Managing Post-Tibial Plateau Fracture Complications: Treatment Options and Insights

Post-traumatic sequelae of lateral tibial plateau fracture collapse?

Dear Dr.
Shi,
I previously inquired about the issue of knee stiffness and tightness following a tibial plateau fracture (case #124076), and I appreciate your response.
You mentioned that intra-articular fractures can lead to tissue adhesion or fibrosis.
Could you please advise on how to treat and improve this condition? Is this issue contributing to the knee tightness and stiffness?
Additionally, when training the quadriceps while seated, I notice a continuous clicking sound at the knee joint each time I begin to bend the joint (at an angle of less than 50 degrees), and the same sound occurs when straightening it back to the same angle.
The physical therapist assessed the joint and indicated that it may be due to osteoarthritis.
Is this symptom indicative of post-traumatic osteoarthritis?
Currently, the affected limb has a self-funded interlocking plate and intramedullary nail, and bone grafting has been performed at the site of the plateau collapse.
Besides taking anti-inflammatory medication, are there any other proactive treatment options available (such as PRP or hyaluronic acid injections)?
Thank you once again.

grace, 50~59 year old female. Ask Date: 2017/06/24

Dr. Shi Guozheng reply Orthopedics

Joint adhesion after a fracture is common, and rehabilitation may help.
Post-traumatic arthritis can lead to cartilage wear, eventually resulting in arthritis.
You might consider trying PRP (platelet-rich plasma) therapy to see if it has any effect.
If it remains ineffective and the joint becomes deformed or experiences persistent pain, then joint replacement surgery may be necessary in the future.

Reply Date: 2017/06/24

More Info

Managing post-tibial plateau fractures can be quite challenging, especially when complications arise such as stiffness, pain, and the potential development of post-traumatic osteoarthritis. The tibial plateau is a critical area of the knee joint, and injuries here can lead to significant functional limitations if not managed properly.

Understanding the Complications
After a tibial plateau fracture, it is common for patients to experience stiffness and a sensation of tightness in the knee joint. This is often due to the formation of scar tissue or adhesions within the joint, which can occur as a result of the injury and subsequent surgical intervention. The fibrous tissue can restrict the normal range of motion, leading to a feeling of tightness and difficulty in bending the knee.

The "clicking" or "popping" sounds you describe when bending your knee, especially at angles less than 50 degrees, can be indicative of several issues. While it could be related to the presence of scar tissue, it may also suggest the development of post-traumatic osteoarthritis, which is characterized by the degeneration of cartilage and changes in the underlying bone structure. This condition can lead to joint pain, stiffness, and decreased mobility.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can guide you through exercises designed to improve flexibility, strength, and range of motion. Techniques such as manual therapy, stretching, and strengthening exercises for the quadriceps and hamstrings can be beneficial.
2. Joint Mobilization: Techniques such as joint mobilization can help in reducing stiffness and improving range of motion. This can be performed by a skilled physical therapist.

3. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. However, it’s essential to use these under the guidance of a healthcare provider.

4. Injections:
- Corticosteroid Injections: These can provide temporary relief from inflammation and pain.

- Hyaluronic Acid Injections: This treatment aims to lubricate the joint and may help in reducing pain and improving function.

- Platelet-Rich Plasma (PRP) Therapy: This involves injecting a concentration of platelets derived from your blood into the knee joint, which may promote healing and reduce inflammation.

5. Surgical Options: If conservative measures fail, surgical interventions may be considered. This could involve arthroscopic surgery to remove adhesions or loose bodies within the joint. In some cases, realignment of the knee joint may be necessary if there is significant malalignment or instability.

6. Bracing: Using a knee brace can provide support and stability, which may help in reducing pain during activities.

Long-Term Considerations
As you continue your recovery, it’s essential to monitor your symptoms closely. If you experience increased pain, swelling, or a decrease in your range of motion, it’s crucial to communicate this with your healthcare provider. Regular follow-ups and imaging studies may be necessary to assess the healing process and the integrity of the hardware used in your surgery.

In summary, managing post-tibial plateau fracture complications requires a multifaceted approach that includes physical therapy, medication, potential injections, and possibly surgical interventions. It’s vital to work closely with your healthcare team to develop a personalized treatment plan that addresses your specific needs and goals. With appropriate management, many patients can achieve significant improvements in function and quality of life.

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