expertise, advice, and camaraderie and all around support for this hideous injury. I predict you will look back on your finding of this site 8 months from now as a treasure, as the rest of us do. And yes, all degrees of success and failure and triumph and accommodation and adaption and acceptance are voiced here.

[powdork]

i know. this thread is what is bringing to light the seriousness of the injury, which is kind of scary.

[Mayaresearchmom]

5 1/2 months out from type 5 TPF. Surgical repair with 6 inch long T plate and 8 screws. 12 weeks NWB, with physical therapy starting at 4 weeks out to keep joint mobility. I have progressed from wheel chair, to walker, to cane, and sometimes just limping along on my own. I still have major swelling by the end of the day, and the numbness to the lateral side of incision. OS says to expect this for at least a year.

I have developed patellar tendonitis with crepitus (a crunching sound and feeling) behind the patella, which is indicative of damage to the cartilage which I know from the operative report has "multiple fractures" through it. I was told to lay off physical therapy for at least 3 weeks until I see OS again, which just really depressed me.

Until I found this forum, I kept thinking that something must be wrong with me if I am working this hard at PT, and I'm not back to "normal" yet. I spent hours yesterday reading all the posts. Realizing that I am not the only one going through this, and that a lot of people are having the same issues came as a relief. I now know that there may be a reason why my knee feels like it is hyper-extending sometimes, or what causes the occasional pain when I inadvertently twist my knee while walking or standing. It helps to see that there is no "schedule" for healing, there are just milestones along the way to getting our lives back to some semblance of normalcy.

So thank you to all who have posted on this site before me. I'm pulling myself out this pit of despair and fighting on.

[Maker]

powdork....looks like a lateral plateau...I did the same thing in AK except mine shattered into 13 pieces with shredded mensicus, MCL tear and LCL tear....which required about that many screws and 2 plates (see avatar)...no one told I had also broken my fibula until I saw the xray 4 weeks later ("you had bigger problems to worry about")

My recovery has been tough so I wont bore you with that.

I would get electro stim on the quad (maybe buy machine) to minimize quad atrophy and get going on leg lifts as soon as possible...atrophy creates a host of issues (malignment, knee tracking problems etc) if you do not stay on top of it.

if you only have two screws that probably means it broke off in one or two big chunks which means your cartilage might still be relatively in tact. Plenty of people are back to full recovery (see Rockbands journal)

[Maker]

Maya - I had a similar injury....made no progress in PT.

Rice Krispies in the knee is just standard now.

The issue I had with gaining strength in PT is that my plateau "settled/ collapsed" post surgery. Because it did..my knee was moved into a valgus position (ie, knock kneed...meaning hip, knee and ankle weren't in mechanical alignment...you can do an xray to see this). I could also actually see visually that my knee looked bent.

Not sure if that is creating a similar issue for you.

Unfortunately the only way to correct that is via a Osteotomy, which I just had done in December. Leg is straight and feels more stable (doesn't want to collapse inward)...but too early to tell because I am just restarting PT.

[powdork]

powdork....looks like a lateral plateau...I did the same thing in AK except mine shattered into 13 pieces with shredded mensicus, MCL tear and LCL tear....which required about that many screws and 2 plates (see avatar)...no one told I had also broken my fibula until I saw the xray 4 weeks later ("you had bigger problems to worry about")

My recovery has been tough so I wont bore you with that.

I would get electro stim on the quad (maybe buy machine) to minimize quad atrophy and get going on leg lifts as soon as possible...atrophy creates a host of issues (malignment, knee tracking problems etc) if you do not stay on top of it.

if you only have two screws that probably means it broke off in one or two big chunks which means your cartilage might still be relatively in tact. Plenty of people are back to full recovery (see Rockbands journal)

yes i think it was just 1 big piece with about a 2.5 mm depression and no other damage so i was lucky. i have had offers for a stim machine from those that still have theirs. the doc said it would be good if it was free but not worth spending on. i think it's because i do have a good range of motion and will be able to keep the strength up with pt.

[Maker]

ok....similar to you I am sure, I had really strong legs prior to getting hurt. problem is leg lifts don't work you enough so I still ended up losing >2 inches off my quad despite following PT closely. Later on, stim while doing leg lifts seemed to tire my legs out a lot more than leg lifts alone. might be a marginal benefit but if you can get one for free, not much downside.

and because you will be non-weight bearing, you cant do many other big leg exercises. I was non weight bearing for 10 weeks (maybe you will be shorter)

anyway, good luck.

[skiplct]

Hi Maker,

You sounds very knowledgeable so... I'm gonna pick your brain. I think I have exactly what you describe as malalignment; that's exactly what it feels like: that my knee isn't "lined up right". I have a big hard bony knob-- the outer edge of the plateau I guess-- on lateral side which feels like a constant pressure forcing my leg inward. Very similar quad atrophy to what you describe but I thought leg lifts (maybe w/ankle weights) were the answer. I had all hardware removed 1/14 in the belief that the hard knob was the plate but the plate's gone and the hard knob is still there, meaning that it must be the edge of the plateau that has shifted out of alignment. So... Now what? What can I do besides leg lifts to strengthen the quad, and once misalignment has occurred, is it too late to correct it? I am not crazy about my surgeon but am "stuck" within him for now because no surgeon will touch this within 3-6 months of another surgeon's work. PN of the peroneal nerve seems to be getting worse since hardware removal, not better. What is an osteotomy? Send private reply message if you don't want to bore everyone with details.

[debraphillis]

not yet, james, but i can see the light. i am 66, female, experienced my first ski injury this xmas day. lateral tibia, reduction w/no split, with no soft tissue damage, so i'm lucky; 6 pins and 1 plate i plan to leave in. about 6 wks into this, riding stationary bike, begin weight bearing in 2 weeks. working with perseverance. i'm old, so i should want to hurry up, but want you to know i plan to bike and paddle board this summer. goals matter.

i was an intermediate, single black diamond lady, planning to take my 6 yr old grandson to Loveland in CO where he lives. grammaw will just have to go a little slower Next year! till then, i will be practicing the Phantom Move ...and good luck to you. do you know the song...low rider don't drive too fast now-low rider don't use no gas now...by War

[skiplct]

Oops, Maker, sorry about that typo: You sound very knowledgeable, not sounds.... Please answer my questions about malalignment when you have time. thanks very much.

[Maker]

My hardware was removed as well. I doubt the tibia has shifted laterally outward. I am guessing the hard knob is just the edge of your tibia, but it seems more protruded because of the muscle atrophy relative to your healthy knee. I feel like I am touching the outside of my tibia, whereas on my good side it appears less protruded because there is more muscle tissue around it.

A few things for the most part can cause mis-alignment from what I have been told that makes it feel like your legs wants to collapse inward. First, is that your hip, quads and hamstrings have atrophied which has definitely occurred in your case.

Second, is that your cartilage and meniscus are damaged so there is not as much “stuff” filling up the gap relative to the medial side of your knee (ie your joint space narrows).

The third is the plateau has settled vertically. Even a small change of a few millimeters will cause the problem.

There is not much to be done for issue two and three. The only thing that I was told is a knee replacement or a high tibial osteotomy (http://www.hss.edu/animation-high-tibial-osteotomy.htm). The osteotomy is a procedure where the cut your tibia to realign it and then the bone reheals.

Your doctor should do a hip, knee and ankle xray….basically from the waist down. They then draw a line from your hip bone straight down through your ankle to see how the hip, knee and ankle line up and compare it to your good side. If you are in mechanical alignment, the line should go straight through your knee and ankle (the exception is if you were born knock kneed or bow legged, which is why they compare it to your good side). The osteotomy corrects that misalignment. This is more in the realm of a sports medicine orthopedic doctor because it deals with movement.

Hopefully, you may just have weak quads, hamstrings and hip muscles. If that is the case, I believe you xray would look fine, but your leg may just want to collapse inward because it isn’t strong yet. On my xray, the line between my hip and ankle passed outside of the knee entirely whereas on my good side it went directly through.

I am not a doctor.

They will want it to heal a little...I had my surgeries in the following order:

April 2011 - Ex Fix
May 2011 - TPF repair
May 2011 - Redo TPF Repair
December 2011 - Hardware out
Jan-December 2012 - PT
Mar 2013 - Told Osteotomy will help due to lack of progress in PT and above issues
December 2013 - Osteotomy.

[skiplct]

Hi Maker, You may not be a doctor but you seem to know about as much as one. I really really appreciate your informative reply. Yes I can see the atrophy clearly, the circumference of the thigh is so much smaller than the good side. I am trying to work on that by doing quad "sets" (where you sit on floor or bed with leg straight out in front of you and put a rolled up towel under the knee and press it downwards into the floor/bed), and leg raises with ankle weights.

How is your progress so far post-osteotomy? Are you FWB? Where was your surgery? (I live in central NJ.)

[Maker]

crutches and toe touch weight bearing for 5 weeks.

just started PT but leg feels straighter and more stable. same grinding and clicking in joint though. hardware typically stays in until knee replacement if that is ultimately needed.

Hospital for Special Surgery in NYC...my trauma doc is the Head of Orthopedic Trauma and the Sports Medicine doctor who did the Osteotomy is Tom Wickiwicz. Not sure how far you live from NYC but the Ortho docs at HSS are pretty much the best...unfortunately they don't all take insurance. You could at least see them for a diagnosis though.

familiar with the quad sets, leg lifts etc....tough to rebuild a ton of strength with those in my experience....but that is all you can do for a period of time post surgery....they do however help prevent further atrophy. I don't have any better alternatives though until I can hopefully start with leg press, hamstring curls and all that good stuff.

[SponsoredByDuctTape]

Crazy this thread is still so active. Haven't been on here in a looooooong time. Busted mine in 2008 at Mammoth, and posted a bunch of threads and pics on here somewhere. In hindsight, I probably wasn't aggressive enough with recovery. Good news is that 6 years post injury, and about 4 years post hardware removal, it's feelin' pretty good. Running not really a problem now, and I find that fighting through the aching actually makes it feel better overall. I saw a story on Henry Josey recently. Great story for those of us feeling like we're damaged goods.

[ladderFALL]

hey man why so down on yourself. its not the end of the world you are still alive so there is hope. i had my tpf fracture 12/23/13 and although it wasnt as bad as yours i still have my challenges. i had no surgery so no pins or braces but i am not allowed to put any weight on my foot for 12 weeks. whenever i am not on my crutches im jumping around on one leg. i see where you say you are struggling with despair, dont let your situation get the better of you, look ahead and try to work with what you have. you could have lost a foot. good luck on your journey ahead.

[ladderFALL]

ladderFALL reply was for skiplct post #1550

[tam0558]

LadderFall, it looks like our injuries were about 2 weeks apart (1/6/14). I just started 25% weight bearing yesterday. It feels great!! We plan on being 100% in 4 weeks. Like many others here, I was really starting to get down. To all those recovering from this injury, stay positive and take pride in the smallest accomplishments!!!! It WILL get better!!!

[SkiTurtle]

Like Powdork above, I debated joining this thread because my wife pointed out I was more depressed after reading it.

My injury was Jan 20th on a cat skiing trip at Monarch. Cruising fast down a beautiful untracked section and, as they say, unmarked obstacles may exist. Hit some rocks under the snow which ripped my ski off and started a slow motion fall ending with my knee hyperextending and fracturing the plateau. 9mm depression and a verticle fracture.

Surgery on Jan 29, 2014. 8 Screws, 6 inch plate and a bone graft. I think I am doing pretty well so far. 10-105 degree range of motion. Pain is manageable. Weird depression. Just cried watching the olympics and it wasn't even anything sad. Kinda strange how brain chemistry works.

I have high hopes for my next appointment on March 11 to go to PWB. I am in a wheelchair at work and that is a very humbling experience.

Long term - anyone golf after surgery? Since my ski season has ended (some friends are still pressuring for a late May/June A-Basin cruiser day), I'm wondering about my summer and fall golf season.

[redlegofficer]

Hello All,

I can see, depending how long you have been on this site, you can see it as either inspiring or depressing. I have gone back and forth but see it as positive now and probably for here forward. I am 46 and over the last 4 years lost 100pounds, did a lot of weight training, ran 12 half marathons, the army 10 miler 3 times, tough mudder, warrior dash 2 times and many other such events. Having all this stop due to the stupidity of a kid not watching where he was driving and hitting me while I was walking in a crosswswalk has been HARD. knowing that there are others that "understand" does help. Add that there are a few like "Maker" that offer a lot of help makes it even better.

Today is 10 weeks post op. I see my surgeon in 3 days and expect to hear (based upon a really good surgery, really good healing, and God's grace) weight bearing as tolerated. I really hope this to be the case because on 20 March 14 is the 4th anniversary of my lovely wifes' being called home to God and i want to be able to walk over to her grave.

Everyone keep your spirits up, let friends help and know that you will get through this. When I was only a week or two post op I felt it woult never end. Add all the show we got and I was going bat crap crazy! But everything has its season and the crazyness is largely gone and all my friends are still talking to me. lol

God bless you all.

John

[kmrrdb]

SkiTurtle,

I am currently 19 months post surgery. I have 5 screws and same size plate as you. 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. At this point in your recovery you will think that is impossible but every week you get more confident. That still hold true for me today. Week by week its still getting better. Best of luck