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 TPF 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 TPF. 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 as well as pain, heat flashes, edema and stiffness Some of these will be cause 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 tpf 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 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 tpf. 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 TPF 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.

538 thoughts on “Recovery

  1. Mine did that all the time, even in the morning when I got up after weight bearing allowed. It quit doing it a couple of weeks later. It will all be a memory soon. Be patient. This site helped me so much. Best of luck. Pauline

    • Not sure why but the rest of my message didn’t show up. Curious if others have issue with blood rush to foot when getting upright on crutches?

  2. I am 17 days into my NWB phase of recovery. I see my surgeon again on the 31st; we will decide if I will be having surgery. I was hit by my 75 lb. black lab running full force and ended up with a tibial plateau non displaced break(although its being held together by one small bone fragment), cartilage damage, meniscus damage, and a hairline fracture to my femur. I am totally struggling with having my family care for me because I am always on the go and doing for everyone. I also attend college with 5 classes 4 days per week. It has already started to bring my spirits down, but I am slowly learning to be dependent. Thanks for the posts to all who are suffering same or similar issues. It has been most encouraging to hear I am not alone.

    • Oh my goodness. the same thing with me. My goldendoodle took both my legs out running full force. Unfortunately for me the tib broke once and 2 breaks to my fib. I had surgery 18 days ago and am seeing surgeon tomorrow for followup and hopefully more information on what to expect going forward.
      I’ve never taken sick leave from work before and its killing me not to be in the office. I’m really hoping that I can return this week even for a couple of hours every day.
      I hope everything goes well for you. I hope you don’t have too many stairs! I live in a townhouse with many many stairs so i actually had a hospital bed brought in so I’m centrally located on the main floor. I miss my bed!!

      The end of the article is so spot on…. its a great time for reflection…. things you can change going forward and things and people to be very grateful for.

      All my best!

    • So sorry to hear of your accident. I too sustained my injury in a dog collision in Feb. 2014. As well as a TPF, I broke my ankle. I had surgery the next day, with pins and plates inserted at both locations. I was 53 at the time and fairly fit. No two injuries are the same, and we all heal differently, but I did not go back to the office until June, though I started working from home about a month into my recovery – mostly to stay sane! I was NWB for about 14 weeks and needed lots of physiotherapy to regain range of motion, then to build back strength in my injured leg. My advice is not to push this. Let your family and friends help you through this, and focus on doing what is necessary to heal. I am now 13 months out, and would say I’m at about 90-95% of where I was pre-injury, which I am absolutely thrilled about. I am back to doing daily workouts and yoga – but it was a long journey. Patience, determination and a positive attitude will get you there!

  3. Thanks so much for publishing this information & all of the comments; they are a blessing. Because I’m merely three weeks into the 6 to 8 weeks healing process, and all that I’ve read has been most beneficial.

  4. Hi
    I had to inject for the first 6 weeks after op 13 weeks ago to stop blood clots. I found them really painful in my stomach every night but I kept thinking about all the good it’s doing!

    I have nerve damage too but I’m numb a narrow part down my outside left leg, outside ankle, whole of the top part of foot and top of all toes. I had my nerve decompressed at 8 weeks post op for plate and screws as it was stuck in 10cms of scar tissue, now a waiting game.

    Foot and ankle is swollen even after being in bed all night… Try and wear shoes and I can’t which I find so frustrating! I’m driving after 12 weeks which I have never been so excited to do a school run! The freedom after being stuck in the house for 3 months was amazing!

    Good luck with recovery.

  5. I developed a blood clot immediately after the five hour surgery and still taking a pill/blood thinner everyday. Hope to be taken off pill on June. Surgery was Nov. 11, 2014.

    I have the numbness on the left side of the left incision but not on the right side incision.

    My foot and ankle still swell but the numbness is beginning to subside a little.

    Patience my friend, lots of patience I am told.

    • Thank you. Sorry to hear of your complications post op too. I’m not very patient in my nature and grew up as the only non disabled member of my family. So having been in the role of ‘carer’ my entire life I am really having a tough time feeling so helpless and needing to rely so much on others. Though I am now able to cook, do the laundry and get myself to work which is all pretty good I think. I carry a rucksack around on my back to bring things upstairs / downstairs. Focusing on the small achievements.

  6. Thanks for writing this advice. I’m 8 weeks and 5 days post op after a skiing accident (just fell sideways and ski’s didn’t come off so took my legs round with them, breaking the top of my left tibia).

    I’m still NWB until I go to fracture clinic on April 2nd. Hope they’ll say I can start partial weight bearing. Seeing two physios one private one nhs nhs, doing my exercises 4x a day. Have good ROM though some stiffness still in knee and quad control is slowly getting there.

    I have significant nerve damage however and can’t feel anything on my leg to the left of my scar in an area about 20cms X 5cms, also have numbness in my heel and little toe and half the base of my foot. But worried that this will make walking feel really odd as I can’t even wear shoes without it feeling uncomfortable!

    Did anyone else have to inject their stomach every day with an anticoagulant to prevent clots?

    I’m back at work part time (thankfully have an automatic car so been able to drive for a month already). Helps mentally to be busy but have had moments recently at home where it’s all felt too much and never ending.
    Nice to know it’s normal to feel like this occasionally.

    Good luck to all with your recoveries!

  7. Hi, indeed the swollen foot and ankle are a BIG problem for me too! I wear a compression hose during the day which helps the knee and foot.
    I have been told the swelling can last a year?

    Also, had non weight bearing for 13 weeks and now on a walker and PT three times a week plus trying the excercises at home. Still can’t give up the wheelchair yet.
    Have loads of patience, you will need it.

  8. Hi, found this very good. 5 weeks into recovery, plate fitted, out of brace Ben and due to get a boot in 3weeks. My problem which no one told me about is my swollen foot and ankle. Does anyone else have this problem.

  9. March 21. Looking at surgery on March 27th. Looks like a long road to full recovery. This artical is very helpful and give me hope that all will be OK.
    On a positive note, I always thought i may look good with a cool looking cain. I guess I will see if that is true.

  10. I’m glad I found this site! I’m in my 5th month of recovery and sometimes have seriously doubted I’d ever walk again. I am walking with a cane and have limited range of motion in my knee, but do physical therapy twice a day, every day. I am trying to avoid additional surgery to address scar tissue issues.

  11. Thank you so much for a very informative site. It answered a lot of my questions. I am into the fourth month of my recovery and was starting to get concerned about my slow progress. Your article gave me a rough timetable for recovery and with it, less concern. PT is essential and the days do get long, but perhaps it gives me a chance to slow down and consider the really important things in life. I started knitting again and have found time for other things I had neglected. Again, thank you.

    • Hi Janice
      I am starting 7 th month,and find recovery slow. But do see improvement. I have taken up knitting as well! Everyone has slippers!

  12. Very grateful to have found this site! Serious MVA (head on crash) on December 8, 2014. TPF plus broken Calcaneus (heel)..in addition to 3 other orthopaedic fractures….TPF surgery was December 10….I know there is a plate and pins, couldn’t count them…honestly just grateful to be alive! Calcaneus surgery was on December 19….on March 10th was cleared by OS for FWBAT….wheelchair and walker right now….PT started in hospital and continuing weekly. Life changing incident plus re-evaluating future….healing thoughts for all here!

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