Complex Tibial Plateau Fractures and Rehabilitation - Orthopedics

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I'm sorry to hear about your complex tibial plateau fracture and the challenges you're facing during your recovery. It's understandable to have concerns about your rehabilitation process, especially after such a significant injury. Let's address your questions one by one.

1. Range of Motion Recovery: Achieving a full range of motion in your knee after a tibial plateau fracture can be a gradual process. With consistent rehabilitation, it is possible to improve your knee flexion beyond the current 90-105 degrees. Physical therapy will play a crucial role in this. Your therapist may employ various techniques, including manual therapy, stretching exercises, and modalities like heat or ultrasound to promote healing and flexibility. It's essential to be patient and adhere to your rehabilitation program, as everyone's recovery timeline can differ based on the severity of the injury and individual healing rates.

2. Surgical Intervention for Adhesions: Regarding the possibility of surgery for joint adhesions (arthrofibrosis), this decision typically depends on the extent of the adhesions and how they are impacting your function. If conservative measures, such as physical therapy, do not yield satisfactory improvements in range of motion or if you experience significant pain and functional limitations, your orthopedic surgeon may consider arthroscopic surgery to release the adhesions. This is usually a last resort after exhausting non-surgical options.

3. Knee Extension Issues: The inability to fully extend your knee to 0 degrees can be concerning, as it may lead to compensatory movement patterns and potential long-term issues, such as joint instability or arthritis. To address this, your physical therapist may incorporate specific exercises aimed at improving knee extension. These could include heel slides, quadriceps sets, and stretching of the hamstrings and calf muscles. Additionally, using a knee extension brace or engaging in activities that promote extension under supervision may be beneficial. It's crucial to communicate with your therapist about your concerns so they can tailor your rehabilitation program accordingly.

4. Knee Swelling and Inflammation: The swelling and the inability to fully extend your knee could be attributed to a combination of factors, including inflammation from the injury, surgical trauma, and the presence of adhesions. It's common for swelling to persist for some time after surgery, especially in complex cases like yours. To manage swelling, consider using ice therapy, elevating your leg, and engaging in gentle range-of-motion exercises as tolerated. If the swelling does not improve or worsens, it would be wise to consult your physician to rule out any complications, such as infection or deep vein thrombosis (DVT).

In summary, your recovery from a complex tibial plateau fracture will require a comprehensive approach involving physical therapy, possibly surgical intervention for adhesions, and diligent management of swelling and knee extension. Stay in close communication with your healthcare team, and don't hesitate to express your concerns or ask for modifications to your rehabilitation plan. With time, dedication, and the right support, you can work towards regaining function and mobility in your knee.