Persistent Pain After Tibial Plateau Fracture: Possible Causes and Solutions

Five months after a tibial plateau fracture, there is still pain?

Hello Doctor: On January 11 of this year, I suffered an injury to my right tibial plateau due to work, which resulted in the anterior cruciate ligament being displaced.
I underwent surgery on January 17, where screws were used to fix the displaced tibial plateau back to the tibia, and a certain type of non-removable suspension device was installed at my own expense.
Since the surgery, the range of motion in my right leg has become comparable to that of my left leg.
However, whenever I attempt to fully extend my right leg, I experience severe pain at the junction of the tibia and femur (approximately where the tibial plateau was injured).
On a scale of 1 to 10, I would rate the pain at about 7.
Despite undergoing rehabilitation, there has been little improvement, and it has significantly affected my daily life and work performance.
During a follow-up visit, my attending physician assessed that the fracture site has healed well based on X-rays, but the ongoing severe pain is attributed to muscle atrophy.
However, even when not bearing weight and simply trying to extend my leg, I still experience intense pain at the tibial plateau area.
I would like to inquire, aside from muscle issues, what other potential factors could be contributing to the persistent pain? Thank you.

Physalis, 40~49 year old female. Ask Date: 2022/06/13

Dr. Shi Guozheng reply Orthopedics

The bone itself may also have a contusion.
After the ligaments are fixed back in place, it is necessary to test whether the stability is sufficient.
If there are any unstable conditions present, pain may also occur.
When ligaments are injured, in addition to the complete displacement of the bone due to the pulling, the ligaments themselves may also have slight tears.

Reply Date: 2022/06/13

More Info

Persistent pain after a tibial plateau fracture can be a complex issue, and it’s understandable that you’re seeking clarity on the causes and potential solutions. Given your situation, where you experienced a significant injury and subsequent surgery, there are several factors that could contribute to your ongoing pain.

Possible Causes of Persistent Pain
1. Soft Tissue Injury: The tibial plateau is surrounded by various soft tissues, including ligaments, tendons, and muscles. Even if the bone has healed well, damage to these soft tissues during the injury or surgery can lead to persistent pain. Scar tissue formation can also restrict movement and cause discomfort.

2. Joint Dysfunction: After a fracture, the knee joint may not function optimally. This can be due to stiffness, swelling, or changes in the way the joint moves. If the knee is unable to fully extend or flex, it can lead to pain during attempts to straighten the leg.

3. Muscle Atrophy: As your doctor mentioned, muscle atrophy can occur after a significant injury, especially if you’ve had limited mobility during recovery. Weakness in the muscles surrounding the knee can lead to instability and pain, particularly when trying to extend the leg.

4. Nerve Sensitivity: Following an injury, nerves in the area may become hypersensitive, leading to increased pain perception. This phenomenon, known as central sensitization, can cause pain even in the absence of ongoing injury or inflammation.

5. Post-Traumatic Arthritis: Depending on the severity of the fracture and the extent of joint involvement, there is a risk of developing post-traumatic arthritis. This condition can cause pain, swelling, and stiffness in the joint long after the initial injury has healed.

6. Hardware Issues: If you have internal fixation devices (like screws or plates), there is a possibility that they could be causing irritation to the surrounding tissues. While your X-rays may show that the fracture has healed, the presence of hardware can sometimes lead to discomfort.

Solutions and Recommendations
1. Physical Therapy: Continuing with physical therapy is crucial. A physical therapist can provide targeted exercises to strengthen the muscles around the knee, improve flexibility, and enhance overall function. They can also employ modalities such as ultrasound or electrical stimulation to help manage pain.

2. Pain Management: Discuss pain management options with your healthcare provider. This may include medications (like NSAIDs), corticosteroid injections, or alternative therapies such as acupuncture.

3. Gradual Return to Activity: It’s important to gradually increase your activity level. Avoid pushing through the pain, as this can exacerbate the issue. Instead, focus on gentle stretching and strengthening exercises that do not cause significant discomfort.

4. Follow-Up Imaging: If your pain persists, consider discussing further imaging studies, such as an MRI, to evaluate the soft tissues around the knee and rule out any complications that may not be visible on X-rays.

5. Consultation with a Specialist: If your pain continues to be severe and unresponsive to conservative measures, it may be beneficial to consult with an orthopedic specialist who focuses on knee injuries. They can provide a more in-depth evaluation and discuss potential surgical options if necessary.

6. Lifestyle Modifications: Incorporating low-impact activities, such as swimming or cycling, can help maintain fitness without putting excessive strain on the knee. Weight management may also reduce stress on the joint.

In summary, while the healing of the bone is a positive sign, persistent pain can arise from various factors, including soft tissue injuries, muscle atrophy, joint dysfunction, and nerve sensitivity. A comprehensive approach involving physical therapy, pain management, and possibly further evaluation will be essential in addressing your ongoing discomfort. Always keep an open line of communication with your healthcare provider to ensure that your recovery is on track and to explore all available options for pain relief and functional improvement.

Similar Q&A

Managing Post-Surgical Discomfort After Tibial Plateau Fracture Repair

Hello Dr. Wang, I apologize for the interruption. I sustained a comminuted fracture of the left tibial plateau in a car accident on July 10 and underwent emergency surgery. Six weeks post-surgery, the cast was removed, and I began rehabilitation. Currently, at 11 weeks post-surge...

Dr. Wang Jiacheng reply Orthopedics
Pain typically does not persist permanently; it usually diminishes gradually after the healing of wounds or fractures. Currently, you can apply heat or take some pain relievers to alleviate the discomfort. Additionally, undergoing rehabilitation therapy may provide some benefit.

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

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 o...

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 ...

Post-Surgery Concerns After Tibial Fracture: Pain and Limitations Explained

Hello, doctor! I suffered a distal tibial fracture due to a car accident, and the surgery involved minimally invasive open reduction and internal fixation. A steel rod was inserted from the tibial plateau and secured with four screws on the medial side of the leg. It has been fiv...

Dr. Chen Yongxue reply Orthopedics
Hello, based on your letter, your fracture should be at the proximal tibia rather than the distal tibia. 1. Proximal tibial fractures can range from very minor to highly comminuted, and the surgical approach and recovery can vary significantly. However, since the injury has alr...

Managing Complications After Tibial Plateau Fracture Surgery

After surgery on March 18, 2022, for a grade 2 tibial plateau fracture, there is a 2 cm wide depression in the steel plate. The lower leg is externally rotated by 9 degrees, and the femur is internally rotated by 4 degrees, resulting in overall joint tightness. The steel plate an...

Dr. Wang Shouji reply Orthopedics
Hello, if the dislocation is so evident, the likelihood of developing post-traumatic arthritis is very high. The chances of successfully realigning the fracture through another surgery are likely low. Some physicians may opt for osteotomy to shift the weight-bearing load of the k...