Revision Surgery for Tibial Plateau Fractures: What to Expect

Secondary surgery for tibial fractures?

Hello, Doctor.
Thank you for your careful response last time.
I have some concerns to discuss during today's follow-up visit.
I was involved in a car accident on February 11, resulting in a comminuted fracture of the left tibial plateau along with a knee dislocation.
On February 12, I underwent surgery for the reduction and internal fixation of the left tibial plateau fracture, using a self-funded locked titanium alloy plate.
I have been very cautious this month, and the wound has mostly healed, with less pain at the fracture site.
I was hoping to hear good news today, such as "You're recovering well." However, after reviewing the X-rays, the doctor mentioned that there is some collapse of the plateau and that I will need another surgery to adjust it.
Although the doctor said it would only involve loosening the screws, adjusting the position, and then tightening the screws again, and that the incision wouldn't be as large as the first surgery, I am still quite worried.

I would like to ask the doctor the following questions:
1.
Is it common to perform a second surgery after this type of fracture?
2.
During my last follow-up (two weeks ago), I did not have an X-ray, but the doctor said I could practice bending my knee slightly.
Since I was unsure about the healing progress of the bone, I have been hesitant to bend it too much (not even close to 90 degrees).
Could bending my knee be a reason for the plateau collapse?
3.
Although it has only been a month since the fracture, and bones do not heal that quickly, I have made some progress in recovery over this month.
After undergoing the second surgery, will my bone healing progress reset to zero and start over?

mikalo, 30~39 year old female. Ask Date: 2019/03/11

Dr. Shi Guozheng reply Orthopedics

1.
It is uncommon but can sometimes be encountered.

2.
It is not that the fracture may have already existed and then gradually collapsed.

3.
The healing of bone grafts in this location occurs quickly because it primarily consists of cancellous bone (which heals much faster than cortical bone).

Reply Date: 2019/03/11

More Info

Understanding revision surgery for tibial plateau fractures can be a complex topic, especially given the nuances of your specific situation. Let’s break down your concerns and provide some clarity on what to expect.

1. Is it common to have a second surgery after this type of fracture?
Revision surgeries for tibial plateau fractures are not exceedingly common, but they do occur. The need for a second surgery often arises when there are complications such as malalignment, nonunion, or in your case, a slight collapse of the plateau. The tibial plateau is a critical weight-bearing surface in the knee, and any deformity can lead to long-term issues, including pain and arthritis. The fact that your surgeon is recommending a second procedure indicates that they are taking proactive steps to ensure proper healing and alignment. It’s essential to trust your surgeon’s judgment, as they have assessed your specific case and determined that this intervention is necessary to optimize your recovery.

2. Could bending the knee be the cause of the plateau collapse?
Bending the knee itself is unlikely to be the direct cause of the tibial plateau collapse. Instead, the collapse may have been a result of the initial injury or the healing process. When a fracture occurs, the surrounding bone and soft tissue can be affected, and sometimes the bone may not heal in the optimal position. The recommendation to practice bending is generally aimed at maintaining joint mobility and preventing stiffness, which is crucial in the recovery process. However, it’s understandable to be cautious about how much you push your range of motion, especially if you are unsure of the healing status. Always follow your surgeon’s guidance regarding rehabilitation exercises, as they will tailor them to your specific healing progress.

3. Will the second surgery reset my recovery progress?
While it may feel like a setback, undergoing a second surgery does not necessarily mean that your recovery timeline starts over from scratch. The healing process can be complex, and while the surgery may temporarily disrupt your progress, it is intended to correct the issues that could hinder your long-term recovery. After the revision surgery, your surgeon will likely provide a new rehabilitation plan that considers your previous progress and the adjustments made during the surgery. It’s important to remain optimistic and committed to your rehabilitation, as the goal of the revision is to enhance your overall recovery and restore function to your knee.

Additional Considerations
- Pain Management and Rehabilitation: Post-surgery, you may experience some pain and swelling, which is normal. Your healthcare team will provide guidance on pain management strategies and rehabilitation exercises. Adhering to these recommendations is crucial for optimal recovery.

- Monitoring for Complications: After any surgery, it’s essential to monitor for signs of complications, such as increased pain, swelling, or changes in mobility. If you notice any concerning symptoms, contact your healthcare provider promptly.

- Long-term Outlook: The long-term prognosis after tibial plateau fractures can vary based on several factors, including the severity of the fracture, the success of the surgical interventions, and your adherence to rehabilitation. Many patients can return to their previous level of activity, but it may take time and effort.

In conclusion, while the prospect of a second surgery can be daunting, it’s a step toward ensuring the best possible outcome for your knee. Trust in your medical team, stay proactive in your recovery, and maintain open communication with your healthcare providers. They are there to support you through this process and help you achieve the best possible recovery.

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