Tibial Plateau Fracture-Need Help!

[m_reeson]

Hello,
Im just hoping to find some answers about my knee.
The story:
I am 31, active male. October 19 2009 sustained depression medial tibial plateau fracture minimally displaced after accident on bicycle. Dr. opted for non-operative treatment. Wore brace immobilizing leg and no weight bearing for almost two months as bone was slow to heal, and risk of displacement was present. Developed DVT (clotts) increasing leg pain and swelling. Since mid-december have been weight bearing, and seeing physiotherapist twice a week. Knee started at 33 degrees flexation and has now improved to 66 degrees (almost 2 months of physio). Have not had MRI on knee, manipulation tests have not been performed as knee is still very swollen and stiff. Physiotherapist hopes to asses ligaments (mcl +pcl) in near future to determine if MRI is required. Leg very stiff, still quite painful after walking, and wakes me up during sleep when i shift leg. Was taking percocet and T3, have stopped taking pain meds, as am on blood thinners due to DVT. Pain is bearable, but i am not comfortable much of the day.

My questions:
I have read online that immobilization of knee for more than 3 weeks can cause permanent damage ie. stiffness in knee that cannot be corrected by physiotherapy. My orthopedic doctor is not very communicative, and im worried that he left my leg immobilized for too long. My physiothereapist is great, and very nice, but not great at giving me information about how im doing, if there is risk of permanent knee damage. I guess im hoping that someone might be able to share their experiences and either reassure me that im on the road to recovery and shouldnt worry, or if there are concerns, i would like to know about them, and consider switching orthopedic doctors.

if anyone requires anymore info, i would be happy to provide it, and thanks for reading this.

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[physiobob]

I have read online that immobilization of knee for more than 3 weeks can cause permanent damage ie. stiffness in knee that cannot be corrected by physiotherapy.

Basically Rubbish.

I tibial plateau fracture is one of the slowest in my experience to recover. And yes perhaps due to prolonged immobilisation just like the old plaster casts for a dislocated patella (which some DR's still do). A plain x-ray of the tibial plateau would be nice to have to see how the alignment of the fracture is. Also consider the get the fracture the joint as a whole suffered a huge trauma. So the fracture might have been the obvious sign but other tissues would have been damaged.

The DVT is a bummer but you'll get over that as you're young and the tissue should cope well with that. Basically you need really good hands on (and hands off) rehab. You could have a general anaesthetic just to see if the knee bends full when you're out to it. That would show the restriction is at the 'brain' level and not locally at the joint. i.e. not a physical/mechanical block.

Overall relax in the understanding you are way early into the rehab process and so you're probably par for the course right now

[m_reeson]

thanks so much for the reply!
its good to hear that its just a slow rehab, and that i shouldnt be worried! I am doing my home exercises diligently and i believe my physiotherapist is excellent.
its an interesting point about the stiffness being mental, maybe ill try doing my exercises with my eyes closed in case i am limiting myself mentally. could that help? i have a fairly high pain tolerance, and push myself quite hard when doing exercises, but perhaps that doesnt exclude the possibility that im holding back on the extension. speaking of pain, is it common to be experiencing consistent pain ranging from 5-7 at worst, at this stage? having difficulty sleeping still? and based on your experience and the limited information you have about my case, would you say i should expect a full recovery of knee functioning?
thanks again, i really appreciate the advise!
m

[physiobob]

Providing the tibial plateau alignment is in good order you should expect 100% recovery. Pain due to the immobilisation is common at this stage. Try to think about rehab as the whole leg and don't focus to much on the knee as this can delay things.

[alicat]

Hi Guys,

I hope your knee is doing ok now, it is a very slow process but I'm sure yours will come good!!

Physio Bob please help..........

2 yrs a go I had a horrific horse riding accident, it left me with two broken feet/ ankles disslocating my navicular bone in my right foot which was K wired. Snapped my right fibular straight through, and if all that wasn't bad enough had tibial plateau fractures in both knees! My left knee was fixed with one screw and to be honest doesn't give me much trouble. My problem is with my right which took the brunt of the impact. It was a displaced fracture which took 9 screws and plating to fix. The hospital did a fantastic job of re building me as it was a bit touch and go whether I would walk again. The problem that I have is that the bit of bone that came away isn't quite in the right place (obviously they where more concerned with getting the top bit right) and I have a big lump on the front of my knee where it now is. It is still very swollen and doesn't really even look like a knee any more. I can't ride any more because of the pain, running is out of the question although I can sort of jog but not for any real distance because of the jarring. I sometimes get a horrendous stabing pain in the front of my knee, they ache constantly and if I do too much I struggle trying to get up stairs etc. Have you any idea what this could be? I can't stand for long periods of time as I get burning pain in my feet and first thing in the morning and last thing at night I am very stiff.

I take Cortaflex Ha and cod liver oil but the difference is minimal. Any help or tips you may have would be very much appreciated. I almost feel guilty even asking, a can walk after all, its just so frustrating and painful. The hospital have said there is nothing more they can do for me.

Thanks

Alex