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- July 27, 2014 at 4:33 am #1805FredGuest
Hello all, I have a tibial plateau fracture (displaced) but no surgery. Doc put me in a cast (ankle to crotch) for 6 weeks. I didn’t ask many question and the doc didn’t really give any info. Any idea how long after the cast comes off that I will be able to walk? Work? Run? I work in a factory so just wondering realistically how long I will be off work? Thanks
- August 15, 2014 at 4:53 pm #2024LisaBGuest
Hi Michelle – The day after my climbing accident, I had a CT scan and an evaluation by my OPS, and found that no surgery was needed. They fitted me with a flexible brace that secured my thigh and calf, to minimize rotation; when my brace was first fitted, it was set for 30 degrees of flexion and 0 degrees of extension. I found that I could actually reach about 20 degrees in the first week, and by the 3rd week, almost 60 degrees.
At week three, I found I could get to 80 degrees and they changed the setting to infinite (No stops) on the brace. I’m doing flexion 5 times per day (keeping my heel on a flat surface, and raising my knee with my hand) and I’m finding that it’s getting better and better.
Hang in there – hopefully, you’ll find that your flexing improves as well.
Happy Healing – LISA
- August 15, 2014 at 12:32 pm #2023EileenGuest
I would be very angry if someone told me that because some people are able to get by being lame, I should try being lame too. There isn’t much that I would not give up to be able to continue doing the physical activities I love. What is your mobility worth? Fight for it. Pay for it, if necessary.
- August 15, 2014 at 10:12 am #2019michelleGuest
Just had my brace fitted as yesterday’s broke and they had no more in the hospital feels so much better than the cast its set at 20% movement really feel so much better and that I’m be able to cope with the next 9 weeks thanks Michelle
- August 15, 2014 at 8:10 am #2018FredGuest
I’m not sure why surgery wasn’t an option. I was put in the cast with no X-rays or anything during the healing. Would have been nice to know it wasn’t healing during. I have read that they can suture, screw or wire the bone back together. Wish that would have been done too. Seems like the conservative approach isn’t a good fit for me. Can’t sleep at night now worrying about this. I think I will also call the doctor and try to discuss surgery again. Will also call the second one to see about cancellation stand by. Thanks for the replies.
- August 15, 2014 at 5:06 am #2016LisaBGuest
Hi Fred- I have a tibia spine avulsion as well, and as far as I know my fracture is healing well… I had about 2 mm of displacement, and have had 2 x- rays ans 2 CT scans thus far. I am four weeks after my injury and no surgery was prescribed.
I’m curious- did you OPS not recommend surgery, if there was a chance that proper healing would be compromised?
Sound like it might be time for a second opinion?
- August 15, 2014 at 1:18 am #2015ChristinaGuest
I feel your pain, Fred. If you feel surgery’s the best option, then I’d pursue that. I wish I had said yes to surgery when it was first on the table, because I think I would have been on my feet sooner and in better shape for the long-term. I’m extremely lucky, though, both living in Canada and being covered by auto insurance during the accident.
With your specialist’s appointment, is there any way you can call them and say you’re on standby for a cancellation? I mean, if you’re at home and not doing anything, just let them know that and that you can come in at the drop of a hat. You have to push a bit for these things if you want the results.
With your age, I think of myself as well. I’m 28, play shinny during the winter, go on vacations where I hike, skydive, snorkel, and live all-out, ride my bicycle and scooter, and want to get back to peak shape. A TPF just does not fit in with my lifestyle.
As for physio, if you’re that worried about running out of your sessions, you can always look up TPF physio exercises on YouTube and perform them in front of a mirror. It’s not ideal, but it’s free, and you can do it entirely at your own schedule.
- August 15, 2014 at 12:11 am #2014FredGuest
I did see the images and it isn’t attached. The way it was explained is that it can stay like that, a person can function without an acl. He told me it would be 8 months to recover from the acl surgery and the best course of action is to do physio for 3 months and if it isn’t stable enough than to do surgery at that point. Sounded reasonable at the time. But now that I have thought about it I have realized that I want it fixed to how it was not just acceptable. My benefits only cover 9 sessions of physio so if I use them now and get surgery in 3 months there’s no physio left for after. Also I have instance for mortgage and truck payments but you have to be off work for 8 consecutive weeks (been off for 7 so far. That’s the only way I would be able to afford being off for the surgery. Also I’m only 30 and play hockey, baseball etc… I don’t want to have to worry every time I’m playing/ running around with my kids. I have an appointment to see another specialist but not for 2 weeks. I’m very frustrated
- August 14, 2014 at 8:22 pm #2007EileenGuest
Did you say the bone did not heal back? I keep suggesting that tpf victims ask their specialist to show the images and explain the treatment. You need to know whether your treatment is the best for your recovery goals.
I hope you find another provider,soon.
- August 14, 2014 at 3:45 pm #2001LisaGuest
I agree with you, Fred.
Time to see someone else!
Best to ya, mate!
- August 14, 2014 at 1:10 pm #1999FredGuest
Update : got cast removed yesterday. The bone didn’t heal back into place. The injury was actually called a tibial spine avulsion so the acl is attached to the piece of bone but that piece didn’t heal back to the tibia. Doctor said essentially I now don’t have a working acl. He said to do physio and see him again in 3 months. Some people are stable enough that its ok to live like that. This seems crazy to me! Going to try to see another specialist to see if acl surgery can be done now
- August 13, 2014 at 7:02 am #1986michelleGuest
Hi Fred I work in the nhs just remember your the patient and its your leg if your not happy with the doctor ask to see another and make a list of questions that way you won’t forget anything good luck.Michelle
- August 13, 2014 at 2:41 am #1983EileenGuest
I like Christina’s list of specific questions. Also, ask the doctor to show you your images and explain the diagnosis of the injury. Ask for specifics about the recommended treatment and why that treatment is your best option. If you are athletic/active, as it seems many tpf victims are, be clear about your goals. Ask the doctor to clearly explain how the treatment will help meet your recovery goals. I suggest you bring a friend to the appointment and that you both jot down notes.
I hope your news is all good.
- August 13, 2014 at 2:04 am #1980ChristinaGuest
Oh hell, questions, lemme tell you…
1. Will the malalignment put undue stress on the meniscus through both normal activity and heavier wear-and-tear?
2. Will my bones heal into an optimal position such that the articular surface will be smooth? If so, how long will that be the case?
3. Can we do MRIs to ascertain the damage to the meniscus (really crucial one here), ACL and MCL?
4. What are the chances of re-injuring the tibial plateau in the future?
5. What are the numbers when it comes to developing osteoarthritis earlier than normal? What will delay it? What will hasten it?
6. Am I a candidate for regenerative cartilage (this is expensive, around $30k, but worth it if necessary)?
7. Is the fracture in any danger of slipping? If so, will an immobilizer be a better option than a cast?
8. How soon can I start working on ROM, and what are the physical signs and symptoms I *absolutely* should not ignore? i.e. if there’s pain, how much pain is a safe amount?
9. What other options do I have besides casting or a knee immobilizer in terms of healing the area?
10. Are there any physio exercises that will harm my inner hip joint? (side note: my inner hip joint has been messed up to some unknown degree, and causes me inner thigh/groin pain that wakes me up)
11. What kinds of surgical options will provide the best short-term outcome? What about long-term outcome? Is there one that makes best efficiency of both?
12. Is surgery even the best option for both the short- and long-term prognosis?
13. How long will it take for circulation to my foot and leg to return to normal?
14. How long will I have to work with a PT on regaining ROM before MUA (manipulation under anesthesia) is needed?
15. How much wiggle room is there if I accidentally put full weight on my foot before it’s time? Is no pain, if this happens, a sign that things are okay, or can I still do damage?
By the way, I find that the more medical lingo you use, the more straight up your doc will be with you. My OS, the first time, tried to explain a depression to me as “the bone squishing down into the other bone”. *rolls eyes*
- August 12, 2014 at 11:23 pm #1977FredGuest
Ct got fixed and had appointment today. See doctor tomorrow for results and hopefully to get cast off. As the doctor wasn’t that helpful the first time I saw him 6 weeks ago does anyone have any thoughts on questions I need to be asking this time. Don’t want to miss anything and he doesn’t volunteer much info. Thanks.
- August 11, 2014 at 8:34 pm #1958ChristinaGuest
Aw jeez, sorry to hear that about the CT machine not working. There’s not another hospital or ortho clinic nearby they could send you to? It’s so frustrating about the cast, though. Last week, and thanks to YouTube, I discovered just how easy it is to take off the fibreglass cast yourself. All you have to do is tug the strips hard and unravel, and then cut the cotton padding.
For the knee pain, it sounds like it’s a “trigger” type of pain where you feel it because something moved the way it’s not supposed to and your body’s telling you to leave it alone. *What’s* causing it can mean so many different things, but rest and protection are the two big ones to keep the pain at bay. My family doctor’s nurse practitioner recommended Tylenol Arthritis (2 x 650mg tablets three times a day) as a way of combatting pain, and she said to not wait until there is pain, but to take it regularly and prophylactically.
- August 11, 2014 at 12:49 pm #1951FredGuest
5 weeks 4 days in cast. 6 weeks 2 days since it broke. Was supposed to have ct scan today and if everything was ok then cast off for good on wed. But hospital called and said ct is broken so now who knows when I’ll get cast off. Still have to find out if I need acl surgery. Pain in knee is a shooting pain if I move it too much, also get a shooting pain up my leg if I rotate my ankle a certain way. Just doesnt feel “right” yet
- August 10, 2014 at 9:59 pm #1946ChristinaGuest
Hey Fred, how many weeks have you been casted? I’m at four weeks casted, five weeks three days with the TPF. My leg has atrophied but not as much as I thought it would. My quad’s feeling okay and I can raise my affected leg no problem, but my ankle feels stiff when I rotate it — the kind of stiffness when it’s covered in scabs on both sides and doesn’t allow for much movement.
My TPF leg does feel “healed”, which is a huge part of my frustration at the course of treatment. I’ve been bad at times: I’ve gingerly tested out my foot on the floor, putting a tiny bit of weight on it and pressing my leg forward as if I were doing lunges (with hardly any weight on it). It feels a bit buzzy and tingly when I do that, but there’s no pain in my knee or anywhere else. I also put my TPF foot down for balance, sometimes with as much as 10% weight on it. I know my OS would not be happy to hear it, but I feel like I’d go nuts if I wasn’t doing anything.
Is your cast coming off because it’s been six weeks? Or just to get changed? And the pain you’re having in your knee — can you describe it? Does it feel warm and swollen, or a fairly normal size and of fairly normal temperature? Does your knee only hurt when you palpate it, when you’re working the muscles in your leg, or just in general?
Sorry…I grew up in a family of nurses, so the pseudo-nurse in me sometimes gets the better of me.
- August 10, 2014 at 7:28 pm #1945FredGuest
Christina, I’m also worried what’s going on inside that cast. I get mine off this week and have only rotated my ankle, done some leg raises etc. my leg is 1/2 the size of my good one (can wrap my hands all the way around at top). Hard to believe it will ever work again. Does yours feel “healed”? My cast is really loose now and I can touch my knee and it is still painful. Also get pains when doing leg raises and rotating ankle.
- August 10, 2014 at 3:40 pm #1943michelleGuest
Thanks I’m keep you posted x
- August 10, 2014 at 3:08 pm #1942ChristinaGuest
Depending on the type of TPF, it can be difficult to pick up with just an x-ray. They had no problem diagnosing mine, but it was the CT scan that showed there to be a bigger displacement than initially thought. Fingers crossed for you, though, that you get off scot-free without the TPF! That’d be a pretty awesome dream scenario 😀
- August 10, 2014 at 2:47 pm #1941michelleGuest
Thank you Christina I don’t have much pain Inca t I keep thinking have they got it wrong so difficult but will try and keep off it
- August 10, 2014 at 2:39 pm #1940ChristinaGuest
That ROM in the first six weeks is at worries me because I just passed the five-week mark and haven’t done anything except rotate my ankle, lift my leg in the air and squeeze my muscles. Trying not to think about what’s going on inside, but…
Michelle, if you’ve got a TPF and full leg cast, I’d probably stay off that leg. You could be displacing bones and end up delaying your recovery. That said, I’ve been given to moments of weakness where I’ve deliberately put my foot down lightly, but I’m always worried that I could be messing something up. Generally, a TPF needs NWB for a period of time to let the bone heal because it’s such an important load-bearing joint in the body.
- August 10, 2014 at 1:29 pm #1939LisaGuest
Christina, thank you so much for the wonderful links. I particularly liked emphasis on range of motion in the first six weeks. You are so right this is emotionally tough especially, for an athlete and in particular I know I’m going to heal.
- August 10, 2014 at 9:42 am #1938michelleGuest
Hi,I did my tibial fracture 2weeks ago have a follow up appt on Thursday for results of CT scan to see if I need surgery I’m in a full cast which will need changing as becoming loose,I’m struggling with my crutches and keep hobbling around with just one instead of two I’m also scared as the knee I’m relying on as already had a partial replacement 3years ago.does anyone have any suggestions if I’ve been using the fractured leg what will happen. Thanks Michelle
- August 9, 2014 at 8:39 pm #1930ChristinaGuest
That’s exactly the point I want to get back to as well: leading the same kind of lifestyle as before, and not just enough healing that I can simply walk. Walking isn’t enough; I want to run and jump and skydive and hike, and do all the other stuff that still gives my mother a near heart attack 🙂
As for the weight-bearing stuff, if it’s a tibial spine avulsion fracture, here are a couple of links:
If it’s info for a TPF and weight-bearing status, here are a couple:
http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical therapy standards of care and protocols/knee – tibia plateau fracture.pdf
and this one especially:
I’m not a medical professional, but my gut has always been to treat things aggressively rather than conservatively. A lot of that has to do with my personal nature, but I also believe the body is a remarkable thing and immobilizing it to let it heal may not always be the best thing. But again, that’s just my opinion and I know plenty of doctors would tell me I’m wrong.
- August 9, 2014 at 8:11 pm #1929LisaGuest
I have a tibia spinal avulsion, and I’ve been off my foot for four weeks – now I have two weeks to go with no weight-bearing and then four weeks moving from partial weight bearing.
My pain has not been terribly serious but I am going nuts sitting around so I do want to recommend and I got the mobile legs crutches and they have made huge difference in my mobility there very early gnomic everybody.
Hi Shell about 30 feet while I was rockclimbing and had to be rescued by helicopter. My doc said I didn’t need any surgery and that’s good news because my injury is to the bone that supports the posterior cruciate ligament.
I am in very good spirits and I know I will not just survive this and get back to 100% because I am an avid mountain climber and love to hike long distances, in fact, it is the core of who I am.
I think I have a good doctor but not getting a whole lot of information on partial weight bearing to full weight-bearing – anybody have any comments or hints about this?
- August 9, 2014 at 5:11 pm #1927ChristinaGuest
Good question, Fred: why, indeed, so long on crutches after the cast comes off? I’m 28 and while I do smoke, my bone density and muscle mass are at or above average, and I lead a high-impact, aggressive life. That’s why I’m seeking a second opinion because my gut, and the medical journals I’ve been reading, tell me there are other courses of treatment I might be able to pursue.
As for the casts, it’s nothing worrisome. The first replacement was because the swelling in my leg went down and I had to get a better-fitting cast. The second replacement was just for a better, tighter, straighter fit. My third one is getting so loose I can reach the top of my knee, but hopefully the second OS I see will find a way that I can have it off and continue to heal.
- August 9, 2014 at 2:43 pm #1924LesleyGuest
I too have a tpf and had surgery 2 weeks ago. I am nwb for 6 weeks and then pwb for 6 weeks. After that I anticipate still needing crutches or a stick to help having read the very useful posts on this forum . I truly did not appreciate how serious this fracture was but I intend to follow all the advice to the letter. I am a high school teacher and will not be returning to work at the beginning of term. I will be off until early November. All of this because my new dog ( staffie cross rescue dog) ran full pelt into my left leg on a visit to the park. I do not have a cast but an ankle to thigh leg brace. It is okay but becomes very uncomfortable at night .
Would like to hear how you are getting on .
- August 9, 2014 at 12:22 am #1919FredGuest
Great reply, thanks Christina. Why have you had so many casts so far? Why so long on crutches after the cast comes off?
- July 31, 2014 at 2:36 am #1852ChristinaGuest
Hi Fred and John
I’m a fairly similar situation to both of you (intra-articular displaced comminuted TPF with 6mm depression). Hardly got any answers the first time I was in the ER, and sent on my merry way with a too-small knee immobilizer and half-assed instructions on how to get up/down stairs with crutches.
Two weeks later, it was determined surgery wasn’t necessary, but I still had to push for answers. Other than being told NWB, I wasn’t given too many other instructions on how to navigate the next several months.
So, I’ve got a full leg cast on and have just under four weeks to go with it, with this one being the third cast that’s been put on. After that, I’m NWB for *three months* with no cast, just crutches.
What I’ve learned I can and cannot/should not do:
-keep the cast dry, or face either blow-drying or getting another cast put on
-I can put my foot down for balance, but absolutely no weight on it
-the world won’t end if something happens and I accidentally put weight on my leg
-rotating my ankle and doing leg lifts are an acceptable form of physio
-I’m allowed to flex my bad leg a bit to keep the muscle somewhat active, but not too forcefully
-getting up off the floor using just my good leg is fantastic for getting it strong (helps with crutching around town, as you’ll need an incredibly strong good leg to compensate), and works the quads in my bad leg, too
-I’ve been told to start weaning myself off the Percocet, so I take one at night only because nights are the worst and sleep is elusive, at best
-I often get a sharp pain in my groin. No idea why, but one or two extra strength Tylenol (500mg each) does the trick in about half an hour (my metabolism is fast)
I’ve also learned, the hard way, that medical staff are underpaid and overworked, and typically won’t offer plenty of useful suggestions and tips. You have to push for answers, even if it means hauling yourself back to the hospital and presenting yourself in the ER with your most pitiful, near-crying face. I hate doing this, but I hate being pushed in a corner to wait even more.
And if your cast doesn’t feel like a full leg blanket swaddling your leg, it probably isn’t fitting right. I went a week with an ill-fitting cast before I succumbed, as I didn’t want to tough out constant pressure on the top/outside of my knee anymore.
- July 27, 2014 at 10:04 pm #1815JohnGuest
I also am in a similar situation. Cast for 7 weeks but didn’t receive much information from the doctor at the fracture clinic. Most of the info that I have found is people that had surgery. Anyone else been thru this particular situation?
- July 27, 2014 at 5:25 pm #1813LisaGuest
Everyone heals differently. Take some time to bounce around this website and read the experiences of others. I know I have gained a lot from doing that.
Typically, casting is done for about 4-6 weeks. The ability to get back on your feet will depend on how much you work at it, so physical therapy is something you may want to consider.
I am sorry to hear your doctor did not give you much information! I think if it were me I would be contacting that doc and asking for some information.