Reply To: Rehabilitation

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Hi Helen

Lisa’s right on all accounts: a TPF isn’t like other fractures at all, and it’s so finicky doctors don’t really have a blueprint in handling it. And she’s absolutely right in saying “it depends” in answer to all your questions. I know it’s frustrating to hear because you want definitive, quantitative answers, but there are so many factors at play.

That being said, here’s a basic rundown of what needs to happen for you to get back to normal:

-the fracture at your tibial plateau needs to form a callus; this is when bone cells knit together to start repairing the break
-during the callus-forming stage, you can think of the fracture as being held together by glue (even though there may be pins/plates/screws holding the bones together), so it’s very delicate and liable of displacing
-alcohol causes peripheral vasodilation when you need the blood more deeply instead of at the surface, and smoking causes vasoconstriction, which tends to restrict the amount of blood (and the nutrients it contains) getting to the injured site
-in the first week to two weeks, your bone is in overdrive mode to heal itself, so you may notice a lot of pain, sleeplessness, muscle cramping, loss of appetite (because of the narcotics) and fatigue in trying to do what came naturally before.
-it’s important to get things moving right off the bat so physio and rehab will be easier later on. This means flexing your ankle to keep your Achilles’ tendon stretched, rotating your ankle, flexing your calf, stretching your fingers past your toes (hamstrings), and lifting and holding your leg in the air (quads). All of this lays the groundwork for getting back on track fast after the first crucial healing stage is over.
-using crutches will make you feel like you’re the most out-of-shape person alive, but it does get better…if you work on it. You have to push past the muscle aches/fatigue, sweatiness and feeling like you’re going to die, because no pro athlete ever got to the top without going further than they thought was possible. You can do this, and a lot of it is mind over matter.

In terms of driving, this is a very tricky subject, and please don’t quote me on this. If your TPF is your left leg and you drive an automatic transmission, technically you’re able to drive (you’d have to check with your insurance company, but I’d recommend calling a competitor and blocking your number before asking if it’s legal). You can also ask a cop on the street. However, keep in mind that should you be in an accident, you’d have to prove that you were able to drive without any impairment, and that can be very difficult to prove. I’d also recommend not asking your OS or doctor because they can contact the Ministry of Transportation (or whatever it’s called where you live) and having your licence temporarily suspended on account of injury, and that requires a lot of paperwork and time to get reinstated. For me personally, I drove near the end of my cast-wearing period — and it was a risk I was willing to take on — because I felt okay in operating a motor vehicle. It was pretty uncomfortable having a straight leg stick out instead of being able to bend it, though.

And in terms of NWB period and rehab, that really differs on a person-to-person basis. I was first told six weeks NWB with a cast on and then three months NWB with the cast off, and the latter part was reduced to six weeks after my x-rays came back great. Some people don’t get to bear weight for months and months (it depends on their age, health, severity of injury, lifestyle, bone mineral and muscle density, healing history, and so many other factors), while others are figurative freaks of nature and get back much, much quicker than that.

Getting back to walking also depends on your muscular strength and ligaments/tendons in the knee area because your knee needs a great deal of support around it to get walking. That being said, it’s been shown that weight bearing facilitates bone healing, but it’s your decision and your OS’s decision when that happens. Your TPF will heal when it’s ready to heal.

Lastly, what I found worked great is getting in a hot tub, positioning your knee inches away from the jet, and bending it that way. This thing will take time, blood, sweat, tears and more effort than you thought was in you, but you will get back to walking.