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.

333 thoughts on “Recovery

  1. Bill,
    This is great news! What level was your TPF? Did you undergo surgery, metal plate and screws? How long was your NWB and physio sessions? And since recovery depends very much on age, do you mind sharing your age (range)?

    Thanks
    BH

  2. GREAT & ENCOURAGING UPDATE:

    Hi everyone, if you’re reading this then you’ve likely been forced to join the club no one wants to be in! But I have some good news to share. I sustained my TPF on 2/15/14 in a ski crash/fall & nearly 10 months to that day (last week) I returned “to the scene of the crime” & skied without a hitch! No brace, no pills, no pain, no nothing! I was very timid & scared to even think of returning to the event that caused me a near year of anguish but I had to see if I could “get back on the horse”. I started out VERY SLOW and progressed even slower (by the 4th day) to return to a level I had nearly reached last year as a new skier.

    This is not meant as a bragging post. As you all likely know, the rehab on this injury is no joke!! I’m merely trying to share some good news on an otherwise bleak topic. I rehabbed very diligently & persistently & to this day I do my stretches nearly every day. My injured knee is still stiffer than the other but it is slowly starting to catch up where it left off nearly a year ago.

    I wish all of you the best in your adaptation & recoveries. This injury really kicked the crap out of me but I was determined (& forced to be patient) to get my leg/knee back in as good a shape as I could. I truly NEVER thought in less than a year I’d be typing this note.

    Keep at it, be kind & patient to yourself, keep progressing.

    Blessings to everyone,

    Bill

  3. I wish I had some insight into the use of crotches. Unfortunately, I was unable to ambulated successfully with them and used a walker. Currently, I am using a four prong cane. I can walk with out it but I tend to limp which I find irritating and is unseemly. Wednesday, when I saw my surgeon, he suggested I advance to just a cane. However, I do not want to surround myself with too much handicap paraphernalia (I am stuck with the wheelchair, company will not take it back because the insurance company paid for it) so I am continuing with the four prong cane to avoid getting into the habit of walking with a limp. Rather than progressing to a single crotch, have you considered using a cane? I think it may be less cumbersome and easier to get in and out of the car. I know there are a lot worse injuries, but for someone who has always been really healthy and enjoyed an active lifestyle, this is the worst experience of my life! I still have a hard time wrapping my brain around the fact that I did so much damage from such a short distance. For heaven’s sake it’s not like I fell off the roof!:) I sincerely hope you can get into therapy soon. I know that my knee did get stiff when I had to suspend the therapy to treat the wound. But my range of motion has improved since resuming physical therapy. I suppose that “Patience” is the lesson that I am to learn from this experience but it is so hard for me.

    Thank you so much for your response and wish you a heartfelt speedy recovery. I am amazed at how many people have experienced this type of injury!

  4. Sustained compressed tibial plateau fracture 27 920114 , coming up to 3 months now. Surgeon said I was on cusp for surgery so was decided to treat conservatively . Can honestly say has been longest 3 months of my life!. Injury caused by falling off my bike. Will never cycle again.
    Am now fully weight bearing but still on 2 crutches and have no idea how to reduce to 1.
    Have had no phyio, was referred 2 weeks ago but waiting list of months.
    Really concerned no phyio will delay recovery which we all know is long enough anyway.
    Would appreciate any suggestions

    • I wish I had some insight into the use of crutches . Unfortunately, I was unable to ambulated successfully with them and used a walker. Currently, I am using a four prong cane. I can walk with out it but I tend to limp which I find irritating and is unseemly. Wednesday, when I saw my surgeon, he suggested I advance to just a cane. However, I do not want to surround myself with too much handicap paraphernalia (I am stuck with the wheelchair, company will not take it back because the insurance company paid for it) so I am continuing with the four prong cane to avoid getting into the habit of walking with a limp. Rather than progressing to a single crutch, have you considered using a cane? I think it may be less cumbersome and easier to get in and out of the car. I know there are a lot worse injuries, but for someone who has always been really healthy and enjoyed an active lifestyle, this is the worst experience of my life! I still have a hard time wrapping my brain around the fact that I did so much damage from such a short distance. For heaven’s sake it’s not like I fell off the roof!:) I sincerely hope you can get into therapy soon. I know that my knee did get stiff when I had to suspend the therapy to treat the wound. But my range of motion has improved since resuming physical therapy. I suppose that “Patience” is the lesson that I am to learn from this experience but it is so hard for me.

      Thank you so much for your response and wish you a heartfelt speedy recovery. I am amazed at how many people have experienced this type of injury!

  5. I am so happy to have found this website and wish I had found it sooner. Your posts have been inspiring. I wish everyone a speedy and full recovery.

    On May 14th I fell off a ladder while washing windows. The ladder moved while I was climbing onto the second or third rung and I fell back onto the ground. At first I thought that I had simply dislocated the knee (there was no blood and no bones sticking out) and did not even want to go to the emergency room. Regardless, I ended up with a level IV tibia plateau fracture with avulsion requiring seven hours of surgery. After being in rehap for 2 weeks I was released from the facility and in home therapy was started. However, the therapist noticed that a small area where the incision was, was not closing. An appointment with the surgeon was scheduled and a culture was taken. The results revealed that it was mersa. I had to be treated by a wound care specialist which took five weeks before it healed and I could resume physical therapy. I am currently going to out patient therapy twice per week. However, I continue to have difficulty walking without a limp, climbing stairs, and cannot kneel to wash my floors (did I mention I was outside washing windows when I fell off the ladder?) I am a bit obsessive compulsive when it comes to cleaning. I am getting very depressed and discouraged and wonder if I will ever walk normally (without a limp) and climb stairs with alternating feet without pain. December 17th marked the 7th month post surgery anniversary. Patience has never been my strong suite. I welcome any and all recommendations/suggestions anyone may have. Please and Thank you.

    • first of all so sorry to hear you have joined our club ,for walking up and down stairs you need to do it gradually as the strength in your legs need to improve . Also there is a method my physio taught me , your strongest leg should be used to go up stairs ie. the uninjured one “up to heaven with the good leg leading” then coming down the bad one first “down to hell ” .Take it easy and try it first on a few steps then gradually build it up . I am 6 months PO and can just about manage it .Now for the cleaning etc try a relaxing hypno app ,the dirt will still be there in the morning but maybe your pain will have decreased a bit ,your friends and family will understand now you must put your health first .I cannot go down on a bended knee to save my life !! I have to accept the fact even with 5 labs in the house that is how must be for the moment and maybe 6 months down the line . But it will get better I am sure try to be happy think of positive things ,when I was in physio hospital I saw amputees and physically handicaps that will never be surmounted ,it put me and my broken leg in my place .One poor man had been paralysed since the age of 10 ( now in his 40’s ) but he still joked

      • Thank you Marion. I do appreciate your response. I know you are right. There are a lot worse things that could happen. I also know that “patience” is the lesson I must learn from this experience. I wish you a speedy recovery and that you will be able to do all the things you were able to do before the injury.

        • The thing is ,it so muddy on the farm that I worry about slipping over in it ,not a new experience by any means! And I so miss training my dogs ,obedience and field labs .I do some inside work with them as my husband let them do their own thing when I was in hospital 12 wks non WB ,and they are finding difficult now that the boss is back.Ironic thing it was 2 labs that charged into me ,not mine ,on a training day that I wasn’t running .So I probably took my eye off the ball so to speak .

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