Sensory Loss After Tibial Plateau Fracture Surgery

There is no sensation at all in the skin over the surgical site of the tibial plateau fracture?

Hello, Doctor.
I returned to the outpatient clinic yesterday and had my cast removed.
Regarding the black spots and the broken lines that I was confused about, I asked the doctor, and he said those are marks from the steel pins used for external fixation during the surgery.
After having the cast removed yesterday, I felt much more comfortable and relaxed.
The doctor also said I could take a shower and get my skin wet.
However, when I got home, I noticed that along the approximately 24 cm surgical incision, the skin near the tibial plateau has no sensation at all when touched, but when pressed firmly, I can still feel some sensation in the underlying tissue; it seems that the skin and the deeper tissue have different levels of sensation.
I compared it to the same area on my other leg and found that it also doesn't have much sensation.

Doctor, I had the cast on for a month (it was an L-shaped cast, covering only half of my leg and secured with bandages).
During this month, I always had a large pillow under my leg while sitting or lying down, and before going to sleep, I often felt tingling in the areas that currently have no sensation, as well as in other connected areas.
After a while, the tingling sensation would go away, and in the morning, I didn't feel any significant discomfort.

Will this gradually improve as the swelling goes down? I have attached a link to a photo of my injured leg after the cast was removed; the areas circled with a colored pen indicate where my skin has no complete sensation, while the other parts of the surgical incision still have some sensitivity.
https://imgur.com/gallery/xZ19N Thank you, Doctor, for patiently answering my many questions and helping me a lot, as well as calming my anxious mind.
I truly appreciate you.
Thank you.

A Cai, 30~39 year old female. Ask Date: 2017/04/20

Dr. Shi Guozheng reply Orthopedics

Near the surgical wound where there is a distribution of nerves in the skin, the epidermal nerves may be cut by the scalpel, leading to a period of numbness.
Over time, the nerves can gradually regenerate, and there is a possibility of slow recovery.

Reply Date: 2017/04/20

More Info

After undergoing surgery for a tibial plateau fracture, it is not uncommon to experience sensory loss in the area surrounding the surgical site. This can be concerning for many patients, especially when they notice a lack of sensation in the skin overlying the incision. Here’s a detailed explanation of what you might be experiencing and what to expect moving forward.

1. Understanding Sensory Loss: The sensory loss you are experiencing could be attributed to several factors. During surgery, nerves can be stretched or compressed, leading to temporary or, in some cases, permanent changes in sensation. The tibial plateau is located near several important nerves, including the peroneal nerve, which can be affected during surgical procedures. The fact that you can still feel pressure when pressing down on the underlying tissues suggests that the deeper structures are intact, but the superficial sensory nerves may have been affected.

2. Post-Surgical Changes: After a month in a cast, it is normal for the skin and underlying tissues to undergo changes. The immobilization can lead to decreased blood flow and nerve function in the area, contributing to the sensory loss. Additionally, the presence of swelling or bruising can also impact sensation. The feeling of numbness or tingling (paresthesia) that you described, especially when elevating your leg, is often related to nerve compression or irritation.

3. Recovery Timeline: Sensory recovery can vary significantly from person to person. In many cases, as swelling decreases and blood flow improves, sensation may gradually return. This process can take weeks to months, depending on the extent of nerve involvement and the healing process of the surrounding tissues. It is essential to monitor your symptoms and report any significant changes to your physician.

4. Physical Therapy and Rehabilitation: Engaging in physical therapy can be beneficial in your recovery. A physical therapist can guide you through exercises that promote circulation, improve range of motion, and strengthen the muscles around the knee. This can help alleviate some of the symptoms you are experiencing and may also aid in the recovery of sensation.

5. When to Seek Further Evaluation: If you notice that the sensory loss is not improving over time or if you experience additional symptoms such as severe pain, weakness, or changes in color or temperature of the skin, it is crucial to follow up with your orthopedic surgeon or a neurologist. They may recommend further imaging studies or nerve conduction studies to assess the extent of any nerve damage.

6. Self-Care Measures: In the meantime, you can take some self-care measures to promote healing. Keeping the leg elevated can help reduce swelling, and gentle massage around the area (if tolerated) may stimulate blood flow. Additionally, ensure that you are following any post-operative care instructions provided by your surgeon, including wound care and activity restrictions.

In summary, while sensory loss after tibial plateau fracture surgery can be concerning, it is often a temporary condition that improves with time and appropriate care. Regular follow-ups with your healthcare provider, along with physical therapy, can significantly aid in your recovery. If you have any further questions or concerns, do not hesitate to reach out to your healthcare team for guidance.

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