The conservative treatment of fractures of the lateral tibial plateau has in our experience produced an excellent functional result. Microfracture of femoral condyle postoperative physical therapy protocol. Initiate closed kinetic chain exercises progressing bilateral to unilateral. The upper surface of the tibia or shinbone is called the tibial plateau. In many cases, a person with a tibial fracture will require physical therapy and crutches or a walker to help them get back on their feet. Continue reading for more facts on how to treat and recover from a tibial plateau fracture now. Thirty patients diagnosed with tibial plateau fractures schatzker type ii. For this, they have to follow proper tibia fibula fracture rehabilitation protocol. Return to running after a tibial stress fracture service. Microfracture of femoral condyle postoperative physical. Due to concern for a fracture, the physical therapist ordered radiographs of the left knee, which revealed a fracture of the left lateral tibial plateau.
My tibial plateau fracture recovery journey continues. This is usually done by placing your knee in a cast or solid brace. The initial stage when treating a tibial stress fracture is a cessation of weight bearing activity, followed by a gradual return to running after a tibial stress fracture has healed. Because these fractures occur around the knee joint, they must be treated differently than tibial shaft fractures. Because most tibial plateau fractures involve thelateral tibial plateau, an anterolateral approach is the most frequently used approach for the treatment of plateau fractures figs. Strategies for treating a tibial plateau fracture healthprep. A suggested protocol 1 doctor of physical therapy student at time of submission, doctor of physical therapy division, department of community and family.
Early detection and appropriate treatment of these fractures are critical for minimizing patient disability and reducing the risk of documented complications, particularly posttraumatic ar. Rehabilitation guidelines for tibial plateau fracture open reduction internal fixation stage 1day 14 weeks. Cien follow up visit at 2 weeks post op begin physical therapy for knee rom at 2 weeks post op rehabilitation maintaingoals kneeext toallow incisions heal and prevent. In some more complex cases, fractures can be managed by external fixation followed by further orif at a later time. Tibial plateau fractures orthopaedic trauma association. Patients will be in a hinged brace for support and to serve as a reminder not to weightbear. Knee tibial plateau fracture open reduction internal fixation. The current study reported uptodate information on the incidence and basic epidemiology of tibial plateau fractures in a large and unselected population, including the mechanism of injury and. Rehabilitation guidelines for tibial plateau fracture 2 p a g e phase ii weeks 612 dates. Populationbased epidemiology of tibial plateau fractures. You will be guided by you physical therapist pt through the rehabilitation process for fractured tibial plateau or tibial plateau fracture.
Emily bolthouse, dpt, cscs1 return to running after a. If you engage in activities such as horse riding, skiing, and certain water sports, you are likely to get a tibial plateau fracture. Tibial plateau fractures are serious injuries, and are common in highimpact sports like football, rugby and basketball. Hindfoot and forefoot varus and compensatory hyperpronation were also linked to tibial stress injuries. Microfracture procedures to the knee there are two types of cartilage in the knee. Post tibial plateau fracture osteoarthritis is common approximately onethird of all tibial plateau fractures due to the articular surface being involved, despite the age of the patient at the time of fracture physical therapy management. Appointments physical therapy 1 time per every 12 weeks. After the orthopaedic doctor makes the formal diagnosis via the mri, the patient is usually referred to physical therapy. Appointments md follow up visit at 2 weeks post op begin physical therapy for knee rom at 2 weeks post op rehabilitation goals maintain knee ext to allow incisions to heal and prevent knee flexion contracture. This particular fracture makes up only 1% of all fractures.
The wellbeing of your recovery from fractured tibial plateau or tibial plateau fractures is determined by making healthy decisions and commitment to physical therapy pt. An 41 year old female was diagnosed with a fractured left lateral tibial plateau after an high impact moment during horseback riding. Since the tibial plateau contains certain structures essential for proper functioning of your knees, a fracture to this area may lead to. Looking at the above photo always makes me cringe when i think back to that fateful daymay 20th 2017 yes, folks, somehow i managed to acquire a tibial plateau fracture tpf.
Associate professor of orthopaedics chief, division of sports medicine tel. After physical therapy has been completed, patients should be able to start back to exercising as well as training for athletic. Phase iii strengthening and proprioceptive phase weeks 6 to 10. The goals of this study were to provide uptodate information on the incidence and basic epidemiology of tibial plateau fractures in a large unselected patient population and to. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. Displaced tibial plateau fracture a displaced fracture is one where the bone breaks into two or more fragments. It is important to return to running on a gradual basis, the pace to which you return to running depends on a number of variables. Return to exercise timeline star tribune physical rehabilitation will help mark the patients return to exercise timeline. Tibial plateau fracture open reduction internal fixation stage 1 day 1 4 weeks. Fracture quality pain and tenderness were noted with palpation over the lateral joint line of the left knee and the left fibular head region. Tibial plateau fractures are complex injuries of the knee. Always seek immediate medical attention after incurring a tibial plateau injury. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high loadbearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis. Lateral tibial plateau fracture journal of orthopaedic.
The aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks. Controversy and confusion exists with the term shin splints. For this, they have to follow proper tibia fibula fracture rehabilitation protocol in this article, we are going to learn about each step of the physiotherapy after fracture tibia fibula. Non weight bearing status for 4 weeks postop resting foot on floor and driving are okay. Tibial plateau fractures were originally termed a bumper or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers. Recovery a person will often recover within 4 to 6 months. Twisting motions and motor vehicle accidents can also cause a tibial. It typically takes a major force to cause this type of broken leg. A tibial shaft fracture occurs along the length of the tibia shinbone, below the knee and above the ankle. Rehabilitation of tibial plateau fracture following.
August 1st, 2017 i was released to 50% wb weight bearing by my orthopedic surgeon. Consist of medial and lateral plateau medial larger medial lower concave medial bone harder thus less likely to fracture lateral higher convex lateral cartilage thicker 3 vs. The physical therapist implements a multifaceted treatment program, beginning by controlling the inflammation and pain. Tunnel fracture, especially through the tibial plateau, following reconstruction appears to be a multifactorial phenomenon. The most common mechanism of injury is motor vehicle accident. The tibial plateau is one of the most critical loadbearing areas in the human body. Bioabsorbable interference screws, bone resorption, and tunnel widening appear to create a stress riser within the tunnel and increase the risk for fracture in the years following reconstruction. The patient was a 30yearold man who was initially seen by a physical therapist for a chief complaint of left knee pain. Tibial plateau fracture brigham and womens hospital.
A tibial plateau fracture occurs at the top of the shin bone and involves the cartilage surface of the knee joint. The tibial plateau is located on the upper surface of your tibia just below your kneecap. Due to concern for a fracture, the physical therapist ordered radiographs of the left knee, 1 which revealed a fracture of the left lateral tibial plateau. After the fracture of the leg and its plaster cast removal, the most important concern of the patient is when will they resume walking. Physiotherapy and recovery for fractured tibial plateau or. Rehabilitation from tibial plateau knee surgery healthfully. Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Group b treated with physical therapy program and delayed weight. Appointments md follow up at week 6 continue physical therapy 2 x week rehabilitation goals regain full knee rom normalize gait out of brace strengthening of les and core pain and edema control. In this case surgery is normally needed to refix the fragments in place to encourage correct healing of the b one tissue. Tibial plateau fracture causes, types, symptoms, diagnosis.
As mentioned previously, early motion with physical therapy as well as continuous passive motion machines has. This approach is typically utilized for splitdepression lateral plateau schatzker type ii and bicondylar schatzker type vi, type v fracture patterns. Evaluation physical exam initial inspection skin integrity soft tissue swelling open fracture gross deformity shortened limb neurovascular status. Diagnosis, treatment, and rehabilitation of stress. External fixation is another option for stabilizing tibial plateau fractures, especially when there are major soft tissue concerns or wounds. The most accurate way to diagnose a stress fracture is via a mri.
After a fracture, physical therapy may be required to help ensure return to optimum function as quickly. Pdf effect of introducing early weight bearing training in. An often missed diagnosis article pdf available in acta orthopaedica belgica 725. When a fracture occurs into or around a joint surface, that joint is at high risk of developing arthritis due to the. But one should remember that any type of tibial plateau fracture can present with softtissue complications. Tibial plateau fractures initial management guidelines. Tibial plateau fracture postoperative protocol rosenberg cooley. Mikkelsen 1 has classified 18 types of fracture involving the proximal articular surface of the tibia. Nonoperative and operative treatment plans are considered by doctors to. He didnt give me any other instructions other than handing me another prescription for 6 more weeks of physical therapy 3xweek. In the first stage of rehabilitation from a tibial plateau fracture, your knee must be immobilized for six to eight weeks to allow your tibial plateau to heal.
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