Recovery


A Tibial Plateau fracture is really not much fun, but it helps if you are prepared and in many cases doctors will not prepare you properly for daily life after your injury. If I had to give you only one piece of Advice on Tibial Plateau eracture recovery it would be: be patient. And in the end, it’s not as bad as it looks.

Below is a more elaborate list of time-tested knowledge and information on different subjects related to your Tibial Plateau fracture. There are also separate sections for the different stages of recovery (from the menu above choose “1-8 weeks” etc.)

*Note: this website is not intended to provide medical advice. Your doctor is a much better source for medical advice.  This information is based on firsh-hand personal experience and research*

What to expect – overview

You will be leaving the hospital on crutches, usually with a hinged brace. For the first few weeks you will experience quite a few different uncomfortable symptoms but these all pass quickly. Natural symptoms include limited range of motion in your leg (in the knee and ankle joints) as well as pain, heat flashes, edema and stiffness Some of these will be caused by the fact that you are not completely mobile. Things will progress from here until in the end you are (in most cases) completely able to do your everyday activities, but it will take some time and hard work.

Time to recovery

Recovery from a Tibial Plateau fracture is different from person to person. It depends very much on the exact type and specifics of injury, your age, prior issues, level of physical activity, physiotherapy, nutrition and many other factors. Given all of these differences it is still quite safe to say that for most people, if you the injury was treated by surgery, you will still be in some kind of recovery for a complete year after your injury¹. In most cases it will be more than that, Improvement showing up to three years after. This sounds like a lot, and it is, but I can assure you that it does get better and that for most people after a few months your the injury will not prevent you from continuing with you daily life and you will be able to do all your daily activities to some extent including walking short distances, going out, meeting with friends, going to work etc.

Weight Bearing

For a period of about 6-8 weeks after the surgery you will be NWB (non-wait-baring), this means that you can not put any pressure on your knee and leg and will need to use a wheelchair, crutches or both. For some injuries it might take up to 12 weeks until allowed FWB(Full weight bearing). Depending on your doctor and your specific health condition you will be moving from NWB to PWB (Partial Weight bearing) or FWBAT (Full weight bearing as tolerated). This period of NWB will cause many mobility concerns and will affect your daily routine.

Mobility

You will be spending a few days in a hospital bed then progressing to a wheel chair and crutches, which you will be using for about 2 months, possibly followed by a single crutch and walking stick (see paragraph above – “weight bearing”). It could be up to 3 months on crutches, and up to 6 still using a walking stick (but usually much less). Also expect that initially you won’t be able to bend your knee much for a few weeks. This is called limited ROM (range-of-motion). Crutches are hard to use at first, and may be painful on the hands and shoulder, but don’t worry you will get used to them very quickly. And as a bonus you will develop very strong arm muscles. In some cases, overuse and pressure on your hands can cause secondary injuries to your wrists, arms or shoulders. If you are in pain from using crutches take it easy and use a wheelchair for a short while. You should also consider testing different types of crutches. Forearm crutches are usually more comfortable (then underarm) and come in ergonomic varieties. Today many advanced crutches also support ergonomic designs, anti-slip, and special features (link, link). Underarm crutches are usually safer then regular forearm crutches (link), but tend to be less comfortable, and don’t come with as many smart designs. Platform crutches might be good for people with a poor grip, but I haven’t tried them myself. Some crutches will also have shock absorbers to help your wrists and arms absorb shock (link).

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All this will require that you prepare for a period of partial mobility. Things you might be limited in doing include – walking up and down stairs, house jobs (cleaning, cooking, washing), carrying things from place to place (no free hands when using crutches), reaching high and low cabinets, showering. At first, you might also have trouble getting dressed and undressed but this will pass quickly. The best way to deal with this is have friends, partners & family help you with everyday chores and prepare the house as much as possible to make things easier. A few things you could do are:

  • Get a shower chair so that you are able to shower without bearing weight (link) and possibly also invest in some big bags or drycast or other cast covers (link) so that you can shower without taking your brace or cast off during the first few weeks.
  • Be very careful when using crutches in a wet surface because you could easily slip. Even more dangerous is if the crutches are wet and the floor is not. Make sure to dry the bottom of your crutches on a towel before leaving the shower.
  • If your crutches are very old and the tips are cracked, replace the tips with new rubber tips. The come very cheaply (link)
  • Use a gripper (link) to be able to reach those unreachable cabinets and to be able to grasp and retrieve items you would not be able to otherwise while on a wheel chair (link).
  • Make sure that someone prepares food and goes shopping for you. Other options include ordering in prepared food and ordering groceries online.
  • If your bed is on the second floor, Consider sleeping in a different room if you find it hard to get up the stairs. You can also climb stairs with crutches, or sitting down.
  • High and low cabinets are are hard to reach. Try moving things around so that they are easier to reach. Doors on low cabinets can also be unhinged to allow for easier access with a wheel chair. They can easily be put back on later.
  • More useful ideas can be found in the “logistics” section and “Tips & Tricks

Physiotherapy


Physiotherapy is going to be a regular part of your life. The are several goals: increase ROM, increase muscle-mass, teach your musculoskeletal system to operate as before and increase your stability. It is very very important that you start physiotherapy as early as possible and keep at it until you are completely better. This is the one factor that will affect your recovery more then any other and it is completely up to you. I’ve written a complete section on physiotherapy alone. Usually you will be given exercises to perform from your physiotherapist. At the very beginning you will probably not be able to bend or straighten your knee at all. This can be quite frightening but don’t be alarmed. Initially exercises will aim to teach your neurological system to control the leg again. It might even only be hours before you will start to be able to bend your leg, or it could be a few days.  After this, during the NWB (not in all cases) period you will be performing gentle exercises to enhance your ROM, strengthen your muscles and reduce stiffness, sometimes using stretch bands(link). Exercises might be done at home or in a medical center. It is very important that during this stage you follow PT instructions and do the exercises as soon as possible and as much as possible. This will reduce stiffness, boost recovery and give you a better chance at developing good ROM. When you progress to WB, physiotherapy will include many exercises with weights and machinery with the aim of gaining stability and muscle and to exercise everyday activities like walking. I can not emphasize enough how important it is that you keep at it (even if it means you go to work less). To be able to do physiotherapy at home you can consider purchasing light ankle weights(link).  For more info and tips, have a look at the physiotherapy section.

Medical professional

Several medical professionals will be involved in your recovery process, including the radiologists, the OS (“operating surgeon”), Physiotherapist and sometimes others. You will be having regular checkups with them. It is very important that you make sure your OS is a good one, and that you consult with him on every question you have. Be curious and ask everything you want to know. Sometimes doctors will not be generous with information, make sure that you get your answers. You deserve them. Seek extra information in sites like this one (more sites in the further reading section). In many cases the PT and the OS will be discussing your condition either directly or passing notes through you. Make sure that they talk if they are not already talking, but remember that when they give contradicting advice – the opinion of the OS is always the one to go by. You might also want to consider getting a second opinion both before or after your surgery.

Diet

Bone healing requires quite a lot of nutritional help, especially during the first 3 months(This is when the bone is healing), so make sure to eat well, and consider supplementation. For your healing to progress well you need to make sure that you get a lot of Calories, Protein, Antioxidants and minerals. During the first few weeks of healing your body will consume about 2-3(!) times as many calories as normal. This is about 6000 calories per day, so no need to feel bad if you’re eating a lot and very hungry. It’s all going to healing.

Protein is an Important nutritional ingredient. By volume, roughly half of your bone is comprised of protein, and you will also need to get a lot of it to reduce muscle atrophy as much as possible. If you think you are not getting enough protein consider using protein powder to supplement your daily protein intake (link), or adding protein rich food to your diet (meat, eggs, milk products, nuts & seeds).

Minerals are very important for several reasons. By weight bone is about 70% minerals. These are the building blocks of your bones. The high need for minerals will mean you might no be getting enough of them, which can cause other problems. If you are depleted in magnesium for example this may cause muscle cramps which are not much fun during a Tibial Plateau fracture. Consider using a multi-vitamin(link) containing minerals during the recovery process just to be sure. Studies have shown a lower rate of complications in healing in people taking multi-vitamins (link). The most important minerals to consume are Zinc, Copper, Calcium and Silicon.

Vitamins are the catalysts for the process of healing and are also in high need during recovery.  Vitamins that play an important role in bone healing include: Vitamin C, Vitamin K, the Vitamin B-series. Be sure to eat a varied diet and Consider using a multi-vitamin for Vitamins and minerals (link).

Anti-Infalmmatory Nutrients help reduce inflammation and pain. Bone creates a lot of inflammation which causes pain.  Unfortunately it is not advisable to take NSAID (Non Steroidal anti-inflammatory Drugs) during the bone recovery process as these slow recovery. Natural Anti inflammatory agents that may work to reduce pain include Vitmain C, Omega-3 (link) and others.

There are many foods you should avoid. Some foods will interrupt normal absorption of nutrients and their consumption should be limited. Some of these are:

  • Salt or foods prepared with lots of salt
  • More than one cup of coffee or other caffeine beverages. If possible, avoid coffee altogether.
  • Sugar
  • Chocolate (because to caffeine content)
  • Soft drinks and carbonated beverages
  • Alcohol (it inhibits calcium absorption)
  • Caffeine (it increases rate of calcium loss and inhibits absorption)

Pain

Pain is an unpleasant but normal part of recovery. You will be experiencing different types of pain and discomfort throughout your recovery. Pain might be felt in different parts of the leg, and won’t neccesarily concentrate only around the knee. Most pain comes during the first few days and weeks after the surgery. Pain management is an important part of your recovery and you should not be in constant pain. You should use pain medication as advised by your OS or hospital medical staff. If you are unable to use the medication prescribed by your doctor or are more comfortable using a different type of pain medication remember that some types of painkillers should not be taken for long periods of time(read the label!), and that you should never take NSAID as pain-killer while the bone is still healing. These types of medications will postpone healing. Brands included in the NSAID group which you should not use include Aspirin, Motrin, Ibufen, diclofenac, naproxen and others. Don’t use these. Instead use what is recommended by your medical staff or another medication that is not a NSAID. In some case, mostly in the first days you might experience more severe pain that can be treated with stronger drugs. This is normal, but if you experience abnormally strong pain or other abnormal symptoms, get yourself evacuated to a medical center as this is usually nothing but could be a sign of a complication. Make that in the first few weeks you have a bottle or box of painkillers in your pocket so that it’s always handy. Remember – liquid pain medication usually act faster then the tablet equivalent of the same brand.

Staying at home/Mental Health

You might be staying at home a lot and will be quite immobile for a while. This can get affect your mood very much and can at some point get depressing, especially if you are used to being very active. There is no magic pill for this, choose a good book, and a good TV series and try to regularly talk to as many friends, family and close people as possible. The proximity of  friends and close ones is very important. You might also want to find a community of people who have suffered from Tibial Plateau fracture before who share your experiences and feelings. There are several such communities, and some of them they can be in the further reading section of this website. Also, try to do as much exercise as you possibly can. Even if this means exercising while sitting or lying down. This can give real boost to your mood. Another good Idea is to start watching a new TV-show you’ve never had time to watch, or subscribe to online video providers like netflix or amazon prime (link). If in need, consult a psychologist or mental health professional. It is quite normal to be affected by a prolonged period of immobility and recovery, and a psychologist will be able to help with this.

Physical Activity

You will eventually probably be able to do anything you were able to do before your injury. However, this might take a long time (1 or more year for some sports) and you might have to be careful when doing extreme sports. There is a limited amount of things that you may not be able to do exactly as before, for example some yoga postures will not be possible with limited ROM, but you can always work around these limitations by doing things slightly differently. Also, you might experience some pain which will be limiting. If you want to take up a fitness activity shortly after the injury bicycling and swimming are both good options which will also help with recovery. Upper body weight training might also be a good option but will not directly advance your recovery.

Work

You Might be dying to get back to work or could be in need for a vacation. Going back to work is something that very much depends on you and on your specific job and state of mind. Some people go back to work on crutches after 4 weeks (me, for example), while others might wait a whole 6 months.  There is a good side to going back to work (aside from money) since you will be interacting with people all day long and will not be bored. The important thing to remember is that you must avoid overworking and stressing yourself out. When you go to work it is important that you leave enough time and mental energy to be able to do your physiotherapy as much as you need, to rest, to relax and to visit your medical professional. This will allow your body to recover. You might be tempted to sacrifice your physio for your career. Don’t do that. Your career will still be there when you recover, the condition of  your leg is something you will be living with forever.

Sex

There is no physical limitation from having sex as soon as the initial pain has subsided, but this injury can affect your sex life, something which you will not find a lot of information about and your doctor might not tell you. Decreased mobility in one leg and one leg which is half the strength of the other can naturally affect sex. This gets better as your leg heals and strengthens, and you will need to ask your partner to be patient as you progress through the recovery process.

On a good note

Tibial plateau Recovery takes a long time but at the end of the process you are looking at excellent recovery and usually a fully functional life.  Moreover, trying to find the good embedded in the bad, this injury can help you put things in perspective and appreciate all the things you have in life: friends, family, health, a loving spouse. It gives you an opportunity to stop and think about what matters most.

1,061 thoughts on “Recovery

  1. I am on day 7 and I can’t tell you how much this article helps and gives me some hope. I am 58 years old and this is scary but I appreciated this information as it sets a clear obtainable path.

    Thank You.

    James

    • If you are on Facebook, sign up for the closed group “Tibial Plateau Fracture Recovery” and you will find SO much information and support, through your recovery and beyond.

  2. I am 6 1/2 weeks post op left tibia plateau fracture. I have all kinds of hardware that was placed. I had a delay in starting any kind of real therapy until 1 week ago. They thought my tendon was not attached to my knee and I had to wait for MRI results which came back fine. The problem is I can not lift my leg from my knee. my quadriceps are not functioning to lift my leg. When I try I have extreme pain and my leg will not move. I am scared and frustrated. I am doing my exercise’s to try to strengthen them. has anyone else had this problem? I am still NWB until 3 months is up. using crutches and I have a hinged brace which is now open. I normally have very strong legs.

    • I had a midshaft tibia fracture and fibula fracture along with the tibial plateau fracture. There was excruciating pain in the midshaft area whenever I moved, therefore I didn’t use my muscles to move. I used my hands to move my leg. I was nwb for three months (using wheelchair and walker). When I started PT at six weeks, my PT would not let me use my hands and made me try to use my leg muscles. It took a good 5 minutes for me to move my leg a few inches that first day. It does get better with time. It’s amazing how fast the muscles go. It’s been almost a year for me and I’m still working on the strength.

  3. Katie, dont rush into this. Take it easy and weight-bear only as tolerated. Use both crutches until it feels easy to move about, then and only then progress to one. I was weeks with two crutches. Its taken me some 15 weeks to feel confident enough to go stick free in the house. I am however MUCH older than you so my rate of progress is much slower. The point I am making is not to get frustrated -you will get there -its not a race. As for bending your knee try heal slids. Put a sock on your foot, get a board that has a slippy surface (I use hardboard- not sure what that might be called in the US), sit on a bed and put your leg on the board. Pull the top of sock with both hands -this will slid your heal towards your bottom and in doing so bend your knee. Try 20 pulls/slids in 3 sets twice or better still three times a day. Try pulling a little further in each set. Also, you can roll a small ball or skate board under your foot when in a sitting position. You will find each week an improvement. Incedently I still do heal slides every day to ensure I maintain my bending ability and I am 40 weeks post op!

    • Thank you Marilyn, your response was very encouraging. I really am trying hard to get past 90 degrees but my leg just seems to get stuck after that and feels so swollen behind the knee that it just can’t bend more. Do you think that 11 weeks post op it’s ok to just get to 90degrees. I suppose my swelling and blood clot could be stopping movement. I do just feel it will never release and I’m so wary of physio just pushing it really hard to try and manipulate it. I’m definately getting better on my crutches though. Were you stiff in the mornings. For the first 15 mins or so my foot just finds it hard to be straight on the floor, then it seems to loosen up. Thanks again :)

      • Hello Katie, I think 11 weeks post op and 90 degrees is fine. I was 6 weeks in a full cast before I even started to exercise. When you’ve had the baby try lying on your front and bend your knee. This may prove difficult initially because of swelling (I know because mine was), so get someone to massage the back of your knee and above and below the joint line, as this will help as you do the exercise. A mirror placed well can help you see the amount of bend you have achieved. Try 10 bends 3 times a day. Again a sock on the foot can be useful tool to assist in pulling the foot. However, to begin with you might not be able to reach back for the sock top because the bend in the knee is insufficient. Dont fret at this. Keep at it and you will do it. My bad leg now bends further than my good one in this exercise!
        My knee is still stiff (I think it may always be so now) especially in the mornings. I do need to use a stick for a few steps then can walk with a slight limp ok afterwards. Must admit if I need to visit the bathroom at night I use a walking frame for safety reasons.
        Do let us know when the baby arrives, meanwhile stay positive andvdo what you can each day. Finally dont forget to RICE -rest, ice, compress and elevate, especially after exercise and to help eliviate swelling. My thoughts are with you. Marilyn

  4. Hi Dennis,

    Im so sorry what your going through! The worse thing that happens with this is depression, its very easy to get depressed with this. Is there any way you can get some emotional therapy, its a good thing if you can. I kept reliving my accident with my horse, and how I was on auto pilot trying to walk away and kept falling, and how vulnerable I was. I needed help with that. The light at the end of the tunnel is near, hang in there!!

  5. Hello again,
    I am now 11 weeks after op and 2 weeks allowed to weight bear. Ten days ago I was hospitalised with a DVT in my leg which is now being treated. I just wanted tips on how to weight bear. I still rely on both crutches and I just can’t put full weight on when walking. The inside of my knee just feels so twingy. I just wondered does anyone have any tips for me to be brave and just start walking. I also still can’t bend my knee past 90 degrees will this come with walking ? I’m just panicking a bit because I feel I should be further ahead and also having a baby in two weeks so any tips would be great. I don’t have Facebook. Many thanks

    • Katie,

      I fractured my tibia mid shaft, head of fibula and the tibial plateau March 2015 and was hospitalized for a week. I was in a straight leg full cast for 6 weeks and nwb for 3 months. I started PT at 6 weeks to work on range of motion which was at 30 degrees flexion and 1 degree extension (good leg -4 extension and 135 flexion). At 3 months (June) I was told that I could weight bear, but was unable to because my foot hurt too much. For one more month I could barely put weight on my foot. The month of August my foot would feel ok and then hurt like hell for a few days.

      It took a lot of effort to get my knee to bend. Finally I reached 90 degrees in July. August 5th, I hit 104 degrees. August 17th, 110 degrees. October 9th, 119 degrees. October 16th, 125 degrees. I’m still working on my flexion and extension. My extension is getting better and is -2. Fortunately I have a great therapist who guides me. After 4 months of using a walker and wheelchair, I used a quad cane and then a single cane. I never used the crutches (my therapist advised against them). I stopped using a cane at the end of October. I continually work on bending my knee.

      The swelling was horrible, so i had to elevate the leg when I wasn’t working on bending the leg. My leg is still slightly swollen, but is a thousand times better than it was.

      I couldn’t imagine being pregnant with this injury. You need to keep working on bending your knee. I know it’s frustrating and painful and sometimes it feels that it will never improve, but it will. The walking can help reduce the swelling which can help the knee bend, but you really need to work at it. I’ve been stuck in the 125 range for awhile now, because i was concentrating on the extension, but now I’m uping my effort to work on both.

      Good Luck!

  6. Hi all,

    I’m currently on week 4 of recovery since my TPF playing soccer.

    Experienced lots different challenges mostly mentally as I am used to a very active lifestyle. The pain in my knee has subsided a great deal and is not really causing me any issues which is great!

    One thing that has been hard has been the lack of information provided by the medical professionals I have seen. I was in a brace that kept my leg straight for week 1 & 2 and now have one that allows me 90 degrees of movement which I now find easy and painless. They have not given me anything to work on at home(i.e. NWB exercises) and only said that I can not weight bare for 8 weeks. I really feel as though there are things that I could be doing but am concerned that I may do more damage if I do the wrong exercises. There has also been no mention as to when I should begin Physiotherapy…. I have another appointment in 2 weeks for a check up and that’s all I have really.

    Anyone have any experience in some exercises that I could be doing while at home?? Also at what point in recovery did other people begin PT?

    Some great reading on this site so thank you :o)

    Jordan

    • Jordan – sorry youre experiencing a TPF injury. My dr.sent me home w some “while laying down / in bed” exercises such as pumping your foot several x’s from flex to pointing toe. Also leg lifts while laying on back w legs straight, left up your TPF leg about 12 inches, hold for 10 seconds, do 10 times, go slowly. Also sitting up w legs straight in front, bend over ur legs slowly to stretch your legs, try to lay your chest on your outstretched legs, grab your ankles, slowly stretch+hold 10-20 seconds. If you can lay on your side, leg lifts are good to do. Alternate between keeping foot flexed & then point toes. Do each side!! It is important to work each side, not just the injured leg. This way when youre given OK to walk / bear weight, you will not experience so much weakness & pain. Please clear any exercises w your doc. I also found some yoga stretches I could do on floor or in bed during my NWB time (total 4 mos). My dr.was low on info. too, thankfully I got the written exercises after surgery & dr’s nurse said do as soon as possible & do everyday. Good luck & stay healthy (dont gain weight) & positive, it will speed your recovery.

    • Hi Jordan, I started PT one week after surgery, my Dr. sent a referral to the PT clinic that I chose, as it was convenient to were I live. I saw them twice a week. With each visit, they would run me through a series of exercises, print theses out for me to take home were I was expected to do them on my own daily. This was all done during the NWB phase ( 3 months ). They would also message and manipulate my knee, at times, soooo painful, I would always ice my knee after thease sessions. They also put electric current application on my quad and small muscles around my knee ( 4 wires with sticky pads ), to contract and stimulate them, for about 20 seconds on, 10 off for 10 min. I continued with this therapy ( plus pool PT and swimming at the Y ) for 6 weeks after I started to walk, ended it when my insurance stopped paying. Every injury is different, and your’s may not be as complex as mine, and therefore perhaps your recovery will be quicker and easier ? Sounds like you didn’t have surgery – lucky you ! Not having pain in bending 90 degrees is super great ! You’ll be fine, and keep getting info, do excersices if you want, it’s the best thing for you.

  7. Hi all

    I hurt my knee late November and have been NWB for nearly 12 weeks. I have a Velcro brace cast that I can take on and off for showering. My knee feels so so stiff and it swells up and down throughout the week. There is an area ( inside of knee) that feels like someone is pulling at a nerve and it’s so very sensitive to touch. Is this normal and will I be able to eventually walk again .

    • Hi Catherine , you will be experiencing all kinds of weird pains, mostly stiffness and pain in the transition from bending to straightening and vis versa. This is normal. As is swelling, so ice your knee when you can. I hope your doing some kind of PT, NWB floor excersices will help you so much when the time comes for you to start walking, and that will bring a whole new set of challenges. Try to work through the pain, breath deep, work slow, take brakes. The important thing is to get that joint healthy again, movement is the best thing for it, get blood into the tendon and ligaments so when you do start walking, you will hopefully have an easier time. Good luck.

  8. I am coming up on 1 year since my accident. I broke my right tibia, fibula and tibial plateau in a skiing accident. I have several screws and titanium plates. It is a long recovery and certainly painful but with determination and lots of physical therapy I can assure you that you will be ok. I am 55 years old and healing is a bit slower but it does happen. Please be patient. Make short term and long term physical goals for yourself

    • Hi Penny, Congratulations on your 1 year anniversary. I too am approaching my 1 year anniversary of my TPF, which also came from a skiing accident!! We’ve come a long way! I was wondering how your rehab is coming along? I have been on a PT schedule that is focusing on strengthening my leg muscles. Those muscles seems to have really lost a lot of mass and strength while I was NWB and PWB. How is your walking? Do you have a limp? It seems that somedays are fine, others not so much. Thanks for sharing… Royce :)

    • Hi Royce
      My physical therapy consists of stationary bike riding, walking, quad strengthening and yoga with modifications.
      I do limp at the end of the day depending on how much activity I have had that day and the weather has a big impact on how I feel. I live in Florida and when humid, I feel tremendous pressure in my leg
      Recently I had a set back with a slip and fall at the grocery store. It is very scary when you make so much progress. I learned from this set back that once you have this type of injury, you need to set goals again and keep determined.

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