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Author Topic: Tibial Tubercle Fracture in adult - problems regaining ROM  (Read 3195 times)

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Offline Skiier Jo Jo

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Tibial Tubercle Fracture in adult - problems regaining ROM
« on: February 07, 2011, 05:25:20 PM »
Dear Someone
I have an apparently very rare fracture for an adult called a tibial tubercle fracture, which happened whilst skiing over Christmas. I made a real mess of my left knee and needed 5 hours of emergency surgery, which resulted in a nice big plate along my tibia and 10 screws. The fracture was horrid, resulting in the knee cap tendon coming away from the tibia (with the tubercle still attached), but I also displaced the exterior meniscus. I have good pictures which I will try to put in my forthcoming diary!! To put this in perspective, I think the symptoms are very similar to that of a tibial plateau fracture (this is just very slightly lower down so should be able to weight bear a little sooner).

The worry I have is that my ROM is taking a very long time to come back. I started at 0 flex and in the last 6 weeks have managed to get to around 80 degrees of flex. With some pain and screaming my private physio can get me to 85 degree bend and about 2 degrees from straight. She has not mentioned any problems yet (only second appointment), but my NHS physio today said she could feel a block and think maybe my cartilage is slightly displaced.....this is really making me feel sorry for myself. She says I will not get further flex without my knee 'cracking' and correcting itself or..........well I am assuming surgery............please could anyone advise? I don't want further hospital treatment and am fed up of this....I need to back to work!!!!



Thanks

Skiier JoJo........ski days are over!!!!
Skiier Jo Jo

Aged 33
Fractured tibial tubercle (plus other bits sloughed off!) and displaced meniscus on 24th Dec 2010
Emergency surgery - Zimmer plate and 10 screws (8 permanent). Straight leg brace
Physio started on day 6. 
Feb 2011 - almost fully straighten leg, with up to 85 degree bend

Offline smillie

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #1 on: February 07, 2011, 06:55:31 PM »
Ouch! Sorry that happened to you!

When you look around this site, you will find people who have had a "TTT" which means that we had our tibial tubercle removed (on purpose) and moved over and reattached. It doesn't have the trauma of yours, but there is a similarity. Then you'll also find the people who have had tibia fractures or osteotomies who have the same sort of plate and screws that you have. Look for the recovery diaries of people with those types of procedures and it may help put your recovery into better perspective. You also might find helpful information in the thread on the patella board called RPT club or something like that. Those folks have ruptured their patellar tendons and have had them reattached. They end up being immobilized for a long time and have to fight to get that ROM back. A lot of people find that when they have been immobilized after surgery for weeks, that ROM takes a long time to get back, so look and see how long that takes. My OS kept me in a brace locked straight for weeks, so getting my ROM back was quite the battle. That hard block that you feel might not be cartilage. It could just be scar tissue. Mine was scar tissue and it felt like a very hard block in my knee that I could not break through. So you might want to read up on scar tissue a little more and talk to your OS or PT about that in addition to checking out your cartilage.

Good luck! I hope you can get some good information to help you in your recovery.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline Rknees4

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #2 on: February 07, 2011, 07:03:18 PM »
Ouch for Sure.
Check out the places Smillie mentioned.  Considering the trauma to the leg I think 85 degrees is quite good.  Be patient, this will be a long recovery we are talking months not weeks.
Hand in there and good luck
Rknees4
Knee pain since teens
06/09 Patella mal-alignment grade 3/4 chondromalasia both knees, PFS
09/11/09 patella realignment,Trillat/LR/scope cleanupRK
10/02/11 patella realignment,Trillat/LR/scope cleanupLK
Cortisone LK 04/06/11
Scope LK,/RK HW removed 28/06/12
Chin up keep hobbling!

Offline Snowy

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #3 on: February 08, 2011, 02:34:37 AM »
Ouch! That looks excruciating. :( As a fellow skier, you have my sympathy - it makes my blown ACL seem very tame in comparison. Out of curiosity, was it a collision that led to such a severe break?

I'm sorry to hear about your flex problems; that must be really frustrating at this stage in recovery. I'm afraid I can't offer advice from my own experience, but as smillie suggests, the TTT threads may be helpful. More surgery isn't necessarily the next step; your doc may want to try something like an MUA (manipulation under anaesthetic) first to see if the knee is capable of bending further or if there is something like cartilage or scar tissue that is actually getting in the way. I don't think it's always possible for a PT to detect this. An MUA is done in hospital but doesn't involve any cutting, just being knocked out briefly while the surgeon bends the leg. It enables the doctor to try bending the leg without triggering a pain response from the patient.

Good luck with your recovery, and do keep us posted. It's worth documenting your recovery when you're unlucky enough to fall victim to a rare injury, as the other unlucky folk who suffer the same injury often find that information about it is scarce.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Skiier Jo Jo

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #4 on: February 08, 2011, 04:38:12 PM »
Thanks everyone, your replies are appreciated.  I see another physio tomorrow and the surgeon on Friday, so will let you know what they say.

No I didn't crash into anyone, there were actually very few people on the piste......hmm, maybe that was the clue :).  It was the 'one last ski' story unfortunately. 

I went out on Christmas Eve morning in blizzard conditions in Avoriaz in France.  The powder snow was lovely and pretty well spread and smooth for the most part.  I haven't done a lot of powder skiing previously but was coping well.  However, came to a run at the top of the mountain where the bashers had not been for a day or two and so was a bit trickier to handle.  I am a nervous skier, so when I picked up a little too much speed I tensed up (yes I know, the worst thing, but not something I can avoid)...anyway, I fell with my legs really tensed up and felt my knee twist with the pull of the skis.  My skis didn't come off very quickly and suddenly something 'gave'.....turns out it was the bone, where the ligament at the front of my knee joined....apparently the ligament normally snaps in the adult to release the tension, but for some reason it was the bone in mine.  I am a nerdy scientist so would love to know why.

Sorry for the graphic story....figured everyone here would be used to gory tales of broken bones  :).  I think the worst part was that I said bye bye to my 2 year old son in the morning and he didn't see me again for the rest of Christmas.  My husband told him I had gone to work, which seemed to keep him happy (he gets work I guess).  However, since the hospital was so far from the ski chalet and I had to stay in hospital for 5 days, we ended up sending him home with our friends to stay with grandparents until we got back......I was really really upset and cried a lot!  We missed what was supposed to be a magical family Christmas in the mountains.  Gutted!   Oh.....the other worst bit was the ketamine they used to knock me out whilst they x-rayed me.....wooah, not nice.  Thought I was in the matrix and had solved the meaning to life!!!!!!!!!
Skiier Jo Jo

Aged 33
Fractured tibial tubercle (plus other bits sloughed off!) and displaced meniscus on 24th Dec 2010
Emergency surgery - Zimmer plate and 10 screws (8 permanent). Straight leg brace
Physio started on day 6. 
Feb 2011 - almost fully straighten leg, with up to 85 degree bend

Offline Rknees4

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #5 on: February 08, 2011, 04:50:28 PM »
Morning Skiier Jo
Yes the scientist in most of us wants to have the answers that are not readily available. No pics though.  I can't believe some OS is getting paid to do this to me in 2 days time. Mind you without the extra chips and cracks.
Hang in there unfortunately it is a long recovery at the best of times. I hope they get everything worked out for you, so you can get back to being Mom without the problems.  You might also want to post on broken bones around the knee there are many who can give you some thoughts.
Take Care, Try and have a good day.  ;D
Rk4
Knee pain since teens
06/09 Patella mal-alignment grade 3/4 chondromalasia both knees, PFS
09/11/09 patella realignment,Trillat/LR/scope cleanupRK
10/02/11 patella realignment,Trillat/LR/scope cleanupLK
Cortisone LK 04/06/11
Scope LK,/RK HW removed 28/06/12
Chin up keep hobbling!

Offline Skiier Jo Jo

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #6 on: February 08, 2011, 04:57:10 PM »
All the best RK4....I hope you don't have to have any more surgeries after this! :)
Skiier Jo Jo

Aged 33
Fractured tibial tubercle (plus other bits sloughed off!) and displaced meniscus on 24th Dec 2010
Emergency surgery - Zimmer plate and 10 screws (8 permanent). Straight leg brace
Physio started on day 6. 
Feb 2011 - almost fully straighten leg, with up to 85 degree bend

Offline smillie

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #7 on: February 08, 2011, 05:03:02 PM »
What a story! I think you need to go post this to all of the ruptured patellar tendon guys. Maybe they will be thankful their tendons gave way like they were "supposed" to. ;-) Either way, it's just no fun and puts a big kink in all of our great plans. Sorry it ruined your Christmas plans!
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline Rknees4

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #8 on: February 08, 2011, 05:55:06 PM »
Thanks Skier JoJo for the good wishes. No more surgery would be nice but i expect most of us will just move on down the board to TKR in the hopefully very distant future.
Rk4
Knee pain since teens
06/09 Patella mal-alignment grade 3/4 chondromalasia both knees, PFS
09/11/09 patella realignment,Trillat/LR/scope cleanupRK
10/02/11 patella realignment,Trillat/LR/scope cleanupLK
Cortisone LK 04/06/11
Scope LK,/RK HW removed 28/06/12
Chin up keep hobbling!

Offline Snowy

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #9 on: February 08, 2011, 07:46:09 PM »
Yikes! That's even more awful that a straightforward fall did that much damage. As Smillie says, it puts the more typical tendon tear into perspective! Perhaps you have an uber-strong tendon and that's why it refused to give way under pressure...

So sorry to hear that the accident disrupted your Christmas so much. Hopefully next year you'll be able to make up for it...perhaps best to leave skiing out of the plans though. ;)

I do hope you get some good news from this week's appointments...best of luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Skiier Jo Jo

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #10 on: February 10, 2011, 11:25:20 AM »
Just an update: Saw my other more evil physio last night and she doesn't think there is a block in my knee, but that it's just scar tissue that we have to work through, so good news...the bad news is that I have to get through that eventually!!!!  That's not going to be nice I predict  ;).  Didn't get further than 82 degrees last night, but it does feel stronger and a bit springier.  Straightening was improved with only a degree or so away from locking it out.

Other good news is that she did some tests on my ability to weight bear and I was fine.  No pain at all, although a lot of muscle weakness and my knee did give.  Fingers crossed for the all clear from the surgeon tomorrow, but am pretty confident.  The bones 'feel' fixed, it's just scarring and muscles I have to sort out now, but I guess that's positive and can be fixed.

I will update properly tomorrow on status.

Skier JoJo
Skiier Jo Jo

Aged 33
Fractured tibial tubercle (plus other bits sloughed off!) and displaced meniscus on 24th Dec 2010
Emergency surgery - Zimmer plate and 10 screws (8 permanent). Straight leg brace
Physio started on day 6. 
Feb 2011 - almost fully straighten leg, with up to 85 degree bend

Offline Rknees4

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #11 on: February 11, 2011, 02:53:18 PM »
Morning Skiier JoJo
Glad to hear the weight baring is coming along.  That is a good positive. So is the straightening.
Well hope you get the all clear from the OS.
Take Care,
Rk4
Knee pain since teens
06/09 Patella mal-alignment grade 3/4 chondromalasia both knees, PFS
09/11/09 patella realignment,Trillat/LR/scope cleanupRK
10/02/11 patella realignment,Trillat/LR/scope cleanupLK
Cortisone LK 04/06/11
Scope LK,/RK HW removed 28/06/12
Chin up keep hobbling!

Offline Skiier Jo Jo

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Re: Tibial Tubercle Fracture in adult - problems regaining ROM
« Reply #12 on: February 11, 2011, 03:27:19 PM »
Thanks RK4.

2nd update:  Saw the OS today and although the uppermost fractures (the most delicate ones at the top of my tibia) are healed, one further down has not even started to heal.  He thinks it is because my plate and screws are doing too good a job so wants me to put as much weight as I can bear through the leg.  This is fine, it doesn't hurt although the muscles are a bit rubbish and my leg gives way at the moment.

I am really pleased about this, although slightly apprehensive as my OS also said if there is no improvement next time I see him, he will look to remove a couple of the screws.....yuck.

I am now allowed to go back to the office (yeah), but flying to conferences is out (boo) due to DVT risk.  I have a fab conference planned in March in Milan that I was really looking forward to, so am going to look up train times!!.....not sure how I'll carry all my shoes in a small rucksack ha haa!!

As for regaining ROM, he was not concerned and said it would take some time and work to get back, but is not suprising considering the seriousness of my injury.

Oh, other goo dnews....no more injecting heparin, yee haaa!!!

Skiier Jo Jo

Aged 33
Fractured tibial tubercle (plus other bits sloughed off!) and displaced meniscus on 24th Dec 2010
Emergency surgery - Zimmer plate and 10 screws (8 permanent). Straight leg brace
Physio started on day 6. 
Feb 2011 - almost fully straighten leg, with up to 85 degree bend