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:hat Can anyone suggest the protocol for the Tibial Plateau fractures...
I feel under pressure when dealing with one!
I once mobilzed too soon (after a week) and the patient had haemoarthrosis!
The doctors blamed Physio, but i thought it is necessary to mobilize the knee post traction application to prevent bone forming into the joint!
Anyone with evidence based protocol just to boost my confidence? :hat
In cases of type 1 Undisplaced fractures the knee is rested on a a continuous passive motion machine CPM and knee movements are begun. Partial weight bearing is started after 6 weeks and full weight bearing is delayed until the fracture is consolidated usually around 8 weeks.
In type 2 fractures ( vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle), Active exercises are begun with traction applied to the leg or alternatively the knee can be put on continuous passive motion machine CPM, increasing the range of movement progressively. After a week of this treatment the machine is removed and active exercises are begun. Partial weigh bearing is started afer 6 weeks and full weight bearing deferred for an other 6 weeks.
In type 3 fractures (depression of the articular surface with intact condylar rim), Active exercises are begun as soon as possible or alternatively the knee can be put on continuous passive motion machine CPM, increasing the range of movement progressively. After a week of this treatment the machine is removed and active exercises are begun. Partial weigh bearing is started afer 6 weeks and full weight bearing deferred for an other 6 weeks.
In type 4 fractures ( fracture of the medial tibial condyle), Active exercises are begun with traction applied to the leg or alternatively the knee can be put on continuous passive motion machine CPM, increasing the range of movement progressively. After a week of this treatment the machine is removed and active exercises are begun. Partial weigh bearing is started afer 6 weeks and full weight bearing deferred for an other 6 weeks.
In type 5 fractures ( fracture of both condyles) & type 6 fractures ( combined condylar and subcondylar fractures), Active exercises are begun with or without traction applied to the leg or alternatively the knee can be put on continuous passive motion machine CPM, increasing the range of movement progressively. After a week of this treatment the machine is removed and active exercises are begun. Partial weigh bearing is started afer 6 weeks and full weight bearing deferred for an other 6 weeks.
Well i'm dealing with a patient GRADE 6 #.. ORIF.. post op week 7.. he's improving well.. range not yet complete but around 120 active.. he'll get an x-ray done in a day or two.. anbd has a meeting with his ortho this week.. so if all goes well i'll let u know my evidence based protocol.. jz wanna make sure 1st that all's well with him.. tc,..
PS i'm scared toooo....
I also have a # tibial plateau case recently, post op 7 weeks, flex/ext 130/-10, on NWB now.
Do you think it is neccessary stretch him to full extension this period on wait until he is allowed for PWB?
hey, well i really think u should get the extension complete fast.. coz i waited on it too and now thats the only thing troubling me and my patient.. you can also start PWB as he's 7 weeks post op..
well now i'll tell u wat i did.. i started PWB by week4 as the x-ray showed me great healing and te patient was improving fast.. i did use PNF.. no use of CPM.. satrted slight moblizations at week 4.. did use wax to give heating.. icing after stretching to prevent any contusion.. the patient is now post op week 8.. the x-ray is good.. range still 125/5 (flexn/extn).. the last 5 of extn seeems unattainable.. quads strength good.. strengthened all other hip and leg musculature.. patient is now ambulating well.. i was scared for using xs mobilization but guess it paid off... the Ortho surgeon is haappy with the results.. so is the patiient.. he can do his ADL's, toileting on a seat, climbing stairs and going places in a car..i've restricted him from full weight bearing until week 12..
ONLy thing i'm concerned now is the range.. i want that 5 extn lag gone and also flexn touching 135.. Is it possible.. help me on that..
any mistake i've done then do rectify me.. i'm a beginner so need guidance to turn into a pro..
Thanks a lot.. hope my experience helps..