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).
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
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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.
Good info here. I broke my tibia plateau 6 1/2 weeks ago. Dr. Said it has heeled well and I must start phsiotherapy and do weight bearing up to 70%. My knee does not hurt, but the bottom of my foot and big toe feel quite numb and strange feeling to step on. Has anyone had this experience and why? The doctor would not give me an answer.
I did not yet meet requirements for FMLA. I would have had to been employed for a year and worked a certain amount of hours to meet requirements. I fell 3 months short. They gave me a leave of absence but only for 12 weeks. They have every legal right to do that since I didn’t meet requirements. Simply put there is no way I can do the job I was doing on crutches or in a wheelchair. Finding me another position with equal educational requirements and pay is no easy task. I reviewed both federal and my states guidelines just to be sure. My short term disability is for the first 6 months then long term disability kicks in.
unless your local laws are different, something doesn’t sound right.
The 12 weeks you are referring to sound like FMLA. FMLA states that they are required to hold your position for the 12 weeks you are out as long as it doesn’t cause undue harm or revenue loss to the company. If the same position is not available they are required to make reasonable accommodations to an equitable position. Legally they cannot terminate you just because FMLA ends.
Short term disability doesn’t go on “as long as you need it”. Its exactly as it sounds, for the short term. Usually about 6 weeks. That is when long term disability kicks in, and that can range from 6 months to 1 year. Usually at 60% pay.
The 2 Federal Acts are the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973. There are state and local laws as well.
Yes, all jobs are considered “at will” meaning they can terminate you but they still have to show just cause. Being on disability gives you a little more leverage than if you were just working.
I am getting short term disability which goes on as long as I need it. I have been employed there for less then a year so they couldn’t hold my position and I can only take a leave of absence for 12 weeks then I am terminated. I am working with HR to find another position. It isn’t easy because bedside nursing is so physical. They want to keep me and I really don’t want to go back through orientation there. A telephone triage position just opened up and I applied to it. I am going to check on this Disability Act you are talking about. Thanks!
Danna, I’m a bit confused.
When you say your last day of employment is next week, is that because you quit or are they terminating you? If you have shorrt and long term disability, you should have been on that already. And if you are on them, they legally cant fire you as its prohibited by the Disabilities Act.
Even so, if you are being termed, what reason are they using? Was there any attempt to find you a position or duties that you could perform while being NWB?
Thank-you for all your replies. You have helped me accept my long recovery. I am now looking for nursing positions where there is no physical patient care and I can work sitting down. I hope I can find something. I have short and long term disability through work but my last day of employment will be next week and I will loose my health insurance. I am trying to keep that from happening because I can’t afford COBRA.
My TBF happened August 23,2014 after a motorcycle accident. I have been in a wheelchair/crutches since because my doctor has made me non-weightbearing til I return to see him December 2. I am a Registered Nurse who specialty is oncology. I haven’t been back to work yet and I am very worried about rehabbing my leg. My goal is to go back to work on December 15. Just so much going on and I have been very worried about bills and if I have to reapply for my job or take another job. I am constantly stretching and moving my leg any chance I can. The doctor feels my leg will be healed by the 2nd and that it may take up to a month for rehabbing. He hasn’t had to send PT in because of my flexibility and previous knowledge. I am a 49 year old female who has overcome many obstacles in my life. I am getting frustrated about not being able to walk. I am so ready mentally to do this. Any words of wisdom would help.
Danna, I hate to tell you but I seriously doubt you will be able to return to work just a few weeks after returning to weight bearing. If your job allows you to sit all day, then you might. I had my TPF a year ago to the day you had yours. I work as a home health PT. I was NWB for 2 months. When I took my first step in therapy I almost collapsed. I had to begin with 3 weeks in the pool to learn to walk again. I then had 2 more months of PT before returning to work. A year later I still limp, and have trouble with stairs.
I don’t say these things to burst your bubble, but it is better to be realistic. I went 4 months with no paycheck or disability. It sucks, and you want to get back asap. But it would be better to prepare yourself for longer time in PT than be disappointed when you can’t return after 2 weeks of WB. I hope I am wrong, and you get the miracle. But don’t be disappointed if you don’t. I was NWB for 2 months, and it took 2 months to rehab enough to return to work in limited fashion. You will be NWB for 3 months, and plan to return to work in 13 days? I’m sorry but, that probably won’t happen, unless you can do your job in a wheelchair. I would plan to be back at work walking well around Groundhog Day in February. You will need at least 6-8 weeks of therapy. Remember the old maxim that for everyday you are in the hospital you lose 3-4 days of strength?. Well for every day of NWB you need 2 days of walking to make up for the loss. It doesn’t matter how great the ROM is, nothing compares to being weight bearing.
Last year I planned to return to work by Thanksgiving, and it wasn’t until mid December before I could. And I was a therapist who knew what to expect. Even a year later, I’d say my TPF leg is about half as strong as other leg. Always keep in mind, this is a very serious injury and rehab-much more involved than a joint replacement or bone fracture. This is a fracture at most important load bearing joint in the body. Be patient, and don’t put too much pressure on yourself to return to work. Your leg will ultimately tell you when it’s ok.
Cheers,
Chris
Chris, what stage TPF did you have? What surgeries?
Hi, Danna.
I agree with Chris. TPFs are notorious for needing lots of time to heal, or to heal properly. If you try to push it too soon or too hard, you may be doing more harm than good.
I, too, crashed a motorcycle and spend 15 weeks in a wheelchair. When given the blessing to weight bear on Sept 3, it took a full 10 days to feel stable just standing. Walking continues to be a process, but I am improving. I stopped using a cane this week (there are times I need it back).
I do wish you well!
I had broken my plateau in 2010 i have pain in my shin and around my shin like shin splints I hardly have pain around were I broke it I have 2 plates and lots of screws any advice would help thankyou
I have that, too.
I have found a heating pad applied to the area helps me. I also purchased a small hand held TENS unit that gives me some relief (look on Amazon.com for dozens of options with these things).
My doctor stated it could be referred pain or injury to the peroneal nerve. To me it actually matters not what the cause is…it just is.
Good luck to ya!
Hi all, I’m thankfully nearing the finish line after my TPF in June of this year. Am down to one crutch that I only need when I’m out as I try to do as much free walking indoors and at work as possible. Only thing is, I still have a noticeable limp when I’m without the crutch. My therapist has said a lot of it is in my head, leg is definitely strong enough now to hold me up, but its my brain telling my body it needs to limp! Has anyone else had this and what did you do? Other than going to see a hypnotherapist Im stumped!
Hi Emma, I am now 15 months into recovery and do not limp. But, when I was around 6 months I was limping and yes, was told part of my problem was “in my head”. Pride I suppose made me concentrate very hard on my walking and the slower I walked, the less noticeable it became. Perhaps it is mind over matter, but I have been where you are and no matter who tells you the leg will support you, it is only you who knows what your leg feels like. Again, its patience and practise. My only problem now is walking down a steep hill or down stairs, I feel the leg is “soft” and won’t hold me, I’m sure it will, but my confidence going down anything is not as good as when I’m on the flat or going up! As with all TPF sufferers, we mend at different speeds and you sound well on the road to a good recovery, but don’t push too hard, the limp will get less as time goes on, even if, like me, you wish everything would speed up. Take care.
My injury was at the end of June; surgery on July 5. I have a plate and nine screws. I’m almost four months into this, and I’ve been very discouraged/depressed at times. I’m walking around my house now without a cane, but with quite a limp. I use a cane when leaving the house. I go to physical therapy 2-3 times per week. We’re mostly working on strengthening my knee. I will need a TKR after this fracture is healed. I’m hoping that I might get my life back after that. I’m doing things like going to book club and out for lunch. My husband and I just took a weekend trip. None of this is easy or pain-free, but I’ve got to move forward. Good luck to all.
I know about the cabin fever. I get depressed too, just from not walking. I am 3 months in and I am so ready to go back to work. I know nothing worth doing is easy. Thankfully I won’t need a knee replacement. I have sewed a lot of things.
I found using a back pack helped even in the house. Using just one crutch is going to put extra strain on your body. I always used two crutches or sticks until I was well on my way to recovery. Be careful try to carry less if possible.
Do any of you have any tips on how I can get me knee to bend? It only bends slightly and then feels like its going to snap in half:( My whole leg feels lifeless. Can move from side to side a bit sitting down but other than that it feels so heavy. Now that the brace is off while sitting some of the heavyness has gone away but definitely still there. Can’t see PT until next week but I really want to get working on trying to bend my knee.
Hello.
Try this:
Use a heating pad on the area for 10-15 minutes to loosen up the muscles and surrounding tissues. Next (and this is the hard one), concentrate on relaxing the large thigh muscle. In these type of severe injuries the body wants to, and works to, protect the injured area from moving. That thigh muscle tends to be the primary criminal in this case.
The thigh muscle tightens up to allow for little joint movement. If you can mentally relax that muscle, the moving of the knee will be easier.
Remember, baby steps. Good luck to ya!
Hi Mamie, I too suffered a TPF in March this year. You have to do things very slowly with this injury and try to bend it first whilst wearing the brace. This will give support and make you feel more confident. Try doing it whilst sat on your bed or the floor, small movements to start with. I have just returned to work on reduced hours after seven months. I still have physiotherapy every week to try build up the quads and to help with the soft tissue damage.
One thing I have learnt with this injury nothing happens quickly…..I learnt patience. It will take you awhile to get to bend the knee but you will. Every week when I was given new exercises I thought I can’t do this but by the next week I had conquered it. I felt great emotion on every step I progressed. Good luck and don’t give up on the exercises as that’s what will. A&e all the difference.
Had surgery Oct.2/14 and after 2 hours operation I got two plates put in and 25 plus screws. Just had second follow up and Surgeon un-locked my brace to 45 degrees. He wants me to start bending my knee and in 3 weeks he will completely un-lock it and start putting a bit of weight on it.
Hello everyone, I suffered a TPF Sept.15/14. Was stepping out of my husbands pick up truck and my right leg slipped causing me to fall about a foot. The way I fell and the velocity caused my Plataue to shatter into many pieces. Worse pain I ever went through in my life. I love this website. It has helped answer many of my questions. Due to the swelling I had an External Fixator put in on Sept.16/14. I hope I never have to get to ne of those again in my life
Good morning everyone, I have an issue that isn’t directly related to the leg injury. I am fully weight bearing with one crutch which means the right arm is having to do all the carrying and lifting, unfortunately this is now causing me pain and discomfort. I have started to take anti inflammatory meds for it but has anyone else found that this has happened and can I ask what you did to alleviate the pain? I have a physio appointment this afternoon so will be asking if there are any exercises for it.