Advertisement - Hide this advert





Author Topic: tibial plateau fracture  (Read 2393 times)

0 Members and 1 Guest are viewing this topic.

Offline maidie

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
tibial plateau fracture
« on: February 22, 2005, 03:06:24 PM »
I have decided to join you because I feel very isolated,coping with my first ever injury. I do not know how well or badly I am doing, how good or bad my treatment has been so far and what should I expect in the future. I am undergoing treatment in Holland, where I have been staying temporarily.
It is now 4 months since I was hit by a car in October 2004 and suffered a tibial plateau fracture of the left leg/knee, lateral and depressed by 7 m, there were no fragments- just 1 break and, as far as I am aware no ligaments were involved. A week after the accident, the knee was operated upon, by arthroscopy and 2 pins were put in. I was put on passive motion for the first 3 days and then  was in plaster for 5.5 weeks.Then I had a brace for 6 weeks which was adjusted each 2 weeks to allow more movement (30 degrees, 60 and  90), and was advised to increase weight every 2 weeks (10-15g first 2 weeks, 20-35  next 2 weeks etc).

However, I was a very slow starter, falling over at the first attempt to walk with the crutches and thus avoind them and using a zimmer frame instead; it took me a long time to gather the courage to put weight on the leg again but at the end of the 6th week in the brace, i.e. 12 weeks after the operation I was putting full weight on the leg and beginning to walk with crutches. I thought I was bending the leg sufficiently, but it seems that I was not ' on course' as planned. When the brace came off at the end of December i.e. at 12 weeks, I was only bending the leg to about 60 degrees!

It is now 4 months since the operation: I walk at home without crutches and use 1 crutch when I walk outside. I have good extension; the leg is strong. My active bending is  about 110 degrees, passive is less. I could not do a full circle on the exercise bike, even with the saddle at its highest. Now, I can do it and started even lowering the saddle. However, the muscles and ligaments in my thigh have shrunk a lot and the area around the knee feels as if there was a vice around it. However hard I try, I cannot get my leg to bend further, but I feel/hope the problem is caused by the muscles rather than the joint???? What can I do to deal with this??? Any good exercises.
I feel as if I were fighting my muscles all the time: I try to strecht them, they shrink.
Also when I sit and line my feet (toes and heels), my knees are not alined and  the left leg appears about 4 cm shorter.I wonder if this is caused by the shortening of the muscles and ligaments???
Can this be remedied?? I despair whether I will ever be able to achieve more flexibility?? Should I have been further ahead at 4 months?
Also, as soon as the plaster was removed, I became aware of a painful area on the right side of the knee/inner side of the leg (thus on the opposite side to the place of impact and the fracture.). It hurts when I walk and bend the leg, but is also very painful when touched. The consultant said initially that the cause was probably the pin; at the next appointment revised his statement, saying that the pins were not deep enough to cause the pain and that perhaps the break had not been alinged perfectly! Meanwhile, the physiotherapist wonders if the pain is caused by cruciate ligaments and tries to loosen them by a massage. By the way, the consultant has never looked at the knee in the flesh, he is just interested in X-rays!! I am worried and in pain every time I walk and as the result tend to keep the leg stiff although I can bend it. Any suggestions as to the cause??? Has anyone had a similar problem?
What should I expect after 4 months??? How can I move forward?? I know it's a bad injury and it will take time to recover, but I am afraid of not doing enough or the right things at the right time and ending up half-handicapped by pain and stiffness.
Is is inevitable that arthritis attacks knee joints after this injury? Is there any way of preventing it?

I am not young (53)and not athletic  but I have always been sprightly and fairly active. How negative is the age factor in all this ??
Do supplements help: I have started taking calcium/magnesium and glucosamine tablets, in hope that they will not do any harm and might do some good.

with best wishes to fellow sufferers
Maidie






shadehawk

  • Guest
Re: tibial plateau fracture
« Reply #1 on: February 22, 2005, 04:11:35 PM »
Maidie,

You are not old, do not think that way.  Welcome to the board - sorry you had the accident.  I have no experience with your type of injury, but there is a section here that might help you out alot.  It is called 'The Specialist's Office' then look for 'Bone Breaks Around the Knee'. 

There are many others in that section that could help you out - there is also a section called 'Rehab Dept.' look for the 'Post-Op Diary', there also might be information that would help you out there. 

Good luck to you,  ;)

Shade
« Last Edit: February 22, 2005, 04:14:15 PM by Shadehawk »

Offline Helein

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: tibial plateau fracture
« Reply #2 on: February 22, 2005, 04:23:21 PM »
Hi

I read your note with interest, I am afraid I can't help but I was knocked down by a car a month ago and have a compressed knee fracture.  I wasn't operated on which I am thankful for.  Presently I am in a hinge cast with 90 degree mobility.  I have crutches and I am getting along okay accept I did slip yesterday due to the snow!!  What interested me, lets get to the point here!  Is that you have pain on the opposite side of your break, so do I.  I am going to see my Consultant on Thursday and I am going to ask him to explain why this might be happening.  It might not be the same for you but I will let you know.

Also I take two alternative therapies which I got from Neals Yard (they are on the web as well) called Comfrey which is an oil I rub into the knee and a tablet called Symphytum.  I don't know if they work but they maybe worth a try.

Take care Helein

Offline maidie

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
Re: tibial plateau fracture
« Reply #3 on: February 22, 2005, 05:12:52 PM »
Helein,
Thank you for your reaction and advice. Yes, I would be very interested to hear what your consultant has to say. I hope that mine will condescend to look at the knee  again- if he does I'll let you know.

Maidie

Offline maidie

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
Re: tibial plateau fracture
« Reply #4 on: February 22, 2005, 05:15:09 PM »
Shade,
Thank you for guidemarks round the system: I'll look them up.

Best wishes
Maidie

Offline rozzzie

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 3589
  • Liked: 0
  • smile:a little curve that strightens everythig out
Re: tibial plateau fracture
« Reply #5 on: February 22, 2005, 06:15:22 PM »
Maidie, Good luck in your recovery.  I was in a pedestrian vs. car accident last April.  Luckily I didn't damage my knee - it's pretty bad as it is.  My Tib/fib fracture took 7 months before I was walking without aide and mostly pain free. 

Like Shade said check out the ‘Specialis‘s  Office'  and 'Bone Breaks Around the Knee', you should find some good information from others in your situation.

:D      H U G S   and   E N C O U R A G E M E N T   coming your way ! ! !     :D
Rozzzie
OA of knees since 85 
93 scrambled ankle - PE
98 PE
99 anlke fusion
04 hit by car broken leg, ribs AC joint seperation
RTKR  Dec 1 2005
LTKR. IM rod removal March 16, 2006

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: tibial plateau fracture
« Reply #6 on: February 22, 2005, 10:29:03 PM »
Maidie,

Sometimes after a traumatic injury like you have and then surgery, the knee joint develops an excessive amount of scar tissue.  This can attach inside the joint to various structures, and outside the joint it can cling to muscles and tendons--it's very painful.  That could easily explain the tight sensation you have.  Also, the problem with scar tissue is that as it ages in the knee, it gets tough and rope-like...and shrinks/contracts.  So that can explain why you feel like your muscles have contracted and shrunk and are resisting your attempts to reverse this.  The best thing to do is determine if you have an excess amount of scar tissue inside your joint or not.  That would help determine next steps.  And if you are making any kind of progress in PT, however slow, I would really encourage you to stick with it.  Add stretches (both assisted by PT and done on your own) and acupuncture, PT modalities like ultrasound, and deep tissue massage like myo-fascial release to help stretch and lengthen both the soft tissue and the scar tissue.

You might want to read around the Soft Tissue Healing Problems section for stories on arthrofibrosis (the medical name for excessive scar tissue).  It actually is not surprising at all that you are struggling, as a TPF is infamous for creating trauma...and this trauma can lead to excessive scar tissue formation.  Most people work their way through--you might want to check the posts of member MHB, as she had a similar situation and managed to slowly and persistently work to stretch the muscles out and return to normal activities.  The fact that you have gone from 60 degrees to 110 is very, very encouraging.  So don't be alarmed by some scary stories you might read on excessive scar tissue!  I had my knee frozen for over a month at 55 degrees, and that was truly torture.  110 is almost functional (that is usually 120 or so) and so you are very, very close.  Keep it up, and in the meantime read the experiences of others with fractures around the knee.  And you can read posts on ROM and regaining it to see if there are exercises or methods that you aren't doing now which may help you.  Above all, be positive!  You have really come a long way, and are almost there in terms of full function.  It will take time, but the fact that you have had a lot of improvement in the past means that you are clearly doing something right.  You might just be at a plateau right now, and it might take just a little nudge in the right direction to get you going again.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline favouritesearcher

  • Forum Faithful
  • ****
  • *
  • *
  • Posts: 201
  • Liked: 0
  • User's Text
Re: tibial plateau fracture
« Reply #7 on: February 23, 2005, 07:42:16 AM »
Maidie,

(1)  When you say that "when I line up my toes and heels the left leg appears 4cm shorter than the other", do you mean that the kneecap appears to be lower?  (Otherwise you could not be lining up your toes.)

If the kneecap is lower than the other, then this is a different problem to having legs of different length.  If the legs appear to be a different length then the only two causes are: (a) the broken leg is not fully extended, flat on the floor, or (b) the bones are different lengths.

(2)  Pain on opposite side of leg to the fracture.  I had a fracture of the tibial spine, which is in the centre of the plateau.  I had one screw put in, going diagonally down through the top of the tibia so that it almost came out the lateral side.

Like you I had pain on the opposite side of the leg, the medial (inside leg) side, seemed to be about where the tibia becomes narrow.  The physiotherapist said this was common for knee injuries and I believe that this was actually ligament pain for whatever reason.  11 months after my accident, the pain here has almost gone.

(3)  After 4 months I could only bend to 70 degrees, so if you've gone from 60 to 110 in just 1 month then I would say you're doing well ... but I can't say whether you'll bend more or not.

(4)  If the plateau surface is uneven, the joint is no longer aligned precisely, or there is scar tissue in there which the surgeon is unable to smooth out, then the joint or cartiledge will probably be irritated or deteriorate and arthritis is likely.

John
Mar 04 - Tibial spine avulsion fracture (skiing). Open surgery to fix, 1 screw.  Max passive ROM 20-75, active ROM 30-45
Aug 04 - Diag. severe arthro. Scar tissue clean up (LOA, removal of scar tissue).
Feb 05 - Discharged from surgeon's care. ROM 3-125.
Apr 05 - Discharged from physio. Same ROM

Offline Helein

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: tibial plateau fracture
« Reply #8 on: February 24, 2005, 07:11:01 PM »
Hi

I went to see the Consultant today and I asked about the pain on the opposite side of the fracture and he said what a lot of people have already told you, it is the ligaments.  The way my consultant explained it to me is that when the Taxi hit my leg the muscles and ligaments stretched and this is now what is causing me pain.  He said it could last up to six months!!

Their have now given me total mobility in my hinge cast to full so I am sitting here at my laptop with my broken knee in virtually the same position as my good leg.  I have been told to bend it as much as possilbe now as this will help me once the cast come off on April 14th!

By nature I am a very positive person and this has really knocked me for six.  However I really do believe in a positive mind is a healing mind.  I have my moments of despair but on the whole I can laugh at my situation and also my fantastic friends and family keep me positive.  Before this happened I was always doing something, I walk quickly and I was always rushing here and there.  Now I have to relax and let others do things for me.  I found it difficult at first but I am kind of getting use to it now.  Before my accident I use to do Tai Chi every morning which I have always found very theraputic.  As I can't do it at the moment I am teaching myself to meditate, during my meditation I concentrate on my knee and I can feel the warmth or the Chi around it, healing it. 

I think what I am trying to say Maidie is stay positive, it has nothing to do with age.

Do keep in touch and let me know how you are getting on. 

Take care Helein x 

Offline maidie

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
Re: tibial plateau fracture
« Reply #9 on: February 25, 2005, 03:20:43 PM »
Helein,
Thank you for your news and words of encouragement. I am glad that your consultant thinks that the problem is caused by the ligaments: I would rather have this than a dodgy meniscus or badly alinged knee joint. It makes a lot of sense and explains a lot, i.e. why the pain was there even straight after the opertation, why it varies depending on the amount of movement, why is it better one day and worse another and why it is still here, after nearly 4 months. Well, let's wait and see what happens in a few months time and after some treatment by the physio.

You seem to have a very positive approach to your situation. Like you, I turned suddenly from a very active and independent person to a plaster-encassed wrreck who needed assistance to heave herself up from bed to go to the loo. However, I was totally unprepared for all the practicalities of the situation and for the trauma of the accident, injury and its (possible) implications. Neither were those who had to look after me. You are very lucky to have a supportive family !

I agree with you that it is important to keep a positive frame of mind: I might try some meditation or yoga: I'm sure it would benefit me!

With best wishes for good progress and many thanks for your response !!
Maidie

 


Offline maidie

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
Re: tibial plateau fracture
« Reply #10 on: February 25, 2005, 03:59:07 PM »
Hi Heather,
Thank you for your response and advice. The idea of scarring, as being one of the reasons why I seem to have hit problems with bending my leg any further and why all the muscles and ligaments feel to tight , makes a lot of sense!
In fact, I raised this point with my consultant, having glanced through your e-mail a few days ago and he confirmed exactly what you've said about TP break and scarring. However, he wasn't very informative about how to deal with it: just' use the leg', he said !
Thank you for your suggestions! I shall look up the relevant sections of the webside.
Q: how does one determine the amount of scar tissue inside the joint? I cannot have an MRI scan as long as I have pins in my leg, which will be at least till May. Are there any other means ?

Thank you also for your words of encouragement: yes, I am probably doing something right to have got so far.
What simply panics me is the awareness of the time going by and the fear that perhaps I am not doing enough or doing things wrongly and that damage (limitations)  might settle in which could be avoided . While my physio is reasonable,  I regret not going to the hospital physiotherapy dept. in the beginning ( being unfamiliar with situation in Holland, I assumed the situation was different from Britain and  did not realise that such  option was also avaialable, so I ended up with a small local physiotherapy practice.) I could have done much more bending earlier on, if only I were given more guidance. Instead the focus was on general mobility, balance, strength? Is it essential to be supervised by hospital physiotherapists in cases like mine or is, in fact, any reasonably qualified physiotherpist  OK?  I appreciate it is impossible to comment on individual cases but any general views on that ? Perhaps, I put too much trust in hospital staff?

Anyway, many thanks for your advice and words of support.
With best wishes,
Maidie





















support