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Author Topic: Tibial Plateau Fracture (Schatzker 6)  (Read 3856 times)

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Offline smileyshaz

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Tibial Plateau Fracture (Schatzker 6)
« on: November 13, 2011, 09:43:19 PM »
Hi everyone, just found you all and it's really nice to know there is somewhere I can come and ask questions!

I fractured my right tibial plateau on 5th October whilst getting on my friends horse (it decided I wasn't quick enough so moved off leaving me with my left foot in the stirrup and then landing full force on my right leg), I was picked up by ambulance and admitted to hospital (the one where I work as a theatre nurse!) After 5 days in a backslab with ice on my knee I had surgery which involved having 2 buttress plates and 10 screws inserted to try and hold everything in place (upside to working there is that I knew most staff and could easily ask questions - and I got a sideroom for a while!  ;D ). 

My consultant told me that it was a "good" fixation but not perfect as there is about a 1mm step on the joint surface (considering the state my knee was in I'm pleasantly surprised he managed to get it that good!)  I went on the CPM machine the same day as my op and was easily getting 0-90 by the time I was fitted for my cast brace (toe to thigh purple plaster with a hinged knee) and discharged on the 15th.

I'm now 5 weeks post-op (well I will be tomorrow) and am starting to get around better on my crutches (don't feel like I'm going to fall over every time I move), but need to use a wheelchair if I'm going much further than house to car.  I'm non-weight bearing for at least 3 months, which I'm sure you'll all agree is a nightmare!  For the first 2 weeks I was pretty much housebound, as I find crutches difficult due to previous surgery on my wrist, then I discovered that you can loan a wheelchair from the British Red Cross - it's been fabulous!

I seemed to be doing ok but I've recently noticed that my active ROM has decreased  (passive is still 0-90) and was wondering if it is because I've been out in the chair more often so the leg is stationery in a bent position (sometimes for several hours at a time if I'm out shopping), if it's likely to be because the cast brace needs adjusting, or if it's just something that happens as the time goes on and muscles atrophy and bone heals? Anyone any experience of this?  Is it normal for ROM to reduce or should I be mentioning it to the surgeon?  I'm seeing him again on the 24th and in the meantime I'm going to actively work on increasing that ROM again.

Thanks for any advice!
Sharon x
Words of wisdom from my consultant "Remember why you're called a patient!"
5/10/11 - Right TPF (grade 6)
10/10/11 - Surgery then CPM machine
13/10/11 - Plaster brace
15/10/11 - Home
27/10/11 - Clips out
24/11/11 - Smaller brace, teeny bit weightbearing!
28/12/11 - Brace gone, wbat
26/04/12 - Work

Offline MSD

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #1 on: November 13, 2011, 10:06:29 PM »
I imagine it's because of muscle atrophy. One of the biggest problems I had was loss of strength in the hamstring, it's a difficult muscle to exercise while non weight bearing. So keep working on the passive ROM and do as much training of your muscles as you can. Hamstring curls both lying on your stomach and while standing on your good leg. You will need to add some resistance later but don't do that without consulting your doctor/PT. Remember that recovery is two steps forward, one step back in any case. So don't be disheartened by setbacks, just keep working as hard as you can!
15/03/2011 TPF type 2 skiing accident
17/03/2011 operation, plate and 7 screws
31/03/2011 stitches out, ROM 10/45
28/04/2011 ROM 0/140, PWB allowed
20/05/2011 full ROM
25/05/2011 FWB

Offline maryc

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #2 on: November 15, 2011, 04:12:07 AM »
Hi Sharon - welcome to the wonderful world of TPF.  Looks like you're doing great.  I was such a menace on crutches that after seeing me use them in the hospital my OS said no crutches until I was weight bearing.  I used a walker and a wheeled office chair in the house and a wheel chair when I was out and about.
Like MSD said, this recovery is sometimes two steps forward and one step back.  But there is a light at the end of the tunnel
One thing that made a real difference for me it to make sure that I kept my ankle flexible and my Achilles stretched.  When I started weight bearing again it was one less thing to have to deal with.
Sending healing rays your way
8/4/07 fell
8/5 diagnosed TPF
8/6 surgery plate and 6 screws
8/12 out of hospital NWM
8/21 staples removed
9/18 OS appt - WBAT with crutches
10/10 - WBAT with cane
10/27 - back to work w/cane
12/26 - no cane, slight limp when tired
1/25/08 - released from PT, no limp
2/3/09 - Released by OS

Offline smileyshaz

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #3 on: November 15, 2011, 01:50:17 PM »
Thanks both of you!

I'll keep working on the ROM and doing as much as I can.  Mary I'd love to be able to flex my ankle but unfortunately the type of brace I'm in at the minute is a plaster boot, with a hinged knee, attached to a plaster tube round my thigh so no ankle movement possible just yet.  I'm hoping that when I'm at clinic next week they'll change it for something a little less huge, but I'm not holding my breath - I'll just go along with whatever my consultant recommends as I know he's bloody good (advantage to working with him before I broke my leg!)

I know it's going to be a long hard slog to get back to normal - but I'll get there!  x
Words of wisdom from my consultant "Remember why you're called a patient!"
5/10/11 - Right TPF (grade 6)
10/10/11 - Surgery then CPM machine
13/10/11 - Plaster brace
15/10/11 - Home
27/10/11 - Clips out
24/11/11 - Smaller brace, teeny bit weightbearing!
28/12/11 - Brace gone, wbat
26/04/12 - Work

Offline liamy

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #4 on: November 15, 2011, 06:24:46 PM »
Hi Sharon. It sounds like we have alot in common.
Back on June 20, I was camping and missed the step while coming out of our trailer and landed on my fully extended right leg. Needless to say, I ended up with a TPF. Like yours, it's a grade 6. My OS said one ofmthe worst he's seen. I was in the middle of nowhere and ended up on a 6 hour ambulance ride back to the hospital where I work as a nurse! I work in the trauma ICU.
I had surgery 3 days later and was in the hospital for a week. I was NWB for 12 weeks. It's now been almost two months since I was given the go ahead to start to bear weight. It's been so hard! I've had so much foot/ankle pain. I'm just now, in the past couple of days, using the cane full time. Yesterday I had X-rays of my foot to rule out an undiagnosed injury but it only showed disuse osteoporosis. He also told me that I will need a knee replacement at some point. 5 years, 10 or 15. He doesn't know when but is sure that I will need one. I'm only 34 so it was hard to hear that.
I agree with the previous poster. Recovery is not a steady process. I feel great for a few days, then the next day I feel like I will never walk again. My knee feels strong, then the next day stiff and weak. It's a roller coaster for sure. The last time my ROM was measured, my flexion was about 130 and my extension was -7. I still have alot of work to do on straightening. I was prescribed some sort of splint to help it but haven't got it yet. I don't want a permanent contracture! I go to PT three times a week. Since I've been able to bear weight, all my sessions have been in the pool. It's amazing!!
I'm dying to go back to work. Like you, I'm on my feet for alot of the day. Do you work 12 hour shifts? I do. The thought of 12 hours on my feet seems totally impossible! Nobody can tell me when they think I will get back to it, only that they are confident that I will. I'm terrified that I'll never be able to go back though. This whole journey has been so hard. I'm starting to see a little light at the end of the tunnel though!
Keep up the hard work!!
:)amy.

Offline smileyshaz

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #5 on: November 16, 2011, 03:50:21 PM »
Hi Amy, we certainly do have a lot in common!
I do (or did) work 12 hour shifts in orthopaedic theatres (hence knowing my consultant very well) so I know that getting back to work quickly just isn't going to happen, I was told I would be off at least 6 months, possibly a year or more. 

I've also been told that I'm going to need a total knee replacement, somewhere between 2 and 10 years time, and I'm only 3 years older than you so I totally understand how much it sucks to hear that, especially in our line of work.  I'm determined that I'll make it 10 years (or more if I have anything to say about it), so I'm working hard to get down to the weight I should be (I'm currently about 3 stone more curvy than my ideal weight)  so my knee isn't under any more stress than it needs to be.

It's nice to hear that it's only taken 2 months till you are down to using the cane full time (although I bet it feels like ages to you) I was imagining needing to use crutches for a lot longer than that so you've given me a goal to work towards!

I have just emailed my consultant to ask about using a stationary bike to improve ROM and he's said that is ok as long as I don't put weight on my leg (so just need to get one ordered), and that once the brace is off swimming will be great for me - roll on the day the brace comes off! 

The last thing he put in his reply was "Don't try and rush things too much, remember why you are called a patient"  So that is what I'm going to TRY and remember!

Good luck and just keep taking it one step at a time! x
Words of wisdom from my consultant "Remember why you're called a patient!"
5/10/11 - Right TPF (grade 6)
10/10/11 - Surgery then CPM machine
13/10/11 - Plaster brace
15/10/11 - Home
27/10/11 - Clips out
24/11/11 - Smaller brace, teeny bit weightbearing!
28/12/11 - Brace gone, wbat
26/04/12 - Work

Offline markw

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #6 on: November 20, 2011, 03:45:48 PM »
Hi all! Newbie here!

I too have a tibial plateau fracture (schatzker 6) Came off my scooter in August,7/8 weeks in full leg plaster and had the last few weeks in a hinged brace.Hinge was first set at 30 degrees and has now been reset to unrestricted so I now have full movement and can also bear weight but I also have DVT  :'(  for which I am on Warfarin and weekly blood tests.
There is still quite a bit of swelling round my foot/ankle and the knee itself,I know I've only just started moving a lot more,but are there any exercises that will help with the swelling and everything else.
My next Xray is in 4 weeks by which time the bone should be completely fixed together and I can discard the brace.

Thanks in advance.I think I've covered everything  :)

Offline MSD

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Re: Tibial Plateau Fracture (Schatzker 6)
« Reply #7 on: November 20, 2011, 05:48:16 PM »
Flex the ankle as much as you can. This helps reduce swelling because when the calf muscle tightens it generates some pressure which helps push the blood along your veins. Once I started loading the leg I found that the swelling got better, but it still took several weeks to really get back to anything like normal. But hopefully you begin to see an improvement, just try to be as active as you can.
15/03/2011 TPF type 2 skiing accident
17/03/2011 operation, plate and 7 screws
31/03/2011 stitches out, ROM 10/45
28/04/2011 ROM 0/140, PWB allowed
20/05/2011 full ROM
25/05/2011 FWB