Rehabilitation Challenges After Tibial Plateau Fracture: Seeking Guidance - Orthopedics

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Rehabilitation issues following a right tibial plateau fracture?


Dear Doctor,
I was involved in a car accident on February 28 of this year, which resulted in a fracture of the right tibial plateau and an avulsion fracture of the lateral ligament.
I underwent internal fixation surgery for fracture reduction on February 29, followed by hospitalization, casting, and rest.
On April 11, I returned for a follow-up appointment and had the cast removed.
I have been doing knee flexion exercises at home, but I can only bend my knee to about 60 degrees.
When I try to bend it further, I feel tightness and some pain, and my progress in bending is quite slow.
Therefore, I would like to ask if I need to see a rehabilitation specialist at the hospital, or if there are other methods to expedite my rehabilitation.
Thank you for your response.

Wade, 20~29 year old female. Ask Date: 2012/05/10

Dr. Li Wenlin reply Orthopedics


After a knee joint fracture, the degree of fracture reduction can affect the range of motion of the joint.
Since you have been rehabilitating for a month without significant progress, you should first consult an orthopedic surgeon to assess whether there are any issues with the joint that may be hindering its range of motion.
If there are no problems, then you can proceed to see a rehabilitation specialist.

Reply Date: 2012/05/10

More Info


Rehabilitation after a tibial plateau fracture can indeed present significant challenges, and it’s understandable that you are seeking guidance on how to navigate this process effectively. Given your situation, let’s break down the key aspects of your recovery and rehabilitation.


Understanding Your Condition
A tibial plateau fracture involves a break in the upper part of the tibia (shinbone) that affects the knee joint. This type of injury can lead to complications such as joint stiffness, pain, and potential long-term issues like post-traumatic arthritis if not managed properly. The fact that you also have an associated lateral ligament injury complicates your recovery, as both the bone and soft tissue need to heal.


Current Status
You mentioned that you had surgery on February 29 and that you are currently able to bend your knee to about 60 degrees. This limited range of motion is common after such injuries, especially in the early stages of rehabilitation. The sensation of tightness and pain you experience when attempting to bend your knee further is also typical, as the surrounding muscles and soft tissues may still be healing.


Rehabilitation Recommendations
1. Consult a Rehabilitation Specialist: It is highly advisable to see a physical therapist or a rehabilitation specialist. They can provide a tailored rehabilitation program that addresses your specific needs and limitations. A professional can also assess your knee's range of motion and strength, and help you set realistic goals for recovery.

2. Physical Therapy: Engaging in physical therapy is crucial. A therapist can guide you through exercises designed to improve your knee's range of motion, strength, and function. They may use modalities such as ultrasound, electrical stimulation, or manual therapy to alleviate pain and promote healing.

3. Home Exercises: In addition to professional therapy, you can perform gentle home exercises to promote mobility. These may include:
- Heel Slides: While lying down, slide your heel toward your buttocks, bending your knee as much as comfortable, and then slide it back out. This can help improve your range of motion gradually.

- Quadriceps Sets: Tighten the muscles on the top of your thigh while keeping your leg straight. Hold for a few seconds and then relax. This helps strengthen the quadriceps without putting too much strain on your knee.

- Straight Leg Raises: While lying down, keep one leg straight and lift the other leg to the height of the straight leg. This helps strengthen the muscles around the knee.

4. Pain Management: If you experience significant pain, consider discussing pain management strategies with your physician. This may include medications, ice therapy, or other modalities to help manage discomfort during rehabilitation.

5. Gradual Progression: It’s essential to progress slowly and listen to your body. Pushing too hard can lead to setbacks. If you experience increased pain or swelling, it may be a sign to ease back on your activities.

6. Assistive Devices: If you are still having difficulty walking, using crutches or a knee brace may be beneficial. These devices can help offload stress from the knee while you regain strength and mobility.

7. Nutrition and Hydration: Ensure you are consuming a balanced diet rich in vitamins and minerals that support bone health, such as calcium and vitamin D. Staying hydrated is also crucial for overall recovery.


Conclusion
In summary, your rehabilitation after a tibial plateau fracture will require a multifaceted approach involving professional guidance, home exercises, and careful monitoring of your progress. Consulting with a rehabilitation specialist is a critical step to ensure you are on the right path. Remember, recovery takes time, and patience is key. Focus on gradual improvements, and celebrate small milestones along the way. If you have any concerns or experience unusual symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. Best wishes for your recovery!

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