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

Post-operative questions regarding tibial fracture?

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 five months post-surgery, and I would like to ask if the pain around the knee and some limitations in daily activities are due to postoperative sequelae.
Is there any damage to the tibial plateau? During physical therapy recently, I noticed a popping sound when the patella was displaced; could this also be a result of the surgery? (I confirmed there were no injuries prior to the surgery, but I did hear a popping sound during rehabilitation.) The area of the tibial fracture still experiences pain; should I get an X-ray to check for malunion? I have quite a few questions...
(I have researched many related topics but have not found cases regarding internal fixation from the tibial plateau.) I apologize for the many inquiries and hope you can respond patiently.

Yun Yun, 20~29 year old female. Ask Date: 2023/12/04

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 already occurred, the focus should be on minimizing future complications.

2.
There are many causes of knee pain; more commonly, it is not arthritis but rather inflammation of the collateral ligaments or scar tissue pain from previous surgeries.
A physician's physical examination is necessary to assess the pain points in order to determine the cause.

3.
Is there any damage to the tibial plateau? In the case of a proximal tibial fracture, the tibial plateau can indeed be fractured, but the extent may vary.

4.
During physical therapy, it was noted that the patella makes a cracking sound when displaced.
Is this also a result of the surgery? It should not be; the surgery for the tibial fracture does not affect the movement of the patella, so another cause should be investigated.

5.
There is still pain at the fracture site; should I get an X-ray to check for nonunion? Generally, fractures take about three months to heal.
If you are currently able to move without crutches, it is unlikely to be a nonunion issue.
Please consult your attending physician for further evaluation.
Thank you.

Reply Date: 2023/12/04

More Info

After a tibial fracture surgery, particularly one involving minimally invasive open reduction and internal fixation (ORIF), it is not uncommon for patients to experience ongoing pain and limitations in mobility. Your concerns about knee pain and functional limitations five months post-surgery are valid and warrant a thorough discussion.

Firstly, the pain you are experiencing around the knee could be attributed to several factors. One possibility is that the surgical procedure itself can lead to soft tissue trauma, which may result in inflammation and pain as the body heals. The presence of hardware, such as screws and plates, can also contribute to discomfort, especially if they are in close proximity to the knee joint or if there is irritation of the surrounding soft tissues.

Regarding the "clicking" or "popping" sounds you hear during physical therapy, this could be related to several factors. It might be due to the movement of tendons or ligaments over the bony prominences of the knee or the presence of air bubbles in the joint fluid, which can create a popping sound when they burst. However, if these sounds are accompanied by pain or instability, it may indicate an underlying issue that should be evaluated further.

The tibial plateau is a critical area for weight-bearing and stability of the knee joint. If there was any damage to the tibial plateau during the fracture or the surgical procedure, it could lead to ongoing pain and functional limitations. It is essential to monitor the healing process closely, as complications such as nonunion (failure of the bone to heal properly) or malunion (healing in an incorrect position) can occur, particularly in complex fractures.

Given that you are still experiencing pain at the fracture site, it would be prudent to follow up with your orthopedic surgeon. An X-ray can help assess the healing status of the fracture and determine whether there are any complications such as hardware failure or malalignment. If the X-ray shows that the fracture is healing well, but you still have pain, further imaging such as an MRI might be necessary to evaluate the soft tissues around the knee, including ligaments and cartilage.

In terms of rehabilitation, it is crucial to follow a structured physical therapy program tailored to your specific needs. Gradual progression in weight-bearing activities and range of motion exercises is essential for recovery. If you are experiencing significant pain during rehabilitation, it may be necessary to adjust your therapy regimen or explore additional pain management strategies.

In summary, ongoing pain and limitations after tibial fracture surgery can be due to various factors, including soft tissue healing, hardware irritation, or potential complications related to the fracture itself. It is essential to maintain open communication with your healthcare provider, adhere to follow-up appointments, and seek further evaluation if your symptoms persist or worsen. Your recovery is a process, and addressing these concerns will help ensure the best possible outcome.

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