Post-Car Accident: Managing Left Tibial Plateau Fracture Recovery Issues

The car accident resulted in a left tibial plateau fracture. After the cast was removed, there is swelling when bending the knee?

I was in a car accident, and the doctor diagnosed me with a closed fracture of the left tibial plateau.
They applied a cast for immobilization, stating that it was not a complete fracture and only the lower part needed to be casted up to the thigh.
Now that I have removed the cast, my thigh has atrophied, and I am unable to bend it.
When I try to bend my knee, it becomes swollen, and there is a bulge of tissue.
Why is this happening?

Wu Bo-xiu, 30~39 year old female. Ask Date: 2016/10/15

Dr. Ye Qingnian reply Orthopedics

A closed fracture of the left tibial plateau can lead to an increased risk of knee joint degeneration in the future.
It is important to avoid activities such as hiking and lifting heavy objects.
After casting, there is a high risk of muscle atrophy and limited range of motion.
Please focus on rehabilitation, consult with a rehabilitation specialist, and regularly elevate your leg and practice knee flexion at home to prevent future functional abnormalities.
If you experience swelling in the knee during flexion, it may be necessary to visit an orthopedic outpatient clinic for evaluation by an orthopedic surgeon.

Reply Date: 2016/10/15

More Info

Post-car accident recovery from a left tibial plateau fracture can be a complex process, especially when complications arise such as muscle atrophy and swelling in the knee. It’s essential to understand the nature of your injury and the recovery process to manage your symptoms effectively.

Understanding Your Injury
A tibial plateau fracture involves a break in the upper part of the tibia (shinbone) that forms part of the knee joint. These fractures can vary in severity, and while you mentioned that your doctor indicated it was a closed fracture and did not require full immobilization, the recovery can still be challenging. The use of a cast or splint is common to stabilize the bone during the healing process, but this immobilization can lead to muscle atrophy and stiffness in the knee joint.

Muscle Atrophy and Knee Swelling
1. Muscle Atrophy: After a period of immobilization, it is common for the muscles around the injured area to weaken and shrink due to disuse. This is particularly evident in the thigh muscles (quadriceps) when the leg is kept in a cast. Muscle atrophy can lead to decreased strength and range of motion, making it difficult to bend the knee.

2. Knee Swelling: Swelling in the knee after removing a cast can be attributed to several factors, including inflammation from the injury, fluid accumulation, and the body’s healing response. The "bump" you mentioned could be related to swelling or possibly a condition known as a Baker's cyst, which is a fluid-filled sac that can develop behind the knee.

Recommendations for Recovery
1. Physical Therapy: Engaging in physical therapy is crucial for regaining strength and mobility in your knee. A physical therapist can provide exercises tailored to your condition, focusing on gradually increasing the range of motion and strength in your leg. They may start with gentle range-of-motion exercises and progress to strengthening exercises as tolerated.

2. Ice and Elevation: To manage swelling, applying ice to the knee for 15-20 minutes several times a day can help reduce inflammation. Elevating your leg can also assist in minimizing swelling.

3. Gradual Weight Bearing: Follow your doctor’s advice regarding weight-bearing activities. Gradually increasing the weight you place on your leg can help strengthen the muscles and improve function.
4. Compression: Using a compression wrap or knee brace can help manage swelling and provide support as you begin to use your knee more actively.

5. Monitoring Symptoms: Keep an eye on your symptoms. If the swelling worsens, or if you experience significant pain, redness, or warmth around the knee, it’s important to consult your doctor. These could be signs of complications such as infection or deep vein thrombosis (DVT).

When to Seek Further Medical Attention
If you continue to experience significant swelling, pain, or if you notice any unusual changes in your knee, it’s essential to follow up with your healthcare provider. They may want to perform imaging studies, such as an X-ray or MRI, to assess the healing of the fracture and rule out any complications.

Conclusion
Recovering from a tibial plateau fracture requires patience and a structured rehabilitation plan. While it’s normal to experience some challenges such as muscle atrophy and swelling, proactive management through physical therapy, proper care, and monitoring can significantly enhance your recovery process. Always communicate openly with your healthcare team about your concerns and progress to ensure the best possible outcome.

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