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Author Topic: tibial plateau fracture with depression  (Read 1165 times)

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Offline katmar

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tibial plateau fracture with depression
« on: September 10, 2010, 03:45:41 AM »
 Happy that I found this but don't seem to get any replies so not sure I'm doing correctly.
One more try! On 9/2/2010 I had arthroscopic surgery for TPF with depression.  They put a bone graft material at the top of tibia where there was some crushed bone.  I think that they put 2 pins in to help hold that and the small fracture on the left side of tibia.
When I woke up I was in a huge brace with metal bars on each side of knee with dials on them at the knee.  I am not to bear any weight for 6wks to 2 months.  The brace is extremely uncomfortable and seems to hit me where the incisions are.  Still having a lot of pain.  They changed the first bandage on 9/7/2010.  Put a very thin bandage on under the brace.  Seem that it is more difficult to move now because the brace slips so easily.  Does any of this sound normal?
Does anyone know of a different brace that may work better?
I would appreciate any advice that you can give me.  I am so very impressed at the helpfullness and kindness of  the responders.   Thank you so much  Katmar 

Offline arthriticknee

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Re: tibial plateau fracture with depression
« Reply #1 on: September 10, 2010, 08:15:49 AM »
Hi Katmar,
Welcome to the world of the tibial plateau fracture. They are painful and the rehab is frustrating and very slow. There are many different types of TPF and the fact you had depression means it wasn't a simple crack.
Surgery aims to restore the anatomy as best as possible by elevating the depressed fragment, filling in any resultant areas of bone loss with a graft, then fixing the fracture.
Post-op the concerns are that the fracture will collapse back down. This would result in an angle at the knee and leg length shortening. This is what the brace is for - to protect the knee from any sideways forces that would put pressure on the previously depressed side. The other thing that would cause the fracture to collapse down again would be weight bearing. Remember that the 6 - 8 weeks you have been quoted before you can weight bear is just an estimate. On occasion it will take longer, particularly when large bone grafts have been used.
Two differnt types of bracing are commonly used. Firstly there is the post-op knee range of motion brace (sounds like you have this one). They aren't much fun to wear but are better than the other option which is a cast brace. A cast brace has the same hinges down each side but instead of a removable brace they are plastered onto the thigh and calf. They can't be taken off so no washing etc.
Tibial plateau fractures have some good characteristics (the bone heals well so unlike midshaft fractures the incidence of non-union is extremely low) but quite a few bad ones: Your fracture is intra-articular - this mean you have broken through the smooth joint surface (often smashing it to bits) - even though it heals well it will not heal smooth. You will end up with a rough joint surface that wears down quickly in the coming years. How long it lasts depends on many factors but the majority of people will need a totaknee replacement some time in the future.
In summary: No brace is going to be really comfortable but a removable one is much nicer than a cast brace. Do you physio as instructed and work hard at it. You won't be able to do much else in the short term and rather than stare at the wall bored all day work on your leg.
Try and be patient because this is a long road. You will recover and get walking again but it is going to take time.
Unfortunately everything you described sound normal to me. Ask for your brace to be re-assessed as once the swelling comes down it needs to be adjusted a bit. They do have a tendency to head south though.
Good luck and hang in there.

Remember that any advice on an online forum is of a general nature.
You are always advised to be assessed by a medical professional so your individual situation is addressed.