Bone breaks around the knee :
Tibial Plateau Fracture - - Posted by exoman (exoman), 20 January 2005
I am 47 and fractured my right tibial plateau one week ago playing in an over 40 soccer league. According to my Ortho surgeon, it is one of the more nasty fractures (6+) of the tibial plateau he's seen. 4 hour surgery to repair with (1) plate, (6) screws, and a LOT of epoxy. Currently using the continuous passive motion machine approximately 8-10 hours per day. My doc believes my goal should be 0-90 degrees. After one week, I can achieve 0-75 easily. My major questions for those that have gone before me are:
1) Do you sleep using the CPM (continuous passive motion) machine? Immediately after surgery, it was wonderful as I was highly medicated and only wanted to sleep. Now, after one week, I find it very diffult to sleep with it on, even if I reduce motion to 20-30 degrees. I would prefer to sleep soundly, then use it 8 hours during the day.
2) I am told I cannot bear weight for 10-12 weeks. I am now the proud owner of both crutches as well as a walker. In order to get out of the house more comfortably, I am considering renting a wheelchair to round out my transportation options. Make sense?
3) Managing medication is a major theme for me. I use pain medication (5mg oxycodone) VERY sparingly. (Like every other day.) Am also using Celebrex as anti-inflammatory, Ambien to sleep, and laxative to counter the oxycodone. My major question here is how long before the pain (when I am on crutches or using the walker) will subside when my leg is suspended? At the moment, it throbs like nothing I've ever experienced. If this pain were not so severe, my mobility (and mood) would be vastly better.
Thanks in advance for any comments and advice.
Posted by Victoria_L (Victoria_L), 21 January 2005
Dear Exoman,
Sorry to hear about your accident. I have just passed my one year anniversary of my tib plat fx (plate & five screws), and want to let you know that it does get better. While it is true that my leg will never be quite the same, I am fully functional and most of the time can forget the injury.
Now, to your questions:
1. I was told by the medical equipment company that they did not recommend using the CPM machine when sleeping. It was explained that if you turned over or moved in your sleep the leg could be twisted and damaged. It made perfect sense to me, and the last thing I wanted to do was hurt the leg, so I used it only when awake.
2. If I had it to do over again (please! NO! I didn't mean it!) I would have rented a wheelchair. I used the walker for inside the house -- after a couple of falls with the crutches I liked the stability -- even though the walker is clunky. I used crutches outside. A wheelchair would have been much easier for many trips.
3. The leg throbbing does get better with time but, man, does it hurt for the first couple of weeks whenever you stand up. As I understand it is the blood flowing down the leg and just the fact that it is dangling that makes it throb. For me, the pain upon standing was all but blinding, but after a couple of minutes it got better. If yours hurts consistently when you are upright (it doesn't lessen after a few minutes as you begin to hobble about), I would suggest asking your OS about it.
Now one other thought. The most important thing I did (and a lot of it was based on advice from the people here) was to start Physical Therapy as soon as your OS gives the okay. You can do exercises well before you can touch your toe to the ground that will help immensely when you start walking. I was not allowed to go full weight-bearing for 14 weeks and it is astonishing how much muscle you lose in that time, even with doing all my straight leg lifts and towel pulls. As you sound like an athlete, you are probably way ahead of me on this.
There are a number of folks here with Tib Plat fractures, and if you have other questions, or concerns, or just want to vent... that's what we're here for.
Victoria
Posted by exoman (exoman), 21 January 2005
Victoria:
Thanks for your feedback. I will sleep MUCH better tonite without the machine running!
One other question. How long did others apply ice to their injury? I have a Polar Care unit (ice chest with insulated in-line pump and specialized knee pad with velcro) which is quite a convenient way to ice the knee. Nonetheless, all these contraptions become a hassle after a while. Don't get me wrong, I'm going to do what I need to in order to heal. I'm only asking where the biggest returns are.
What a great community here @ kneeguru!
Posted by hkssuppie (hkssuppie), 21 January 2005
Exoman,
Sorry to here about you joining the club of 1%er's. But keep in mind there are many on this board that have been what you are going through, and can act as a great source for answers to questions you may have.
1. Don't know, I never was on the CPM, but I would have to agree with Victoria.
2. I had one in the house, but found it to cumbersome because of clearance issues, between countertops, doorjams etc etc.
3. The throbbing didn't go away for around 2 weeks for me, but I had stopped using most pain meds except to put me a sleep, after the 1 week point. Even then, sitting on the thrown and sitting in general with my foot at a downward angle produced blue toes, tingling ankles and the such. The heeling process for these breaks are very long. At 1 year post-op, there's not a day I don't know that i've had surgery on the leg, but there are days where it's just not that bad, and others where it still lets me know I had a terrible injury. Hang in there and use this board to help you through. There are many emotional ups and downs left to go, but eventually it gets better
Posted by Victoria_L (Victoria_L), 21 January 2005
Exoman-
Ice is your best friend! Also elevation. It IS hard, and it is a hassle, but it is important. To get the swelling down (and the pain), it is important to keep the leg up as much as possible. You can also do foot pumps while lying down -- as if you are stepping on the gas pedal of a car -- to help the swelling by increasing circulation to the foot.
As to how long to ice: I STILL ice my knee if I've been pounding on it or have twisted it. I never used the machine -- just a regular ice bag, which might be easier to manage sometimes if you are not near the machine. Don't let the ice "burn" your leg by leaving it too long, though. Twenty to thirty minutes on, then off.
Try to take it easy. As hkssuppie says, there are amazing emotional ups and downs. It is, as my OS told me dryly, a "significant" injury. Which most people just don't get. It's just a broken leg, they'll tell you, why aren't you better?
Hang in there,
Victoria
Posted by exoman (exoman), 21 January 2005
I see my OS tomorrow and will inquire how quickly I can begin PT. He knows I am motivated.
Also hoping to have the 30 staples removed as the incision is dry and looks pretty good. It is too early (9 days post op) to expect their removal? Is it fun? haha.
Posted by hkssuppie (hkssuppie), 21 January 2005
I had my 22 staples removed at the 2 week post-op visit. Fun stuff, not to bad, just make sure you take a lauratab or something before hand. At least you'll be able to get to showering again.
suppie
Posted by kgrosskurth (Kathy G), 23 January 2005
Hi, exoman. Sorry you had to join the 1% club. I really cannot add much to what was already said. I didn't use a CPM machine, but when I was given clearance for PT, I purchased a recumbent Stationary Bike through www.fitnessquest.com which I use to this day. It was a Godsend for me, and I was able to use it adjusted to the least resistence. Boy, it was great to get all the way around!! 
I would recommend the wheelchair!! It's great for getting around the house and for outside trips to the store, etc.
As far as recovery goes, it is lengthy. I had some initial issues getting with the program in the beginning, but I'm glad to say I'm functioning near normal and have resumed most normal activities, and I'm getting better all the time by alternating using the bike and treadmill.
I have a online diary which may be of interest (the link is below in my signature), and you can access others through www.mybrokenleg.com website.
Wishing you all the best, and feel free to post your questions for us!
Posted by exoman (exoman), 23 January 2005
Thanks for the advice on the stationary bike. That is great news since cycling is one of my passions and I hope something I will be able to do without pain in the future. A friend of mine will bring his Schwinn Aerodyne next week. Although it is an upright stationary bike, it allows you to use your arms to reduce to zero the force required by your legs. I have my first PT on Tuesday (2 weeks after the injury) and I will ask her if this will be acceptable excercise for me.
I visited your "my broken leg" story last week. Thanks for sharing this information with all of us. It is nice to read others stories, so as not to feel alone with this injury.
Posted by kgrosskurth (Kathy G), 23 January 2005
That diary was a godsend for me. It allowed me to keep a record of just how far I've come. I still post in it occasionally. Glad to hear it was helpful!!
Posted by ngeorge (ngeorge), 25 January 2005
Hey guys......can't tell you how nice it is to read these messages. I discovered this site just today. I suffered a TPF on 4/6/04...a day I will never forget. I have done tons of PT.....doing a lot of cycling, but I'm at BIG TIME low point. I'm 32 years old.
Compared to some of your stories, my situation seems to not be that bad. I only had two screws and some mcl tear that my OS did not do surgery on since he felt it would heal on it's own...hard to say if it did.
With all of that said, It's been almost ten months guys and I'm pretty miserable. The emotional roller coaster has been almost too much for me. My progress is so incremental, that I could easily forsee being in similar shoes a year from now. In other words, I feel pretty much the same as month 7, for instance.
Also, occassionally I will do something (I don't always know what it is - some form of excercise) that sets me back a few weeks each time.
I'm a very active person. When healthy, I was such an avid athlete (running, snowboarding, cycling, mountaineering, etc). I have also broken 22 bones outside of this due to my athletic past.....this 23 bone though is unreal. No one understands it. I try not to even complain to anyone...not even my immediate family or girlfriend - please excuse this negativity but I need an outlet....at least today.
I'm really ranting, but I'm having one of those days. I do have a question for some of you further advanced people with this injury. Can you sprint? Could you if you wanted to? Will I ever be able to really run, move with agility and strenghth from side to side? Do any of you know someone who has been able to go back to running....for instance, that has run a marathon after a TPF? I know that sounds aggressive, but I'm looking for inspiration and information regarding the best possible training regimen for people like us. I want to beat this in a big way...not let it beat me, like it has today.
Knee feels like junk,
nhg
Posted by Victoria_L (Victoria_L), 25 January 2005
Dear Ngeorge,
Boy, do I know the feeling that you're stuck with a leg that's never going to get better and the depression that follows. I wish I knew some people who've recovered from Tib Plat fractures and gone on to run marathons, but frankly, until this happened to me I'd never even HEARD of a tibial plateau. I can jog now, but I have never done sprints, so I haven't tried anything close to that. I heard that the bone isn't fully healed until 18 months, so I am very wary of putting too much pressure on it till then. My sport, horseback riding, puts a lot of strain on the knee so I'm taking it very easy there for a while longer. (That's how I got in this mess. The horse stopped and I continued over the fence.)
As for me, I also hit a recovery "plateau" (forgive the pun) and what helped me break through it was a second opinion from a physical therapist. I would be fine for walking as long as it was straight and level, but any kind of twisting or pivoting movement of the knee sent me running for the ice bag and the Advil. This second PT spent a long time analyzing how my knees -- both the good and the bad -- worked and realized that I needed to strengthen the muscles on the inside and outside of the knee. Up till then I was doing tons of leg lifts and hamstring pulls, but nothing for the muscles that support the knee laterally. If you haven't already done so, perhaps it might be worth while to see if a therapist who specializes in sports medicine could give you an assessment.
And as for your breaking 22 other bones... the Tib Plat is the main weight-bearing bone of the body, so it makes sense that it takes a long, long time to heal. And you are right. Nobody (outside of an orthopedic surgeon) understands this kind of break. It is hard not to complain to others, but this site is a great place to vent. Or to ask questions, or to celebrate the little victories.
Are you taking supplements (calcium, glucosamine, etc.)? I know that the evidence is anecdotal that they make a difference, but I think it helps. (And I put my arthritic Brittany spaniel on glucosamine and she has improved mightily -- and I doubt she knows anything about placebo effects.)
Hang in there, and let us know how you are doing.
Victoria
Posted by ngeorge (ngeorge), 26 January 2005
Wow.....it's good to hear that I'm not alone. Very frustrating situation we are in.
I had not heard about it taking 18 months for the bone to completely heal. Makes sense to me though. Especially given how long it's taking to feel ANY better.
I am taking the calicium and glocu. supplements. Can't hurt.
I'm surprised you can do leg lifts. Near impossibility for me. Way too much patellar pain. I do squats (with very little weight), and cycling for strength building. My biggest weakness is my close chain movements. My knee totally collapses. Even after 10 months, going down stairs is sloppy business and my balance is very off.
It's bizarre, I can cycle 40 miles over a couple of hours, but I can't go down the stairs with much coordination. So frustrating.
How is your "healthy" knee? Much pain there? I have quite a bit due to over compensation. I get a lot of soreness in both knees now after phsycial therapy or cycling jaunts.
As far as my PT, I feel like I'm dealing with the best in the business. My PT works with several pro athletes, including Jerry Rice. Nevertheless, they see such few of us with TPF's that all the info is inconsistent. He just sighs and tells me to be patient w/o being able to offer very good explanations for what's going on with me....still. Every time I come in he throws out different theories. Only time will tell. Until then I hope not to die from excercising my "patience" so much.
Are you a skier/snowboarder? Do you see that kind of sport as a possibility this year/next year?
Thanks for caring enough to write. I really appreciate it.
Best,
nhg (Neal Howard George)
Posted by Victoria_L (Victoria_L), 26 January 2005
Dear NHG,
Yes, going down stairs is still an adventure. If they are not too deep I can manage, otherwise it's either a kind of lurching motion or even a "one step", like a three year old. It is pretty discouraging.
Your description of your therapist made me wonder if you (and he) aren't measuring yourself against other athletes who have far less serious injuries. My first PT actually HAD a tib plat fracture himself (though no surgery), so he knew what it was like. And he got me through the first awful months. But it was the second who figured out another piece of the puzzle that has continued to help me.
Also, despite the fact that my cartilage is "powder" (according to my OS) I remarkably had little ligament damage. Perhaps it would be worth a visit to your OS to see whether he or she could make any assessment in case that is holding you back.
I had a fair amount of pain in the "good" knee at first as well as in my back as I got used the adjustments in gait and stride. But that has pretty much gone away. And I can do leg raises without much trouble, but squats and lunges are SO painful. I keep doing them, especially the wall-slides, but I hate them! I guess there's plenty of variation, even with the Tib Plat folks.
Maybe some other folks can help you with the skiing question. Even with two good knees I was a menace on the slopes, and I can't see trying it for a while. (You might post a separate topic about sports after TPX, which should get some answers from more knowledgeable jocks.)
Continued good healing,
Victoria
Posted by exoman (exoman), 26 January 2005
NHG:
Though I am only 2 weeks post-op, I've asked my OS many of the questions regarding recreation. I was a pretty aggressive skier, even now at 47 skiing double black diamonds @ Jackson Hole and elsewhere. He told me that due to the severity of my fracture (LOTS of "bondo" in my TP!), he seriously doubts if I will ski hard again. I try to find the positives, and cycling is something I am passionate about and really glad I will be able to do. For winter recreation, I am thinking perhaps snow shoeing is in my future now. (Or ONLY skiing powder days, nothing less than 24") Easier said than done for me in Wisconsin! I would bet you're going to be able to do more than you think since since you're 15 years younger than I. Don't give up the fight, be optomistic, even if you can't perform everything you could pre-injury, with your determination you'll learn what you can do and still find great recreation. Mark
Posted by ngeorge (ngeorge), 26 January 2005
Thanks Mark. Tough compromise. But on the positive note, there are people far worse off in the world and here I am complaining about "recreational possibilities." 
I appreciate the advise and wish you the best of luck with your healing. Rest up.
Best,
nhg
Posted by hkssuppie (hkssuppie), 26 January 2005
Nhg,
I am at the 1 year post-op mark. Did mine on a dirtbike. I have incredible ups and downs, both emotionally and physically. I have just got to the point where i can jog, not sprint, and not for long, but I can jog. Sometimes it's better, sometimes it's worse. I read a survey of 23 tpf'ers that only 20 some odd percent got back to running. I can traverse stairs fairly well, just a little rough in the mornings. There is a certain spot when bending, right inside full extension, where the knee still feels like it could give way. Shoot, I can even go up two stairs at a time, with a great push off from the good leg 
Leg lifts are not a problem, but in the beginning were something that I practiced with a sock shoved in my mouth (to bite on). I bought a home gym and couldn't do leg lifts/extensions with the pin pulled out of the machine. Now I can pretty much get all the plates up. I started bowling late in the recovery period, say the 6-7 month. I started out slow with a 10 lb. ball and have worked my way up to a 15lb. ball and am averaging 190. Granted it's 16 pins off of what I averaged last year, but it's a sport I love, and am glad I can get back and actually play. I still have some pain when pivoting in and out of the truck, but with the "bondo", which my doc actually said also, I don't think that gets much better with time. I get a weird twang, akin to a tunning fork, when I stub my toe or trip over something (doc said i will always have it). It's just good smarts right around the surgery/tendon area. Doctor said that all my tendons were intact from what he saw, but may have been stretched during the break. I think one of the great exercises you can do are nice one mile sprints on the eliptical machines. There is no impact, and it simulates muscle movement as close to possible, that is experienced when running. I also felt some of my best days, were after doing a few laps in the pool. It seemed to work alot of muscles that may have not been used in other workouts, also great for working on balance ie standing on one leg, gently hoping around and the sort. All in all, I want alot more out of the leg, and will work hard at achieving that goal. It seems as though i'm getting close to plateauing (there's the pun again). I asked my doctor, and he said that i would not probably notice leaps and bouds after the 1.5 yr to 2 yr mark. So now is when I got to make it happen. There are days when I get down, but I am walking. There are people that roll by in a wheelchair, and I always think that it could have been worse. I never take walking for granted anymore, and have learned to appreciate what freedoms you have with two usuable legs. Did I mention that this board is great for just having a shoulder to lean on, or ask a question. All the best in your recovery.
suppie
Posted by exoman (exoman), 26 January 2005
Ditto what Suppie said, this site is fantastic to keep the spirits up! Thanks to every one of you who take the time to read, ponder, post your experiences for all to benefit. Each and every one of you who has paid the PT price inspires me to work my butt off to get the best possible results. While I know it will be hard work, I'll take the challenge. Don't really have much choice, do I? Never having been addicted to anything or had a life changing event such as this, I've never needed a "support group". Well, here I am to bear my "tibial plateau soul" to all of you so that you may help me survive. And along the way, I hope I can give back just a fraction of what I know I'm getting from all of you! Peace, Mark
Posted by yippy (yippy), 26 January 2005
Hi Mark,
It is 7 months since my accident. My situation was slightly different as I was treated with an external frame which I had on for 3 months as the bone was too shattered to pin and plate.I can't recommend enough the help physio has been for me, and yes sometimes I almost want to cry at the thought of going but I have progressed so well thanks to the wonderful physio I have had helping me. I think the more input and effort you can put into physio the greater the results. On saying that I must admit to many many down days when my expectations didn't meet my physical ability and I have posted several times when things have been awful.You obviously have a great possitive attitude to your treatment and I am sure you will improve quickly.
Reading the posts sent to you have also been great for me as I live in New Zealand and have little contact with people who have done tibial plateau # so it is great to get a time line of other peoples progress so I don't beat myself up when things are not progressing as fast as I think they should.
Good luck with your healing. I hope you keep getting better fast and that the site helps you heaps.
Cheers Marianne
Posted by ngeorge (ngeorge), 26 January 2005
Vitcoria,
That is all great advice. It is very interesting how each case is different.....it's actually fascinating to me that you can do leg lifts, but that squatting, after so much time, still hurts you. I can't do leg lifts at all, but can squat...and squat weight (although I haven't tried a lot of weight). Crazy.
I'm in the process of arranging for a second opinion by another OS. Not sure how long getting an appointment will take. I should know more this week.
Interesting enough, I spoke to friend last night that had spoken to a man he met at a bar last year with our injury. My friend spoke to this man about my injury (don't ask me why my friend decided to tell me this story just last night...long story..argh!), and the man totally related. He said that he tried running one mile one year after surgery and it was incredibly painful. Nevertheless, he was in his fourth year of recovery and in the process of training for a marathon. I wish I had this person's contact information. Still, I found the story very inspirational....even with 4 years being a REALLY long time. So ironic how I was asking for this yesterday, and then learned this story last night.......life is funny.
Updated Mon Oct 6 2008