Knee Issues After Tibial Fracture: Recovery and Rehabilitation Tips

Knee issues following a tibial fracture?

Hello, I had a car accident on October 1st, resulting in an open fracture of the tibia and fibula in my right lower leg.
That night, I underwent surgery for intramedullary nailing of the tibia.
I was able to get out of bed on October 3rd and was discharged on October 4th.
Approximately 30 days later, I can walk slowly without crutches, but occasionally when walking, my straight knee suddenly buckles as if it has given out, causing me to lose my balance.
Is this normal? What can I do to improve this? Additionally, is it appropriate for me to climb stairs at this time? When I attempt to climb stairs normally while holding onto the handrail (not leading with my good leg and taking two steps at a time), my knee experiences some pain.
Is this also normal? Should I continue practicing climbing stairs, or should I wait for a longer recovery period before starting? Thank you.

Mm, 30~39 year old female. Ask Date: 2017/11/18

Dr. Shi Guozheng reply Orthopedics

Surgical treatment for tibial fractures often involves the use of intramedullary nails, with the entry point located at the proximal tibia near the knee joint.
This typically requires an incision through the patellar tendon to insert the nail.
Occasionally, this may irritate the patellar tendon at the proximal tibia, leading to your symptoms.
Focusing on strengthening exercises and improving knee extension and flexion will generally lead to improvement over time.

Reply Date: 2017/11/18

More Info

After experiencing a tibial fracture, particularly an open fracture that required surgical intervention, it is common to have concerns about recovery and rehabilitation. Your situation, where you had surgery on October 1st and were able to start walking with assistance shortly thereafter, indicates that you are on the right track. However, the symptoms you describe, such as your knee feeling unstable or "giving way," are not uncommon in the early stages of recovery.

Understanding Your Symptoms
1. Knee Instability: The sensation of your knee buckling or feeling unstable can be attributed to several factors. After a significant injury like a tibial fracture, the surrounding muscles, ligaments, and tendons may weaken or become stiff due to disuse. This can lead to a lack of proprioception (the body's ability to sense its position in space), which is crucial for maintaining balance and stability.
2. Pain During Stair Climbing: Experiencing pain in your knee while climbing stairs is also a common issue during recovery. The knee joint undergoes significant stress during activities like stair climbing, which can exacerbate discomfort, especially if the muscles around the knee are not yet fully rehabilitated.

Recommendations for Improvement
1. Physical Therapy: It is highly advisable to engage in a structured physical therapy program. A physical therapist can provide you with exercises tailored to your specific needs, focusing on strengthening the muscles around your knee and improving your range of motion. This will help in stabilizing the knee joint and reducing the sensation of it giving way.

2. Gradual Progression: When it comes to activities like stair climbing, it is essential to listen to your body. If you experience pain, it may be a sign that you need to strengthen your knee further before attempting more challenging movements. Start with simple exercises that promote knee stability, such as straight leg raises, heel slides, and gentle range-of-motion exercises.

3. Balance Training: Incorporating balance exercises into your routine can significantly help with knee stability. Simple activities like standing on one leg or using a balance board can enhance your proprioception and strengthen the stabilizing muscles around your knee.

4. Ice and Rest: If you experience pain after activities, applying ice to the knee can help reduce inflammation and discomfort. Ensure you are allowing adequate rest between exercises to prevent overuse injuries.

5. Stair Climbing Technique: When you feel ready to attempt stair climbing again, focus on using the handrail for support. Start with one step at a time, and consider leading with your stronger leg if it feels more comfortable. If pain persists, it may be beneficial to wait a bit longer before resuming this activity.

When to Seek Further Help
If your knee instability continues or worsens, or if you experience significant pain that limits your daily activities, it is crucial to consult your orthopedic surgeon or a physical therapist. They can assess your knee's stability and function and determine if further intervention is necessary.

Conclusion
Recovery from a tibial fracture is a gradual process that requires patience and diligence. Engaging in a comprehensive rehabilitation program, focusing on strength, stability, and balance, will be key to regaining full function of your knee. Remember to listen to your body and progress at a pace that feels comfortable for you. With time and appropriate rehabilitation, you should see improvement in your knee stability and overall mobility.

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