Tibial Plateau Fracture

[JohnRI]

While skiing last weekend, I had a big fall. They tell me I have a tibial plateau fracture. I went to an orthopedic surgeon. He said I wouldn't be happy if we just let it heal without surgery. I guess there's a limit to how large the fracture can be before they recommend surgery, and I'm beyond that. The fracture is on the outside edge of the tibia plateau. His concern is that there would be too much wear due to the fracture such that in 20 years I'd end up having to have a complete knee replacement. He wants to either take bone from my hip (ouch!) or use a synthetic bone material to replace what broke off.

It doesn't hurt at all now unless I try to put weight on it. I'm sure it will hurt a lot after the surgery. It sounded very involved. I have no idea what kind of time I'd have to be out of work.

[sarah1928]

Hi John

Sorry to hear that your having such a bad time of it at the moment. It doesn't sound good at all. Hope everythink goes okay for you, you'll be back on your feet in no time

Good luck

Sarah

[JohnRI]

Thanks, Sarah. It's a scary thing. And they expect me to decide quickly what to do. Any advice is greatly appreciated!!!

John

[MarionS]

Hi John,
Sorry to hear about your accident. That must have been fun getting off the hill in that state!

What to do? I'd definitely go for the bone graft. I don't think it would affect how much time you need to take off work, and you want to do all you can to help your knee heal the best it can. Depending on what kind of work you do, you're lookng at minimum 7-8 weeks, more likely 12 weeks. That was always a question I asked the doc - how much time off work. Even if he/she doesn't really know, he can still provide a better guess than me.

My TP hardware surgery wasn't as painful as all that. The worst was 1) standing up and feeling ALL THE BLOOD IN YOUR BODY rush into the lower leg (or at least that's what it feels like), and 2) after you've been lying still for a bit, moving the leg again required a bit of teeth-gritting, but as soon as I was moving it got somewhat better. At least that was my experience. But certainly there are lots of different experiences out there, no 2 injuries are the same.

Good luck to you!
Marion.

[JohnRI]

Thanks, Marion. I actually got up and skiied to the bottom of the hill. But, something just didn't feel right. After sitting for about a half hour, it swelled up to twice its normal size. At that point, I couldn't really put weight on it. So, I went to the ER. When I looked at the X-ray, the tibia looks O.K. as you look across until you get to the end. Instead of rounding, it sort of drops off. Looks like a little piece just broke off.

I didn' expect to be out of work for that long. The doctor talked like I would feel better enough in about a week to do some work. I work in an office and can do some from home if necessary. I don't think I asked enough questions. I found a list here in the forum that I wish I had seen before the visit.

Why do you recommend the bone graft versus synthetic? Anyone have experience with the synthetic bone?

[MarionS]

Hi John,
I just realised I misunderstood your choice, so I'll retract my bone graft suggestion. If you have a good feeling that your OS is 'current' on all the research, I'd ask him for the recommendation: If it was your leg, doc?
The reason for the long time off work is that it is really hard to protect that joint to keep the 'bits' in place as they heal. Which is why fixation hardware is so common.
Decide fast! Your knee is attempting to fix itself as the hours go by!
M.

[JAZZY]

TPF'er here. I have a bone graft. They got my graft from the bone bank, so I didn't have any other indignity to my body. Perhaps, because of my age. I didn't even know that there was a synthetic bone graft. My bone was broken into several pieces so I have hardware plus bone graft. I would research and then ask several questions. My first questions is usually, "If I was your mother what would you recommend." I'm 54 so I can ask that one. I wonder if recovery time is different because they are not adding any hardware. It was 12 weeks before I was released to return to teaching, and even then my doctor was not happy that I went back full time. They will also remove hardware next Nov. And at some point I will have to have a knee replacement.

I am amazed that you managed to ski to the bottom of the hill. To be able to bend your leg more quickly will certainly speed your recovery. I'm like Marion in the pain dept. and protecting the joint. I think that taking it slowly makes for better healing in the long run. You do need to protect the joint until everything they reattach can grow back together. This site has a bunch of threads that might answer some of your questions on what has happened to others with this injury.

Keep us posted on your recovery. And do decide fast--you definitely don't want them to have to undo what your own body has tried to do!!!!

[JohnRI]

Thanks for the response. They didn't offer bone bank as an option. My doctor seemed to think that synthetic was a good choice for me. I'm 43 and in good health. So, he felt my body would respond well. It's only fractured in one spot on the outer edge of the plateau. They haven't quite convinced me yet that surgery is the best way to go. I guess it's just because it hasn't hurt at all. Or perhaps I'm just in denial!

Hopefully, I'll hear back from my doctor tomorrow. He wanted to do the surgery this week since it's still within the 2-week window. He will be on vacation the following week and would have to have one of his colleagues do it if I wait. He's supposed to be the best in Rhode Island for knee surgery, so I'd much rather him do it.

[exoman]

John:

If you haven't found this page already, there is some information here that may be of interest for your
situation...

/KNEEnotes/knee-dictionary/tibial-plateau-fracture

Mark

[JohnRI]

Thanks, Mark. I just got back from an appointment with a different surgeon. He explained it much better. Apparently, my break is much worse than I realized. There is a full centimeter depression on the lateral side. He will need to push the plateau back up, fill in with the synthetic bone material AND put on a metal plate with about 5 screws. There's still the possibility of arthritis setting in even after the surgery.

It doesn't hurt right now, but I'm sure it will afterward.

[JAZZY]

Owwwwww! I'm glad he explained it better.
Yep, you're gonna feel it. Don't rush, do what you're told (that won't be too hard--you won't want to do more for a while) and know that we all sympathize with you. The damp and cold will also let you know you've injured the knee since there isn't a lot of padding on the outside of it to cushion the metal. I think all of us have been told about arthritis in the joint. In some of us it appears fairly quickly.

When the questions come, we'll be here. Take it slow and easy, so it heals right the first time. You're not alone. Just think, the next time someone tells you that you have a screw loose--you can tell them with a perfectly straight face that you certainly do not! And you have
x rays to prove it! LOL

Keep us posted!

P.S. Take the pain meds. And the first time you stand up don't be surprised at how purple and painful your foot feels--it is just the blood flow moving around. That scared me the first time I saw and felt it.

[cah7]

John - So sorry to hear about your injury. Everyone here can certainly sympathize.
On an encouraging note.............I have just started skiing again this season after having to skip last year as I was still recovering from a nasty patella fracture that happened in the summer of 05. I have been skiing this winter with a friend (She is not on this forum.) who has just gotten back on the slopes herself - exactly a year after a skiing fall left her with a TPF and torn ACL. She had TPF surgery (synthetic bone material to fill the depression) and then a few months later an ACL graft...and of course PT, etc. Off work about a week and a half for the TPF surgery as I remember. Of course, every injury is unique and not everyone heals at the same pace, but there is light at the end of that tunnel. (I know we really celebrated after our first day back on skis! )
It can seem like a long recovery, but you'll get there!
This forum can be a really valuable resource - you will find lots of posts from folks with similar injuries and recoveries. I gained a lot of valuable information from reading about how everyone else had coped and recovered. I found it very encouraging to read about others with injuries similar to mine who made it back to the sports/activities they enjoy.
Let us know how it goes.
Cathy

[JohnRI]

Thanks for the support. Doctor says I'm looking at 2-3 months on crutches. It's my right leg, so not sure about driving. Right now, it's not a problem, but we'll see after surgery. I'll be going in for surgery on Thursday.

[exoman]

John:

Good for you on getting the second opinion! With the option you were given by your first doc, I bet some would not have gone forward with the surgery and endured the next decade(s) with far less mobility until a total knee replacement. I'm certain you made the right choice and you will be amazed at your recovery.

I can tell you that after my injury, I was SCARED TO DEATH at the prospect of never skiing, running, walking with a limp, etc. after surgery. I had some rough days and nights, but it was worth it. In my experience and after reading many of our brethrens reports, the doctors often give you a worst case scenario about what you should expect. (arthritis, future joint replacement, etc.) While some have future complications, most recover very well. For those that don't regain all or most of their mobility or live with chronic pain, I am TRULY sympathetic. For those folks, TKR may be sooner rather than later.

As you have found out already, we can help you through this. If I had not found this fantastic support group, I would have cracked up on some days. I can still hear my wife saying "are you on that website again?" during my recovery time. There is such a wealth of information here and an almost family bond with those in this "club". Hang in there, be thankful for modern medicine, work hard, and life will be good for you.

Peace,

Mark

[JohnRI]

Thanks for the encouragement Mark. It really helps a lot. Sounds like my surgery will be similar to yours. I was told NWB for 2-3 months. Looks like you were on the short end of that scale. I appreciate any tips for healthy recovery!!!

John