About 2-1/2 weeks ago I had an accident in which I fractured my Tibial Plateau it is Non-displaced. My leg was braced at the ER and I was referred to an Orthopedic Surgeon. My appointment with the Orthopedic was 5 days later. At that time he put me in a hinged knee brace. All that he told me was no weight to be beared on my leg, that I will develop arthritis in that knee eventually and that I will need physical therapy, no surgery needed. He sent me home and told me to keep it elevated. My next appointment is 4 weeks after my first was.
I am concerned about the amount of time between the appointments. Since I am not having surgery, from other stories I have read online, it sounds like I should be starting physical therapy by now and have a second set of x-rays at this time as well to monitor the healing. I am worried about muscle loss and strength in the leg due to the immobilization.
When I called his office to question the amount of time between appointments, I was told it is only because the doctor is on vacation for 2 weeks!! Shouldn't he have had me follow up with his colleague in the meantime?
I just don't want my recovery to be take longer because the surgeon went on vacation.
Unfortunately, you are going to develop some significant atrophy with this injury. The first two to three weeks are the most important to make sure that absolutely no weight is applied to the knee and as much stress across the joint as can be avoided is done. So, during this time, most patients are treated by immobilization and elevation. The immobilization can be in a splint, a straight knee long leg cast, or a locked out hinged knee brace.
In the first two weeks or so, the body will start to lay down some osteoid, which will “glue” the fracture fragments together. Then, the body will start to calcify the osteoid, to make callus (new bone).
Some orthopedic surgeons will look at a nondisplaced tibial plateau fracture at about 3-4 weeks to see if there is any early callus formation. If there is, then the patient may be allowed to begin very, very gentle knee range of motion, in the brace, but still absolutely no weight bearing.
Other orthopedic surgeons will just wait until the six week mark to start range of motion, no matter what the x-rays show.
Others, will look at the appearance to the fracture pattern (Schatzker Classification), and if it is one of the stable patterns, will start range of motion right off the bat.
About the only constant factor there is, in the early treatment of nondisplaced tibial plateau fractures, is no weight bearing. If the patient weight bears, the fracture could displace, requiring surgery. Displaced intraarticular fractures carry a higher incidence of the development of traumatic arthritis.
Besides the damage to the articular surface, displacement of a tibial plateau fracture can damage the meniscal cartilages.
Surgery for tibial plateau fractures ranges from the placement of a couple of percutaneous screws under the articular surface, all the way to the placement of buttress plates, compression screws, and the need to large block bone grafts. Surgery on the tibial plateau can require a lot of periosteal stripping, which can devitalize the bone, leading to avascular necrosis (AVN).
So, you want to avoid the displacement of a nondisplaced tibial plateau fracture, if at all possible. Though surgery will usually make a displaced fracture better, it is best to avoid surgery, again, if at all possible.
If your surgeon has allowed your brace to be unlocked, then you could begin to very gently work on knee range of motion. But, if your brace is locked out, then about all you can do is keep the foot elevated to reduce the swelling, work on ankle pumps and circles, toe wriggling, and you can do thigh muscle isometric contraction.
The best thing you can do for yourself is get this fracture to heal in its anatomical position. That way, the change of significant articular cartilage damage is lessened. The possibility of future traumatic arthritis depends a lot on how much the articular cartilage is damaged.
You can always rebuild your muscles, but you cannot undo cartilage damage.
If it very difficult to sit around when you want to get things started. But, let the bone heal so that it does not displace, and then you will be able to go to town on your rehabilitation.
I am afraid of blood, that's why i don't want to do operation and we don't have money to do so. the doctor advice that i have do operation and needed three metal to put in my leg, can someone check on my picture and tell me if i can recover without operation? my leg now have cast. thanks.