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Author Topic: Type VI Tibial Plateau Fracture  (Read 5949 times)

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Offline BikerGuy

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Type VI Tibial Plateau Fracture
« on: December 02, 2002, 09:27:44 PM »
Hi all...

I just found this site today -- THANKS!!

Although this beat the head-on collision that otherwise would have probably happened, I snapped 4 big pieces off my tibeal plateau by putting my foot down at 50+ MPH on my M/C.  I too am assured that my riding days are over...

This was made much more complicated by the fact that in 1984 I shattered the middle 1/3 or-so of my tibia and fibula, which resulted in a pretty serious malunion and yielded an essentially useful but butt-ugly below-knee result...

The swelling from the latest Fx resulted in "compartment syndrome" necessitating a 2-cut 4-way fasciotomy, one of which could only be closed by skin graft.  Leg now looks like I stepped on a land-mine, but my foot is still there -- a big bonus I am told...

4+ months later I seem to have hit a plateau with my PT and ROM -- I am stuck at about 15-degrees from straight in spite of exquisitely painful 3x-weekly PT sessions and nearly constant stretching on my own -- it just won't seem to move any more than it is.  

The pain also is constant, and the docs seem to be from the old-school (we can't give you any more narcotics cause you might get addicted) of pain-management, so I pretty much get no pain relief.

These two conditions are beginning to cause me some depression -- I think (hope) the fact that I am AWARE of this is helping to minimize it, but knowing I'm not alone sure helps...

Anyway...

(1) Has anyone else had this "it ain't going no farther" plateau experience with ROM therapy? Did you get past it?  How?

(2) What does one need to say to get the doc to understand that you NEED the low-dose (oxy-contin 10 mg 2x daily) to get through the afternoon and eveing and a little extra kicker (5-10MG oxycodone) before the therapy session if you are to EVER get better?

Thanks!!
« Last Edit: April 09, 2004, 02:46:59 PM by admin »
3/29/84 -- hit by car, shattered L Tib&Fib.  mal-union, bones fused

7/2/02 -- Type VI Tibial Plateau Fx due to MC Accident, 4 screws, Ex-Fix, etc same (Left) leg

3/4/08 -- TKR, painful "clunk" ...
7/18/08 -- Dx "hypertrophic infrapatellar fat pad"

burbn8r

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Re: Type VI Tibeal Plateau Fx
« Reply #1 on: December 02, 2002, 10:02:17 PM »
I wish I knew what it took to get humane pain management. I had 3 open surgeries in an 18 month time period, the last being a partial knee rplc and I am still in intense pain. There is so much going wrong with my knee that my OS said surgery is not an option.  He referred me to a pain management doc since I have been on vicodin HP for the last 2 years and it does little more than take the edge off. I did not go to the doc he referred me to since he was not covered by my insurance plan...what a big mistake. The jerk that I saw has no business calling himself a pain management specialist. He told me right off the bat that the best I could hope for was a 20% reduction in pain and asked me if I had considered a knee rplc. Had he actually read my chart he would have known I'd had one. He the proceeded to tell me that he hated treating knee patients because there wasn't much he could do for the pain. He gave me an Rx for Neurontin and said to take it once a day at night. I asked if it was a 24 hour drug and he said no so I asked what I was supposed to do during the day. He asked if my OS would continue to give me vicodin and I told him I thought he would be taking over my pain management. He said he GUESSED he would give me vicodin if my OS refused. I told him that I was hoping to get something longer acting that did more for the pain and he pretended not to know what I was talking about. I had to spell it out for him and then I got the DEA and addiction lecture.  The reason this guy could only offer me a 20% reduction in pain is because he refuses to script narcotics. I understand that there are other options drug wise but I feel when those have been exhausted they should be willing to go the narcotic route to give you some pain relief. I wonder how these people would deal with chronic pain if they had to.
 I am going to see another pain doc (the one my OS recommended) later this week. I am fearing I will get more of the same attitude the last doc gave me. If you find out how to get through to these people that our pain is real let me know.

Audrey

Offline jade

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Re: Type VI Tibeal Plateau Fx
« Reply #2 on: December 03, 2002, 05:14:29 AM »
BikerGuy,

Sorry to hear about the problem with getting pain meds.  My OS is still giving me vicodin and it has been about 5 months.  Of course the vicodin just takes the edge off so I can function.  I don't think there is anything that will really get rid of the pain.  The cold weather is really causing me lots of pain now.  I figure he will cut me off at 6 months but who knows because whenever I call and complain about the pain I get it is the weather and take something to stay comfortable.

At about 3 months I could not get to a 90 degree bend and the pain was so bad I contacted my OS ready for manipulation.  I went to 3 pt sessions taking a good dose of vicodin and I hit 90 degrees without manipulation.  I was excited!  I am sure if I had not taken the vicodin it would not have happened because of the intense pain.

I wish I had answers.  Maybe if your OS knows the pain your are in and how it is limiting your pt sessions he will reconsider.

Jade
tibial plateau fracture - July 5
plate, 4 screws, synthetic coral, femur smashed into tibia crushing it, splintering off 3 pieces vertical, bicycle seat broke the bone horizontal (ouch)

Offline erniej

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Re: Type VI Tibeal Plateau Fx
« Reply #3 on: December 04, 2002, 11:39:25 AM »
Biker Guy,

Welcome to the club.  These  breaks affecting the articular surface seem to be bad news, and all of us here have slightly differing recovery experiences.  My pain is reasonable well controlled now with 1-2 tabs of tramodol, although like you I started on oxycodone.    I am now about 6 months post # and flexion is my problem, stuck on 90 degrees (like Jade).  Hydrotherapy helped, and ice post PT also helps.  A search on this site for other recent posts on tibial plateau #s will pull up the discussion on exercises to increase extension.  

Good luck.

ernie
Tibial Plateau Fracture June 7th 2002.  Schatzker type V.  Internal fixation.















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