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Author Topic: Tibial Plateau Fracture - No Displacement  (Read 8422 times)

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Offline damien

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Tibial Plateau Fracture - No Displacement
« on: November 25, 2013, 12:18:41 PM »
Hello everyone,

I have been reading a lot of threads on this board over the past few weeks and I have found a lot of very helpful pieces of information, so I figured that the least I could do was share my own experience and hope that it may one day be useful to someone.

A bit of background info on me. I am a 30 year old male living in France. I work from home and train for long-distance running events.

3 weeks ago (on the 2nd of November 2013), I was the witness of a mobile phone theft in the streets of Paris (I live there), so I ran after the culprit and tackled him. The tackle did not exactly go as expected and he fell on my right leg (as in, he fell first and I took all his body weight on my right knee while I was still standing). I felt pain instantly, but with the rush of adrenaline, I managed to get back on my feet and hold the guy down (with the help of my cousin) while we waited for the Police. By the time the Police came, the pain had worsened quite a lot and I was no longer able to bear any weight on the leg. So, I had to be taken to the ER (H˘pital Cochin in Paris).

At the ER, I was first received by an intern who diagnosed a possibly sprained knee (with a follow-up MRI to be done 3 weeks later) and was ready to discharge me with pain medication, a knee brace, and two crutches. I was also told that I should try to bear as much weight as possible on my right leg (the damaged one) while walking with the crutches. Not wanting to waste any time, I started practicing with the crutches while I was waiting for the intern to come back with the discharge papers (in retrospect, I probably should have just stood still).

15 minutes later, the resident doctor came and decided that maybe it was preferable to do some x-rays, just to be sure. The x-rays showed a non-displaced fracture of the lateral tibial plateau (a 1-2mm vertical crack right next to the tibial spine). Then, I was transferred over to the orthopedic intern, who decided to do a CT scan to make sure I did not need surgery. You can find the x-rays here: http://www.icy-veins.com/damien/radios.zip

I eventually left the hospital with a leg-long cast and a prescription for pain medication and Lovenox (to prevent blood clots from forming in my immobilised leg).

My main worry at the time was that on the 4th of November, I was supposed to leave for the US. It was a 2-week long business trip that I had been planning for months and it was very important to me. The orthopedic intern that I saw at the hospital told me there was absolutely no way he would allow me to fly with my cast (like he made me feel stupid for even asking). He also pointed out that the treatment for my injury would not allow me to stay in the US for so long (I had to come back to the hospital 10 days later and the Lovenox treatment requires a platelet count check twice a week).

So, I canceled my trip to the US and started looking into ways to go there any way, but only for the most important part of my business trip (a conference in Los Angeles on the 8th and 9th of November). One of my cousins is a cardiologist, so I called him on the 3rd of November to ask for advice and he did not think that flying to the US in my state would be a problem, so I rebooked a trip from November the 7th to November the 11th. I checked my platelet count on the 4th, the 5th, and the 6th. It turns out I was having an allergic reaction and my platelet count kept dropping, so my cousin faxed me a prescription for a different anti-coagulant, Arixtra, which does not have the side effects that Lovenox has. He also wondered why the intern did not give me Arixtra, after I mentioned a trip to the US.

At the time of my injury, I was having physical therapy for a sprained ankle. So, I went to see my sports doctor on November the 5th to tell him I had to cancel the PT sessions he had prescribed. He was concerned about my knee injury, so he told me to cancel my follow-up appointment at the hospital. He then arranged for a colleague of his (Dr. Djian, a knee specialist who happens to be listed on this very website: http://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-patrick-djian) to see me right away. Dr. Djian reassured me that taking the plane with a cast was not an issue at all and he decided that we should see each other again 3 weeks later to remove the cast and see how I should start physical therapy.

The trip to the US went fine. Spending 12 hours in a plane twice was not very comfortable, but I was not in any pain. I was traveling in economy class and was sitting in a normal seat. I had to sit on the edge of the seat and was able to position my injured leg under the seat in front (there is plenty of room under there and I am 186cm tall). I had brought a large cushion on which my foot was resting and I requested more cushions from the flight attendants to put behind my back. Every 2 hours or so, I would stand up and walk around the air planes with the crutches. Twice during the flight, I went to see the flight attendants and they arranged for me to sit somewhere for like 10-15 minutes with my right leg elevated. I did waste a lot of money rebooking the flights and canceling domestic flights in the US that I had booked. I wish the orthopedic intern at the ER had been more open-minded.

Ever since the injury, I have tried to live as normal a life as possible. I have not been in a lot of pain, so I've been working normally (I just need to sit down at my desk and type stuff on the computer, so no worries there :p) and have been doing stuff around the house (like cooking and washing dishes). I found that the most annoying aspect of being on crutches is that it is really difficult to carry things around. My wife has been extremely helpful in making sure that I will not need to carry anything while she is at work, so I have not had to design any clever way of carrying objects with my crutches.

Tomorrow, I have the follow-up appointment with Dr. Djian. My sports doctor was very worried about ligament damage (especially the ACL, given the site of the fracture), which is why he sent me to Dr. Djian, who told me that the priority was to first ensure the proper recovery of my bone and then check for ligament damage. I run a lot, so I have been very worried about ligament damage (in the ER report, it is said that they had doubts about the laxity of my MCL). Two days ago, I got to see another of my cousins who is a radiologist. He looked at the images from the CT scan and said that in some images my knee ligaments can be distinguished (something to do with fat tissues that make the ligaments visible). To my relief, he ruled out ligament damage.

While reading up on TPF, I was mostly interested in seeing how people with a non-displaced fractured recovered, but most of the testimonies are from people with more complex injuries. I will post again as I start Physical Therapy. My goal is to be able to ski a bit on the 29th of December.
« Last Edit: December 20, 2017, 02:47:14 PM by The KNEEguru, Reason: Fixing broken links »
2 Nov. 2013 - Lateral Tibial Plateau Fracture
26 Nov. 2013 - Cast off, Partial Weight Bearing
15 Dec. 2013 - Full Weight Bearing
28 Dec. 2013 - Skied
30 Jan. 2014 - Started jogging again
02 Mar. 2014 - Paris Semi-Marathon: 1h47m25s
09 Mar. 2014 - Skied again
27 Apr. 2014 - Annecy Marathon: 3h43m15

Offline IHMK

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Re: Tibial Plateau Fracture - No Displacement
« Reply #1 on: November 25, 2013, 04:01:51 PM »
Wow - cousins to help you take down criminals and cousins to orchestrate your medical care afterwards! That's a grand collection of relatives - you're very lucky!

I'm glad there seems to be no ligament damage & that you'll confirm that with Dr Djian tomorrow. Also surprised to hear you were put into a cast.

For what it's worth, I had a similar fracture along with some other injuries, and when I finally saw a physical therapist 5 weeks after the accident, I was down to one crutch and the PT was quite concerned & wanted me off the crutch as soon possible. I took that to heart and shed it the same day. So in my case, staying on crutches as long as I did was a software issue.

Get well soon!
My knee story: http://www.ihurtmyknee.org

28 March 2013: tore right ACL (also meniscus tear, MCL tear ["Unhappy Triad"!!], tibial plateau fracture & condylar bruise)
28 June 2013: surgery to reconstruct ACL (allograft)

Offline damien

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Re: Tibial Plateau Fracture - No Displacement
« Reply #2 on: November 26, 2013, 03:44:29 PM »
Indeed, it is very convenient to have them :) The "doctor" cousins are actually my dad's cousins (I think the proper English term is first cousins once removed). Anyway, we are all very close, so I just call them cousins.

Thanks for your wishes and it does look as if it is going to go very well.

I had my follow-up appointment today. The radios were great (http://www.icy-veins.com/damien/radio-2.jpg) and the fracture is healing very well. My cast was taken off and I had some pain in my calf muscle, so the Dr. Djian sent me to do some ultrasound (not sure what the proper term is in English) to check for deep vein thrombosis. It turned out to be just some hematoma from the cast, so nothing serious.

I am now partial weight bearing and should be full weight bearing in 3 weeks. PT starts tomorrow, so I hope to see rapid progress with my range of motion, because it is pretty bad currently. I can fully extend the leg without any issue, but I can barely bend the knee (I would say the maximum I can reach is about 40 degrees). The knee is still very swollen, which I guess explains the lack of mobility, but the doctor said it is normal so I am not worrying. As far as bearing weight goes, I manage to bear 20 kilograms without any problem (I used the bathroom scale to measure it), so it looks promising.

The orthopedic doctor at the ER told me I was going to stay in a cast for 2 months, so may have been over-cautious. He was an intern, so maybe his knowledge of TPF without displacement is still incomplete :p When I saw Dr. Djian for the first time, I asked if there was any way I could get a new cast (the cast I have had for the past 3 weeks had no cotton layer between the tissue and the plaster, so it was really uncomfortable). He replied that at this stage it would be better if I just kept the cast for another 3 weeks and not risked displacing the fracture by having the cast replaced. So, I did as he said.
2 Nov. 2013 - Lateral Tibial Plateau Fracture
26 Nov. 2013 - Cast off, Partial Weight Bearing
15 Dec. 2013 - Full Weight Bearing
28 Dec. 2013 - Skied
30 Jan. 2014 - Started jogging again
02 Mar. 2014 - Paris Semi-Marathon: 1h47m25s
09 Mar. 2014 - Skied again
27 Apr. 2014 - Annecy Marathon: 3h43m15

Offline IHMK

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Re: Tibial Plateau Fracture - No Displacement
« Reply #3 on: November 26, 2013, 07:19:58 PM »
That all sounds great Damien - glad you are in good hands. And I retract my comment that I had a "similar fracture" - it sounds like I got off more lightly than you did as far as the break went (and made up for it in other ways ;) )  I hope the swelling will go down as you are able to move your leg more.  Good luck with PT - it must be exciting to start this new phase of your recovery.
My knee story: http://www.ihurtmyknee.org

28 March 2013: tore right ACL (also meniscus tear, MCL tear ["Unhappy Triad"!!], tibial plateau fracture & condylar bruise)
28 June 2013: surgery to reconstruct ACL (allograft)

Offline damien

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Re: Tibial Plateau Fracture - No Displacement
« Reply #4 on: December 06, 2013, 09:34:08 PM »
So, it's been 10 days since the cast removal.

I have made great progress. My flexion is now at about 130 degrees and more like 110-115 degrees with no outside help (as in, my leg is doing the flexion by itself using the leg muscles). My extension is looking pretty good too, but my knee is still swollen so it prevents me from reaching full extension, like on my other knee (I think I still need about 3-4 degrees).

I currently bear 35-40% of my weight on my injured leg. I had another x-ray this morning and I saw my doctor in the afternoon. Apparently, everything is going well and I will be able to walk in 10 days. I feel like I could bear a lot more weight on my leg right now, but I do not want to risk another injury, so I am taking it easy.

I have physical therapy 2 to 3 times a week for 30 minutes each and I repeat the exercises at home once a day, on days where I do not have physical therapy. I try not to over-exercise myself and I put ice on the knee 3 times a day. That is about it :)
2 Nov. 2013 - Lateral Tibial Plateau Fracture
26 Nov. 2013 - Cast off, Partial Weight Bearing
15 Dec. 2013 - Full Weight Bearing
28 Dec. 2013 - Skied
30 Jan. 2014 - Started jogging again
02 Mar. 2014 - Paris Semi-Marathon: 1h47m25s
09 Mar. 2014 - Skied again
27 Apr. 2014 - Annecy Marathon: 3h43m15

Offline damien

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Re: Tibial Plateau Fracture - No Displacement
« Reply #5 on: January 07, 2014, 09:08:52 PM »
Hello everyone and happy new year!

I just wanted to follow up on my recovery. I have been full weight bearing since the 15th of December. I had an MRI a few days later (on the 19th of December), and it showed no ligament damage (http://www.icy-veins.com/damien/mri/).

Even though my Physical Therapist disagreed, I went to ski for 3 days at the end of December (29th, 30th, and 31st of December). It caused me no pain and I was able to ski ok. I would not say I skied normally, as I was very cautious and did not force much, but I was able to enjoy it (although sitting on the chairlift was very uncomfortable at times).

I still have PT 3 times a week and since I recovered most of my ROM (still missing 3 or 4 degrees in flexion), I mostly do exercises to regain muscle strength. Everything is going fine and I hope to start jogging again next week.
2 Nov. 2013 - Lateral Tibial Plateau Fracture
26 Nov. 2013 - Cast off, Partial Weight Bearing
15 Dec. 2013 - Full Weight Bearing
28 Dec. 2013 - Skied
30 Jan. 2014 - Started jogging again
02 Mar. 2014 - Paris Semi-Marathon: 1h47m25s
09 Mar. 2014 - Skied again
27 Apr. 2014 - Annecy Marathon: 3h43m15

Offline damien

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Re: Tibial Plateau Fracture - No Displacement
« Reply #6 on: July 14, 2014, 07:53:43 PM »
It's been 7 months and a half now and I wanted to give people an update.

I recovered quite nicely. I did a half-marathon in 1h47m about a month after I started running again and a marathon in 3h43m 2 months after that. I could have done better at the marathon, but I broke a rib while skiing during the month of March, so that set me back a bit as I had trouble breathing for a few weeks. I am currently training for another marathon in October and a 75-km trail in December.

The knee is obviously doing ok, otherwise I would not have been able to finish these races. For about 2 months after I started running again, the knee would get swollen after training, but this has stopped now. It is still painful when I make sudden turns left or right and there is always a bit of pain (more of a discomfort now) when I start running, but it disappears after a few minutes. I still need to work on my quadriceps, because my right left lacks power compared to the left one, but I wanted to wait about 8 months before pushing the right leg to its limits. Also, I now use orthopedic inserts.

I regained my entire range of motion, but getting to full flexion is still easier on my good knee, so I frequently stretch.

That is about it for now. I will post again in a few months to let you know if I manage to repeat my performances from before the accident.
2 Nov. 2013 - Lateral Tibial Plateau Fracture
26 Nov. 2013 - Cast off, Partial Weight Bearing
15 Dec. 2013 - Full Weight Bearing
28 Dec. 2013 - Skied
30 Jan. 2014 - Started jogging again
02 Mar. 2014 - Paris Semi-Marathon: 1h47m25s
09 Mar. 2014 - Skied again
27 Apr. 2014 - Annecy Marathon: 3h43m15















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