Tibial Plateau Fractures and Knee Pain After Surgery

Tibial plateau fracture with knee depression?

Hello, doctor.
I was involved in a car accident on March 18, 2017, which resulted in a fracture of the left tibial plateau along with a depression in the knee area.
I underwent surgery on March 19 at 7 PM, which lasted until 2 AM the following day.
In addition to the several tens of thousands of NT dollars spent on self-paid steel nails and plates for fixation, a piece of bone graft was also added to support the depressed area, and I stayed in the hospital for five days.
Now, it has been nine days since the surgery, and I am resting at home.
I wear a walking boot when moving around, but just now, with the assistance of my family to go to the bathroom, I stood up and, due to my disoriented state in the morning, I accidentally put full weight on the injured left foot while my healthy right foot was suspended, and this lasted for less than five seconds.
Should I return to the clinic promptly? Originally, my follow-up appointment was scheduled for two weeks after discharge.
Is it necessary to have an earlier check-up, or can I wait for the scheduled two-week follow-up? If something happens to the injured foot during this waiting period due to accidentally putting weight on it, should I return to the clinic immediately? Thank you.
Additionally, I would like to ask, during my hospital stay post-surgery, I never felt any presence of pain in the knee, but once I got home, it started to hurt seriously—swelling, sharp pain, and even a very intense aching sensation.
Is this aching a cause for concern? Thank you, doctor.

A Cai, 40~49 year old female. Ask Date: 2017/03/29

Dr. Shi Guozheng reply Orthopedics

After fracture surgery, fixation with steel nails is usually not that fragile, and you can wait until your follow-up appointment for the doctor to examine it.
If there is sudden displacement, it can cause severe pain, or pain due to joint deformity is inevitable and will take some time to improve.

Reply Date: 2017/03/29

More Info

Tibial plateau fractures are significant injuries that can lead to various complications, especially after surgical intervention. Your experience following the surgery for your tibial plateau fracture raises several important points regarding recovery, pain management, and the need for follow-up care.

Firstly, it is crucial to understand that the tibial plateau is the upper surface of the tibia (shinbone) that forms part of the knee joint. Injuries to this area can be complex, often involving not just the bone but also the surrounding ligaments, cartilage, and soft tissues. The surgical procedure you underwent, which involved the use of plates and screws along with bone grafting, is a common approach to stabilize the fracture and restore the anatomy of the knee.

Regarding your question about whether you need to return to the doctor after accidentally placing weight on your injured leg, it is advisable to err on the side of caution. If you experienced any immediate pain, instability, or unusual sensations in the knee after the incident, it would be prudent to contact your surgeon or healthcare provider for guidance. They may recommend an earlier follow-up appointment to assess the integrity of the surgical repair and ensure that no further damage has occurred.

As for the pain and discomfort you are experiencing now that you are home, it is not uncommon for patients to experience increased pain and swelling after surgery, especially when transitioning from a hospital setting to home. The pain you describe—sharp, aching, and sometimes accompanied by swelling—can be attributed to several factors:
1. Postoperative Inflammation: After surgery, the body initiates a healing response, which often includes inflammation. This can lead to swelling and pain as the body works to repair the injured tissues.

2. Weight Bearing: If you inadvertently placed weight on your injured leg, even for a brief moment, it could have caused additional stress on the healing tissues, leading to increased pain.

3. Muscle Weakness and Stiffness: After a period of immobilization, the muscles around the knee may weaken and stiffen, contributing to discomfort when you start to move or bear weight.

4. Nerve Sensitivity: Surgical procedures can sometimes irritate nearby nerves, leading to sensations of pain, tingling, or discomfort.

The "soreness" you mentioned is often a normal part of the healing process, but it is essential to monitor the severity of your symptoms. If the pain worsens, if you notice significant swelling, or if you experience any new symptoms such as fever or increased redness around the surgical site, you should seek medical attention promptly.

In terms of managing your pain and discomfort at home, consider the following strategies:
- Rest and Elevation: Keep your leg elevated to help reduce swelling. Rest is crucial for healing, so avoid putting weight on the injured leg unless advised by your doctor.

- Ice Therapy: Applying ice packs to the knee can help alleviate pain and reduce swelling. Make sure to wrap the ice pack in a cloth to protect your skin.

- Pain Management: Use prescribed pain medications as directed. Over-the-counter pain relievers may also be beneficial, but consult your doctor before taking any new medications.

- Physical Therapy: Once cleared by your doctor, engaging in physical therapy can help restore strength and range of motion to your knee.

In conclusion, while some pain and discomfort are expected after a tibial plateau fracture surgery, it is essential to remain vigilant about any changes in your symptoms. If you have any doubts or concerns, do not hesitate to reach out to your healthcare provider for advice. They can provide the best guidance tailored to your specific situation and ensure that your recovery proceeds as smoothly as possible.

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