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Author Topic: Tibia Plateau Fracture - Feel the need to share  (Read 4011 times)

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Offline Adalricc

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Tibia Plateau Fracture - Feel the need to share
« on: August 03, 2014, 02:35:34 AM »
Hi,

It seems that I have joined a group of people nobody really wants to be part of, like that common joke about the one friend named Dave nobody actually wants to be around (sorry to any Daves). So about two months ago now, a little under actually I was having a perfectly normal day, finished up in the office and planned my experiments for the next week. I should point out i'm 23 and a PhD student and after work on Friday I got on my bike to go have dinner in town before my dancing lesson (I dance Ballroom and Latin and take part in competitions...or did). When I turned a corner and my push bike got into an argument with a car parked on the very edge of the bend and I couldn't avoid it. My left leg did what all good legs do and took out his lights while his light took out my tibial plateau.

After the typically long wait in A+E (one of the girls I dance with is a nurse who was on duty at the time - made for an awkward moment) they finally told me what I had done and admitted me to a ward and put me in a splint. A week later I had surgery, I was in a fair amount of pain pre-op and didn't really take in all the technical terms as the doctor told me it could be a year before I competed again and it frankly left me so dark I didn't listen to much. But the jist was it was depressed and needed putting back together possibly using bone from my Iliac Crest (thankfully proved unneeded). Surgery was a success and I had two pins in my leg holding the thing together. Given what other people have had I am guessing it was not as serious as it could have been, though didn't stop me bursting into very manly tears watching old Tango routines I did thinking I might not get to do it again.

But they put me straight in a full cast with no movement at all allowed and told me I would be NWB for 2 months and PWB a month after that. Gradually they allowed up to 60 degree flexing of my leg in the full cast. It's been two months now and last week I went in and they removed the cast (set at 60 degrees still) they did an xray that I got to see - my research group work with imaging systems and bone a lot so I was curious. But the upshot was I was sent home soon after with a Velcro brace and not much else at all. No PT or recommendations at all, just a have fun see you soon. As such I am a little in the wilderness about what to expect, I have managed to get an appointment with a doctor soon but it won't be my OS and frankly I am worried. Before my break I danced 6 days a week amounting to up to about 20 hours, so to say it is important to me is an understatement especially since one of the few requirements to dance is a working leg.

I have tried to do some basic hamstring stretches and the like while lying in bed or sat on a chair as well as upper body weight lifting just for general health but I have got no more movement out my leg at all it gets to about 50 degrees and stops dead, no real build up of soreness over the range of movement, just 50 degrees then bang like it's hit a wall. Any attempt to push past this (rather foolishly I have tried) just hurts and the leg doesn't give at all. Under normal conditions I have no pain or discomfort in my leg, sometimes lifting it and moving it side to side causes it to ache but very very mildly. So I have been luckily I think in that.

But my question is this. Should I be worried? I am still NWB so there is not much I can do but I can't help but think I should be seeing some RoM increase from my leg as it seems many others do at this point. I was wondering what people's experiences with this are and if I could prompt anyone to share them with me. I'm not so worried about the bone as i'm young and sort of fit that should heal fine (indeed the xray looked pretty good) but the idea of the leg not regaining near full RoM terrifies me for obvious reasons.

Thanks for reading
Matthew

Offline mjeffrey

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #1 on: August 03, 2014, 01:42:13 PM »
Hi Matthew

It sounds like you were treated badly by the OS. You need to get an OS to give you some guidelines on rehabilitation and instructions for PT (and if I were you I'd get a second opinion).
I didn't have a TPF but in any case each injury is different and you need professional advice.
When you go, write down a list of questions and don't leave until they are all answered to your satisfaction - some try to rush you (golf game no doubt).
And if it takes X weeks to get an appointment make them in advance, cancel if you decide it's not needed.

Loss of ROM can be serious and needs to be treated early. It is not necessarily arthrofibrosis but  I suggest you take a look here:

http://www.kneeguru.co.uk/KNEEnotes/primers/rehab-issues-primer/key-arthrofibrosis-resources-kneeguru-site

and read this:
http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-12-part-course-frank-noyes-md

p.s. are you in NZ by any chance?
clues: "pushbike" :)

cheers,
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline Adalricc

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #2 on: August 03, 2014, 06:19:45 PM »
Hi Mark,

No I am not from NZ actually can't get further really. I am from the UK which also means my treatment was on the National Health, admittedly being fully casted until about 10 days ago meant I couldn't do too much in the way of Physio but I will be bringing up when I see someone next week. I am worried that it could be Arthrofibrosis though obviously it could be a number of things as I haven't started putting weight on yet so maybe that will help when I do. I am not sure. If it is something like AF what is like after treatments such as MUA in terms of movement, my worrying mostly comes from the fear I could not dance competitive again.

The links were helpful thank you.

Regards

Offline daihard

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #3 on: August 03, 2014, 08:35:44 PM »
Hi Matthew.

Just read your posts. I know how it feels about joining the club. I biked 6-7 days a week before falling and breaking my right patella. I am now 4 weeks into recovery. I'm still in a brace but was allowed to start PT (physical therapy) last Thursday. My OS (orthopaedic surgeon) told me it would be at least 3 months before I could get back in the saddle. It is sad that I'm missing out on the whole summer, but all I can do is take it slow and recovery fully. It's probably the same for you. Hope you get some good news from your second doctor!

Dai
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline Adalricc

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #4 on: August 03, 2014, 09:22:43 PM »
Hi Dai,

Sorry to hear about you accident I do hope you can get back on a bike sooner rather than later, though I think for both of us we have to take it slowly and make sure we get our legs sorted before getting back to our respective sports. Honestly I have found the idea of getting back on a bike scary as hell. I was told a year before I could compete again though my OS was very vague about even that, which makes sense but doesn't much help my mental state.

Hope your healing goes well :).

Matthew

Offline mjeffrey

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #5 on: August 04, 2014, 07:59:44 PM »
Hi Guys,

Mine was a bike accident as well, I used to mountain bike about 120km a week but I have to say I'm also feeling a bit apprehensive about getting on the bike again as well. If I do, I think I'll get some knee protectors. I broke a vertebra in the neck a few years back (not serious, didn't need surgery) but with this on top I wonder if I'll continue. The irony is that this is the best exercise for rehabilitation :).

Anyway good luck with the recoveries.
mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline daihard

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #6 on: August 05, 2014, 04:22:06 AM »
In my case, it is my wife who wants me to stop cycling. I understand her concern after I went through a broken wrist in February and this, but cycling is where my passion lies and no way am I going to stop riding after I heal. Every time I see a roadie riding around, I feel extremely jealous! Getting back in the saddle is my motivation for doing PT diligently. :)
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline morgana

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #7 on: August 07, 2014, 03:46:41 AM »
Matthew (& the rest of the bike gang   ;) )

Also did my destruction on the bike.  Will say I was able to ride comfortably before I was able to walk without a limp.  At the time of the injury (massive destruction is what I initially called it) we were riding 50 miles per weekend and 8-10 miles several other days a week.  When I was finally allowed fwb we rented a couple of 4 wheel "racer" bikes, commonly available here for touring the waterfront, lightweight, fluff bunny bikes that would be very hard to gain any real speed or wipe out.  My spouse was a trooper and rode one with me.  It took a few weekends of riding those before I built up the strength to switch back to my two wheeler.  I am now six years later & still riding my bike.  Because of other changes in our lifestyle (nothing related to the accident at all) we don't get to ride so much any more, but that's been in the past 18 months or so. 

Matthew - truly, aggressively, go after a second opinion, list of questions, ask about rehab, etc. AND take someone else with you, someone you have discussed your concerns with so that when you stop hearing what's being said they can help get the conversation back on track.

I was NOT young when my accident occurred. I was 50. I was in good physical shape.  It did take me a lot longer than I expected to get back to the things I could do prior to the accident.  I am certain age played a role in that.  There are days now that the limp reappears after some workout or another, but they are not often and don't last long.  I put everything I had in physical therapy, followed every DON'T. DO given by the Ortho and PT.  When Ortho & PT released me I continued looking up everything I could find to strengthened areas, stretch areas and regain flexibility.   It took me forever to regain squatting, but these days I can squat, talk to whoever I need to at that level, for as long as I need to, then stand up without putting either hand to the ground.  Many 56 year olds can not. 

I can't promise you that your passion for dancing will resume quickly,  I hope it does.  I hope youth plays a very, very good role in your fast recovery to biking & dancing!
5-26-08 Severely comminuted bicondylar fracture-right tib plat - locking plate & 6 screws  Bicycle Accident
nwb for 12 weeks
6-12 started pt
7-21 added swimming
8-25 pwat with walker
9-02 four prong cane
10-07 cane
10-15 cane as needed,slight limp
10-27 OS:next visit 10-2009

Offline MSD

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #8 on: August 31, 2014, 06:40:39 PM »
First thing to get straight is that rehab from a TPF hurts. A lot. To get back your full range of motion you have to be prepared to suffer. The scar tissue stops the joint moving and you have to break it up by pushing the joint to bend a little bit more every day. Try to set a goal (5 degrees more per week) Sometimes people are unable to stand the pain and one option is to have the joint manipulated under anaesthetic. But from your post, I suspect you are just being too cautious and think that if it hurts you shouldn't push it. That's the wrong idea. You have to push it until it hurts a lot and if you aren't making progress, you need to push it harder.

Get on an exercise bike. If you can't pedal all the way round, pedal forward as far as you can, then pedal backwards until you hit your limit going the other way. Go backwards and forwards, try to get a bit further round each session. Walk everywhere and as soon as you can ride your execise bike properly, get back onto a bike.

I did my TPF is a skiing accident. I was back skiing the next season, although not at full capacity. Yes it was scary when I started skiing again, but after the first hour it was ok. Last season was my third season after the accident and I was skiing better than ever. So yes, it is possible to make a good recovery. However, most of the responsibility to make it happen is down to you. I had one consultation with a physio which was a total waste of time, it was obvious that their level of ambition didn't match mine. So I had to just get on with the rehab by myself.

You need to work AS HARD AS YOU CAN. Go for it and have the attitude that you are going to get back to full strength, whatever it takes.

Mark
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 iMax

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #9 on: September 03, 2014, 12:02:30 AM »
Hey mark I have exactly same type of fracture as you. I also injured on 15th had surgery on 17 now I can bend fully without much pain. Do you think my recovery is OK? I haven't been to physical therapist yet. Just checking out YouTube videos and some basic common sense. May be that's a bit harsh? Can't wait to get back on the saddle. I need stationary bike now thinking about buying cheap bike trainer or something instead of pt.I don't drive or have the money to see PT and commuting cost. Guess I just have to keep walking until I find a cheap basic bike trainer. Need to strengthen my knee muscles before quadriceps. Have pain on my patella when I put my injured foot on the floor.things have been good and I'm happy so far.
15/07/14 - Type II = Lateral tibial plateau fracture.
17/07/14 - Surgery 7 screws+1 plate
23/09/14 - FWB  1 Crutch ROM nearly full extension normal.
09/07/2015 - Hardware Removal +FWB
21/07/2015 - Stitches removed
24/07/2015 - 5-10k on Threadmill 4/7 days
 ! Pain is Temporary , Gain is Permanent !

Offline MSD

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #10 on: September 06, 2014, 06:01:11 AM »
If you have full ROM after 2 months you are doing well. Can you straighten your leg to a few degrees hyper extension as well as bend it fully?

Cheap stationary bike will help a lot. And as soon as you get the go-ahead for FWB start walking as much as you can. Practice stairs (on a stair with a handrail). Then progress to light jogging and plyometrics.

M
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 iMax

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Re: Tibia Plateau Fracture - Feel the need to share
« Reply #11 on: September 07, 2014, 07:20:41 PM »
Hey mark thanks. Almost 8 weeks since the fracture and I have been walking like a crazy person who n the last 4 days. I believe in old school stuff  so been bending a lot as well as walking. Almost no pain in the last couple of weeks except few odd pain around my patella. My foot arch was a bit sore after 7 km of walking 3 days ago but stayed the next day and it was gone.I'm becoming inpatient since 2 weeks ago I guess it's just human thing :D can't wait to ditch them crutches
15/07/14 - Type II = Lateral tibial plateau fracture.
17/07/14 - Surgery 7 screws+1 plate
23/09/14 - FWB  1 Crutch ROM nearly full extension normal.
09/07/2015 - Hardware Removal +FWB
21/07/2015 - Stitches removed
24/07/2015 - 5-10k on Threadmill 4/7 days
 ! Pain is Temporary , Gain is Permanent !

Offline christineuk62

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  • 14/jan/2014 RTA with moped - hospitalized for 6 wk
Re: Tibia Plateau Fracture - Feel the need to share
« Reply #12 on: September 11, 2014, 08:37:02 PM »
in Jan 2014 I was hit head on by a car and received TBF schatkers 6 broken in 4 places, along with 2 torn ligaments to the other knee, fractured shoulder in 3 places and a break in my right upper arm.
after spending 6 weeks in hospital laid up i was sent home with no treatment apart from MRI CT scans and xrays.
The consultant didnt know what to do about my injuries so i was referred to Mr Smith at Wrightington near Wigan and after another MRI, another CT scan and more xrays he is doing a full right knee replacement within 6 weeks and the other ops approx 6 months later.
although ive got a long way ahead still im happy things are moving at last. just wondering what the pain is like after op, i still take morphine as my kneecap is grinding and very painful walking

christine maloney















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