Impact of Custom Steel Plate on Knee Flexion After Tibial Plateau Fracture

Medial tibial plateau fracture

I would like to ask if the installation of a self-funded steel plate on the inner posterior tibial plateau of the right knee will affect the flexion angle of the knee.
Currently, after the installation, I am unable to flex my knee to 105 degrees like the normal leg, and can only maintain a flexion of 90 degrees.

1.
Will this affect my standing posture?
2.
I asked the doctor, and he said I should try to bend it as much as possible, but no matter how I try, I cannot increase the angle.
I would like to know if removing the fixed plate could allow for an increase in the angle.

3.
It has been six weeks, and I can still see the fracture line; is this normal?
4.
The fracture has not yet healed.
If the plate is removed, is there room for adjusting the angle? Would it be feasible to switch to a cast for stabilization afterward?

Jerry, 40~49 year old female. Ask Date: 2022/05/07

Dr. Shi Guozheng reply Orthopedics

1.
Factors that may be affected.
2.
You can seek assistance from the rehabilitation department; it is important to start rehabilitation as soon as possible to potentially increase the angle of curvature.
3.
It is still considered normal for the fracture line to gradually disappear after six months.
4.
The metal plate must not be removed before the fracture has healed; the plate at the fracture site will not significantly affect the bending of the knee joint.

Reply Date: 2022/05/07

More Info

The impact of a custom steel plate on knee flexion after a tibial plateau fracture is a significant concern for many patients recovering from such injuries. The tibial plateau is a critical area of the knee joint, and any surgical intervention, such as the placement of a steel plate, can influence the range of motion and overall function of the knee.

1. Impact on Standing Posture: The inability to flex the knee beyond 90 degrees can indeed affect your standing posture. A normal range of motion for knee flexion is typically between 0 degrees (full extension) and about 135 degrees (full flexion). If you are limited to 90 degrees, it may lead to compensatory mechanisms in your gait and posture, potentially causing discomfort or strain in other areas, such as the hips or lower back. Over time, this can lead to secondary issues, including muscle imbalances or joint pain.

2. Flexion Improvement Post-Plate Removal: As for whether removing the steel plate could improve your knee flexion, it is essential to understand that the plate itself is not the only factor affecting your range of motion. Scar tissue formation, muscle tightness, and joint stiffness can also play significant roles. If the plate is removed and the underlying soft tissue and joint mechanics are addressed through physical therapy, there is a possibility that your knee flexion could improve. However, this is not guaranteed and would depend on various factors, including the extent of your rehabilitation efforts.

3. Visibility of Fracture Line: It is not uncommon to still see a fracture line six weeks post-injury. Bone healing can vary significantly from person to person, and while some may see complete healing in a few weeks, others may take several months. Typically, it can take anywhere from six weeks to several months for a fracture to heal sufficiently, and the visibility of the fracture line can persist during this time. Regular follow-ups with your orthopedic surgeon are crucial to monitor the healing process.

4. Removing the Plate and Using a Cast: If your fracture has not yet healed, removing the steel plate is generally not advisable. The plate provides stability to the fracture site, and removing it prematurely could lead to complications, including malunion or nonunion of the fracture. If there are concerns about the angle of flexion, your orthopedic surgeon may suggest alternative rehabilitation strategies rather than removing the plate. Using a cast might be an option, but this would depend on the specific circumstances of your injury and the surgeon's assessment.

In summary, the placement of a custom steel plate can impact knee flexion, and while it may limit your range of motion initially, rehabilitation plays a crucial role in recovery. It is essential to engage in a structured physical therapy program to improve flexibility and strength in the knee joint. Always consult with your orthopedic surgeon regarding any concerns about your recovery, the status of your fracture, and the best course of action moving forward. They can provide personalized advice based on your specific situation and help you set realistic goals for your rehabilitation.

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