Post-Tibial Fracture Surgery: Common Concerns and Rehabilitation Tips

Post-operative inquiries regarding tibial fractures?

Hello Doctor: I was involved in a car accident on January 24 of this year, resulting in a comminuted fracture of my left knee and lower leg.
I subsequently underwent tibial plate surgery (on both sides), with three surgeries in total (one external fixation and two plate fixation surgeries).
However, on March 2, one of the wounds became infected, leading to a debridement surgery for that wound.
I completed my final suture removal on March 22, and the doctor said I can now begin rehabilitation therapy.
I have a few questions for the doctor.

1.
After the surgery, my left foot has been persistently numb.
Is this normal? The doctor mentioned that it might be due to peroneal nerve damage.

2.
Currently, I am unable to bend my left big toe, and when I try to bend it intentionally, it shakes.
I also cannot dorsiflex my foot.
Should I force myself to continue working on this every day?
3.
The doctor said that the rehabilitation angle for my left knee can reach 95 degrees, but my current rehabilitation goal is set at 30 degrees.
However, when I try to achieve 15 degrees, my knee feels very tight.
Is this normal? Are there any other supportive methods you would recommend to help with knee flexion?
4.
Are there any medical treatments or methods that can assist with nerve damage?
5.
Is there a possibility that the wound from the debridement surgery will become inflamed again?
Thank you very much for your assistance, Doctor.

Mr. Hsu, 40~49 year old female. Ask Date: 2023/03/26

Dr. Shi Guozheng reply Orthopedics

1.
What the doctor said may be correct.

2.
It is important to continue rehabilitation to allow for gradual recovery.

3.
Improvement may occur gradually due to swelling; performing rehabilitation slowly can help.
Taking anti-inflammatory medications may make rehabilitation easier.

4.
Taking vitamin B12 may help improve the situation, and we should also wait for the nerves to repair themselves.

5.
There is a possibility of inflammation; comminuted fractures can decrease resistance to bacteria.

Reply Date: 2023/03/26

More Info

Post-tibial fracture surgery rehabilitation can be a challenging journey, especially after multiple surgeries and complications such as wound infections. Here are some insights and recommendations based on your concerns:
1. Numbness in the Foot: It is not uncommon to experience numbness or tingling in the foot following tibial fracture surgery, particularly if the peroneal nerve (a branch of the sciatic nerve) has been affected. Nerve injuries can occur due to swelling, direct trauma, or surgical manipulation. While some degree of numbness may improve over time, it is essential to monitor this symptom. If the numbness persists or worsens, consult your physician or a neurologist for further evaluation. They may recommend nerve conduction studies to assess the extent of the injury and potential recovery.

2. Limited Mobility in the Big Toe: The inability to bend the big toe and the shaking when attempting to do so may indicate stiffness or weakness in the muscles and tendons controlling toe movement. It is crucial to engage in gentle range-of-motion exercises as tolerated, but you should do so under the guidance of a physical therapist. They can provide tailored exercises to help improve flexibility and strength without causing excessive strain. Consistency is key; performing these exercises daily can gradually enhance mobility.

3. Knee Flexion Limitations: Achieving knee flexion can be particularly challenging after surgery. The tightness you feel at 15 degrees is not unusual, especially in the early stages of rehabilitation. It is essential to gradually increase your range of motion, but pushing too hard can lead to pain and setbacks. Your physical therapist can guide you through specific exercises, such as heel slides and gentle stretching, to help improve your knee flexion. Additionally, modalities like heat therapy before exercises and cold therapy afterward can help manage pain and stiffness.

4. Nerve Injury Recovery: Unfortunately, there is no guaranteed medical treatment to expedite nerve healing. However, some therapies may support recovery. Physical therapy focusing on nerve gliding exercises can help improve nerve function. In some cases, medications such as gabapentin or pregabalin may be prescribed to manage neuropathic pain. If significant nerve damage is suspected, surgical options such as nerve repair or grafting may be considered, but this is typically a last resort.

5. Risk of Wound Infection Recurrence: After a debridement surgery, the risk of infection can still be present, especially if there are underlying issues such as poor circulation or diabetes. It is crucial to keep the wound clean and dry, follow your surgeon's post-operative care instructions, and attend all follow-up appointments. If you notice any signs of infection—such as increased redness, swelling, warmth, or discharge—contact your healthcare provider immediately.

In summary, your recovery from tibial fracture surgery will require patience and diligence. Regular follow-ups with your orthopedic surgeon and physical therapist are essential to monitor your progress and adjust your rehabilitation plan as needed. Engaging in a structured rehabilitation program, focusing on both mobility and strength, will be vital in regaining function in your leg and foot. Remember, every patient's recovery journey is unique, so it's important to listen to your body and communicate openly with your healthcare team about your concerns and progress.

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