Post-Surgery Knee Issues After Tibial Plateau Fracture: What to Expect

After tibial plateau surgery, the knee may encounter several issues?

Hello Doctor, I underwent surgery for a comminuted fracture of the right tibial plateau about five months ago.
After the surgery, I was in a cast for approximately six weeks, and after removing the cast, I wore a knee brace for about a month.
Currently, I can flex my knee to 120 degrees and extend my leg on the bed to nearly 0 degrees.
My attending physician has advised that I can go without the knee brace at home, but should wear it when going out.
I can now bear weight on the injured leg at about 30%.
I am encountering several issues:
1.
When my leg is extended on the bed, I feel no discomfort.
However, if I try to lift my bent leg while suspended, I encounter a barrier at about 15 degrees, accompanied by pain and trembling.
I struggle to fully extend it but cannot do so.
2.
When my leg is extended on the bed, if I try to maintain that position while lifting my leg off the bed, my lower leg tends to drop by about 5 to 10 degrees, making it impossible to keep it fully extended.
3.
After lifting my leg straight, if I attempt to bend my knee, I also face a barrier.
The knee gets stuck at about 15 degrees, causing pain, as if a misaligned catch is blocking it.
With some effort and discomfort, I can push the misaligned catch back into position, allowing me to bend my knee normally afterward without further discomfort.
4.
During my second follow-up appointment after the cast was removed, the doctor mentioned that the screws in the plate were misaligned but did not specify any necessary actions.
Will leaving the screws misaligned affect my recovery?
5.
When standing, my injured leg seems unable to fully extend compared to my healthy leg, feeling about 5 degrees short.
I can feel the plate inserted during surgery through the skin, which is slightly prominent, though not very noticeable unless closely examined.
Could this be related?
6.
The skin on the anterior side of my knee feels strange.
Although it appears normal externally, the sensitivity is diminished, especially when I touch it with ice, where I feel nothing.
This lack of sensation extends from the front of the knee down the tibia to about five centimeters above the ankle, with the sensation improving as I approach the ankle.
Below the ankle, the skin feels completely normal.
Could this unusual sensation be due to the slightly prominent plate?
I would like to ask if these conditions are normal and if they will improve over time.
Are there any rehabilitation exercises that could help? I hope you can provide some answers.
Thank you.

cc, 20~29 year old female. Ask Date: 2022/08/08

Dr. Shi Guozheng reply Orthopedics

1.
Misalignment of the steel plate screws may lead to unstable fixation and could affect bone healing.

2.
Abnormal skin sensation may be related to the injury or surgery and should be monitored for a period of time.

3.
Poor range of motion in the joints is commonly encountered after a tibial plateau fracture and can only be gradually improved through rehabilitation.

4.
Insufficient muscle strength in the thigh post-surgery can also impact joint mobility.

5.
You must continue to follow up at the outpatient clinic.
If you have any questions, your attending physician will have the best understanding, and regular follow-up X-rays are necessary to assess the healing of the fracture.

Reply Date: 2022/08/08

More Info

After undergoing surgery for a tibial plateau fracture, it is common to experience a range of issues and concerns as you navigate the recovery process. Based on your description, you are approximately five months post-surgery, and while you have made significant progress, there are still some challenges you are facing. Let’s address your concerns one by one.

1. Pain and Stiffness When Extending the Leg: It is not uncommon to experience pain and stiffness when trying to extend your leg, especially when it is in a suspended position. This could be due to several factors, including scar tissue formation, muscle tightness, or even joint stiffness. The sensation of your knee "catching" at a certain angle may indicate that there is some mechanical blockage or tightness in the surrounding soft tissues. Engaging in physical therapy focused on stretching and strengthening exercises can help improve your range of motion and alleviate some of the discomfort.

2. Difficulty Maintaining a Straight Leg: The inability to maintain a fully extended leg when lifted off the bed may be related to muscle weakness, particularly in the quadriceps. After a significant injury and surgery, muscle atrophy can occur, leading to decreased strength. Strengthening exercises, particularly for the quadriceps, can help improve your ability to hold your leg straight. Your physical therapist can provide you with specific exercises tailored to your needs.

3. Challenges with Flexion and Pain: The pain and difficulty you experience when trying to bend your knee may be indicative of residual swelling or tightness in the joint. It is essential to continue with your rehabilitation exercises, focusing on both flexion and extension. Gradual progression in your range of motion exercises, combined with modalities such as heat or ice, may help reduce pain and improve mobility.

4. Screw Misalignment: If your doctor mentioned that the screws are misaligned but did not recommend any further intervention, it may suggest that the misalignment is not significantly affecting your recovery. However, it is crucial to follow up with your orthopedic surgeon to monitor the situation. In some cases, misaligned hardware can lead to complications, such as irritation or discomfort, but many patients recover well without needing additional surgery.

5. Difference in Extension Between Legs: A slight difference in the ability to extend your injured leg compared to your healthy leg can be expected during the recovery phase. This discrepancy may be due to muscle weakness, joint stiffness, or even psychological factors related to fear of pain or re-injury. As you continue to rehabilitate and strengthen the affected leg, this difference should gradually diminish.

6. Altered Sensation in the Skin: The altered sensation in the skin over the surgical site is not uncommon following knee surgery. This could be due to nerve irritation or damage during the procedure, which may take time to resolve. The fact that sensation is returning as you move further away from the surgical site is a positive sign. Over time, many patients experience improvement in sensory function, but it can take several months for full recovery.

In summary, while some of the issues you are experiencing are common post-surgical concerns, it is essential to maintain open communication with your healthcare provider. Regular follow-ups and physical therapy are crucial for addressing these challenges. Your rehabilitation program should include a combination of stretching, strengthening, and functional exercises to help restore your knee's range of motion and strength. Additionally, consider discussing your concerns about the screw alignment and altered sensation with your orthopedic surgeon to ensure that your recovery is on track and to address any potential complications. With time, patience, and appropriate rehabilitation, many patients can achieve significant improvements in function and quality of life after a tibial plateau fracture.

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