New to forum / Ski accident

[Raymo]

Not a great start to 2015 new years day i was taken out by another skier in Andorra (Spain/France) i went into someone else my knee and tibia went one way and i went another, i knew straight away i had done a lot of damage my left knee was numb and i couldnt move my lower leg, i was X-Rayed and was told no broken bones!!(wrong) my knee was huge and had to be drained i was in excruciating pain!! i could move toes and ankle but not lower leg, they plastered my leg Crutch to toe, as soon as i got home (London) i went to see an OS after a CT scan he said that the back of my tibia has shattered at the plateau but said that he wont operate! is this normal?? its over a week now and i still cant move my lower leg and feels very unstable swollen and painful, is this due to ligament damage?? im seeing my OS again tomorrow night hopefully to arrange a MRI, i am wearing a immobiliser brace and have crutches and was told not to weight bear, i took the brace off (OS said that it would be OK) to have a shower still not weight bearing but i had no control or movement in the lower leg as i stood up so had to put the brace back on.

[MDAL]

Raymo:

2 issues you asked... yes sometimes doctors prefer to let things heal on itself than to make a surgery... if your tibia plateau is broken, it might just connect back without being cut in pieces to have it nailed. If that is so... lucky you... opening your knee to nail stuff is not a first option if things can heal on their own.

About not being able to move the lower leg, yes that is normal after a big trauma or surgery. The knee locks as some sort of a defensive response to the trauma, the inflammatory reaction seems to disable everything around...

I had a fracture too in the knee and for a week, my leg was so swollen I could barely move toes, could only control a bit of the bigger one and move it by millimeters... The pain was so insane I was biting my own fingers at night. So being locked does not mean you have broken ligaments, it simply means the inflammatory reaction is disabling the control you have over the functions around your knee.

You should loose some range of motion during this period, which will need to be recovered by physiotherapy later when the doctors believes it's time to start... so things will get back, but you will still have work to do in order to recover...

Do pressure the doctor for an MRI, in case you have further damage still undiagnosed, the MRI might show it...

[mjeffrey]

Hi Raymo

You may be interested to read this http://www.scielo.org.za/scielo.php?pid=S1681-150X2010000300015&script=sci_arttext

There is general consensus in the literature that TPFs that are stable and show minimal displacement do not require surgery

so as MDAL has said you are lucky that you don't need surgery (it really isn't something you want at all if possible).

And I also agree with MDAL on pushing for an MRI to check soft tissue damage.

MRI has a high sensitivity for demonstrating soft-tissue injuries (Figure 5) and is also effective in demonstrating the fracture pattern.10 Due to the high rate of concomitant soft-tissue injuries in TPF, there is a move towards more frequent MRI studies.11 The limitations to this approach are the high cost of MRI and its limited availability.

When you see the OS make sure you have a list of written questions and don't be fobbed of by non-responses, ask again. Some to start you off. When can I: partial weight bear, full weight bear, start PT, start bending the knee, how much, what progress can I expect, What if my progress is less?. When is my next appointment? Do you recommend CPM, if so when? Can you use an electro muscle stimulator, when? What pain meds/anti inflammatories? Can I reach you by email, phone and when?

Your quad muscles will tend to atrophy but you should try to keep them as much as possible. Increase protein and calories and get an electrical muscle stimulator to exercise them without having to bend your knee.
Consider getting or renting an ice machine or an inflatable ice pack for the knee (e.g on amazon)

Also check the bone breaks forum and maybe cross-post there. There are a few new TPF sufferers there, check what preoccupies them (most felt they were abandoned without enough info) and try to get explanations from the OS upfront.

At the beginning of last year my OS said that 2014 will be "the year of the knee", I'm afraid 2015 will be yours. It's a tough injury but at least you don't need surgery.

good luck
Mark

[Raymo]

Thank you both for the great advice, i am happy not to have surgery for sure but was more worried about the shattered bone what happens to all the pieces do they just stay there, will hopefully find out more tomorrow, thanks for the list of questions i did have a few of those already but always good to be armed with more :-) i will also be happier when the MRI is done, i will keep you posted 

[MDAL]

Yes, it's possible, once you break a bone (even shattered pieces), there is a bleeding of bone marrow. This bone marrow contains stem cells and growth factors (hormones). From that bleeding a clot forms that will form solid bone again merging the pieces...

The only issue is if things can be held in place without screws while it heals... like I said, if your doctor believes so... then lucky you...