Managing Tibial Plateau Fractures: Rehabilitation and Recovery Concerns

Fracture of the left tibial plateau and rehabilitation issues?

Hello Doctor, I was in a car accident on February 9th.
At that time, I was unaware that I had a fracture in the tibial plateau of my left knee.
I continued to stand for long hours at work until March 2nd, when I discovered the fracture.
The doctor mentioned that the bone had slightly collapsed, but fortunately, it was not severe enough to require surgery; however, there may be issues with wear and tear in the future.
Yesterday, on April 18th, I had an X-ray, and the doctor said there was some improvement, but I took pictures of the X-ray myself, and many of my friends and I feel that there hasn't been much change.

I need to return to work in May, where I will be standing for 9 hours a day.

1.
Can I engage in rehabilitation training for the muscle strength of my left leg while there is still a fracture?
2.
Is it not necessary for the fracture to completely heal before starting any training?
3.
Is there a possibility that the bone could collapse again if I return to work (standing for 9 hours) while still having a fracture? Should I continue to rest?
Regarding the issue of collapse, my attending physician mentioned that not everyone's situation is the same, but this response feels too vague and makes me very worried about worsening my condition.
With only ten days left before I have to return to work, I am concerned that I won't have enough time to fully recover.
Here are the X-ray images from mid-March: https://drive.google.com/file/d/0B9YF11IyWW5tdmdpM3pjXzhfZE0/view?usp=drivesdk and from April 18th: https://drive.google.com/file/d/0B9YF11IyWW5tdzVpNWRwY2pqSEU/view?usp=drivesdk.

Shèngdàn Jié, 20~29 year old female. Ask Date: 2017/04/19

Dr. Shi Guozheng reply Orthopedics

If there is no significant swelling near the joint, it is advisable to start moving the knee joint early, as there is a possibility that it may not bend well in the future.
After the bone screws are fixed, movement should be possible.

Reply Date: 2017/04/19

More Info

Managing a tibial plateau fracture can be a complex process, particularly when considering rehabilitation and recovery. Your situation, having sustained a fracture and experiencing some degree of bone depression, raises several important questions regarding your recovery and the potential for complications.

1. Can I start rehabilitation training for muscle strength while there is still a fracture?
Yes, you can begin rehabilitation exercises, but it is crucial to approach this cautiously. Rehabilitation typically focuses on gentle range-of-motion exercises and isometric strengthening exercises that do not place undue stress on the injured area. The goal is to maintain muscle strength and flexibility without exacerbating the fracture. Consult with your physical therapist or orthopedic surgeon to develop a tailored rehabilitation program that considers your specific condition.

2. Is it necessary for the fracture to be completely healed before starting training?
While complete healing is ideal, it is not always necessary to wait until the fracture is fully healed to begin rehabilitation. However, the type and intensity of exercises should be modified based on the healing status of the fracture. Engaging in low-impact activities that do not place excessive load on the tibial plateau can be beneficial. Your healthcare provider will guide you on when and how to safely progress your rehabilitation.

3. Will returning to work (standing for 9 hours) risk further depression of the bone?
Returning to a job that requires prolonged standing can indeed pose risks, especially if the fracture has not fully healed. Standing for extended periods can increase stress on the tibial plateau, potentially leading to further complications such as worsening of the fracture or additional pain. It is advisable to discuss your work situation with your doctor. They may recommend a gradual return to work or suggest modifications, such as taking frequent breaks to sit down or using supportive footwear.

4. Concerns about bone depression and the variability of recovery:
Your concern about the potential for further depression of the bone is valid. Tibial plateau fractures can lead to complications such as post-traumatic arthritis if not managed properly. The variability in recovery is due to individual differences in healing capacity, the extent of the fracture, and the presence of any underlying conditions. Regular follow-ups with your orthopedic surgeon are essential to monitor the healing process through X-rays and clinical assessments.

5. What to do if you feel uncertain about your recovery?
If you feel that your recovery is not progressing as expected, or if you have concerns about the healing process, it is important to communicate openly with your healthcare provider. They can provide reassurance, adjust your rehabilitation plan, or consider further imaging studies to assess the healing status of your fracture.

In summary, while you can begin rehabilitation exercises with caution, it is essential to prioritize your safety and recovery. Engage in discussions with your healthcare team to ensure that your rehabilitation plan aligns with your healing progress and work requirements. Taking a proactive approach to your recovery will help you achieve the best possible outcome while minimizing the risk of complications.

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