Tibial Plateau Fracture Recovering from fractured tibial plateau surgery

lilmom21

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Hello everyone, I know this is for total knees but I hope you won't mind my being here... due to this injury, I've been warned that a TKR is probably likely one day, so I could be a legitimate future member soon.

But right now, I could sure use advice and encouragement. Two weeks ago I fell violently and fractured my tibial plateau in several places. I also tore a meniscus, my ACL and my MCL. And I tore my calf muscle and have some nerve damage extending down the bottom of the foot. I have a plate and some screws holding my knee together

I'm 30 years old and my husband and I just welcomed our first baby this summer. He's about 6 months old. I stayed home with baby but had just started tweaking my resume to go back to work and was interviewing daycares a few days before my accident.

It's been about 12 days since my surgery and I'm feeling really down. I've been on limited amounts of pain medication since I'm still exclusively breastfeeding my baby (the pain medicine was cleared by our pediatrician, my ob and 3 nurse lactation consultants but well, you know first time mom here) and my surgeon's goal is to be only taking Tylenol and ibuprofen by Wednesday. He already said he won't write me another script. And I agree. I have been taking 10mg Norco every 4-6 hours. Today I did 7.5mg every 5-6 hours and it was bearable for most of the day with ice on.

I'm worried about starting pt next week. Does everybody just use over the counter meds and ice? I'm just apprehensive of the pain. I'm not sleeping well though thankfully my baby is a trooper thru the night and only wakes for one night feed, usually. I'll probably sleep better when I am permitted take off my monstrous leg brace.

I also don't know what we are going to do as far as caretaking. My husband's got to go back to work soon and we live 1600 miles away from all of our family. Yesterday, we were told that I need to be completely non weight bearing for at least the next 6 weeks. I'm so unhappy that I can't easily get to my baby and I can't hold him unless I'm sitting down. Can't help much with bath time and someone has to bring me everything so I can change and dress him. We can't afford to hire a nanny --we made the decision that I'd stay home with baby for the first 6 months. I had just started looking for work again.

Right now, I've got a family member flying in to care for me and baby for the first 10 days of January. But we still have to get through another month at least! And once I'm allowed to put weight on my leg, I think it'll take a few days to get used to walking, right?

I've asked my surgeon about all this as all he said is that I'm going to need help for at least the next 10 weeks. He suggested the hiring of a nanny. But, like I said, I'm embarrassed but we can't really swing that.

I am not even sure what I am asking. The facts are that I'm not really able to care for our son by myself and can't really care for myself. We are alone in a new city. And everything really hurts. I'm afraid. I don't know what to do.

My husband's going to talk with his boss and HR next week -- he's got a great job but we need him working... in addition to the expensive city we live in, there are extensive medical bills now on the way. I feel so wretchedly useless.

Any advice? It's got to get better soon, right? I feel so helpless. I did not have post partum depression and in general I'm not prone to being sad. Before this happened, I was having the best year of my life.
 
Welcome to Bonesmart, best place for all things knee related. I’m so sorry about all you are going through.

It’s so easy for a dr to just say hire a nanny! Maybe he’d like to pay for it!

I totally understand being a stay at home mom, and a breastfeeding mom, that’s what I did. We wouldn’t have been able to hire a nanny either!

I can’t offer you any advice, others with more experience will be along to do that, but I can offer hugs and prayers.
:console2:
 
I’m sure there are many who wouldn’t be able to afford a nanny. My bff was very ill while her kids were young and they couldn’t afford one either, but friends and family who lived nearby stepped in to help. You said family was far away, but coming to help for a short while. If you attend a church there’s every chance that some retired ladies would love to help care for a newborn and often are looking for ways to help within their community. Even if you don’t attend a church you can always call a nearby one to ask if they have a service program you could take advantage of. I know I’d help if I was given the opportunity and because I was a teacher I have all the clearances needed to work with children. Do you know of any stay at home neighbors that could help? What about college kids home for their holiday break? Take the 10 days you’ll have help to do some research.
 
@lilmom21,
Welcome to BoneSmart, you are in the right place. :welome:
Josephine our Nurse/director with 50 year of orthopedic experience will be along soon to advise.

Sending you positive thoughts and (((Hugs))). Hoping you find some answers to your child care challenges.

I'm worried about starting pt next week. Does everybody just use over the counter meds and ice? I'm just apprehensive of the pain.
We recommend no additional pain meds for PT, pain is a warning signal that your PT is asking too much of your knee. Your PT should be able to help you with getting your swelling down with electrical stimulation, retrograde massage, and set you up with a TENs unit for pain.
TENS machines for pain management

I am going to give you a copy of our knee replacement recovery guidelines, you will find the guidelines will apply to your recovery. Be sure to ask any questions you may have.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
due to this injury, I've been warned that a TKR is probably likely one day
Well, you face that when it comes to it. Could be 3 or 4 years yet!
It's been about 12 days since my surgery. My surgeon's goal is to be only taking Tylenol and ibuprofen by Wednesday He already said he won't write me another script. And I agree. I have been taking 10mg Norco every 4-6 hours. Today I did 7.5mg every 5-6 hours and it was bearable for most of the day with ice on.
You agree with your surgeon and in the next breath say that what you have been taking was 'bearable'? No, that won't do, my dear. You need the pain meds in order to get back your knee's function and movement.
Does everybody just use over the counter meds and ice?
Not after 12 days! And ibuprofen is no good at all as a painkiller. It just isn't. If your surgeon is one of those 'grin and bear it' people, then approach your GP and see if he will help you out. The Norco is not essential but you must have something with the Tylenol. One drug I've found to be less aggressive than hydrocodone is Tramadol. See if he will prescribe you that but you will need it for at least 6-8 weeks because that's how long the pain will last.
I'm worried about starting pt next week.
Sadly, this is one time when you do need PT to get back your ROM. However, I suggest you read the articles Pumpkln left you because they all apply.
I'm just apprehensive of the pain.
So the first rule of rehab is that you don't allow a PT to cause you any pain whatsoever. Not even discomfort. No pushing on your leg for bending or straightening. And the exercises they give you to do at home is the same. NO pain!
Yesterday, we were told that I need to be completely non weight bearing for at least the next 6 weeks.
I would imagine so. The fracture and the ligament repairs need time to heal and weight bearing can cause the sutures and stuff to break down, and I'm sure that's the last thing you'd want to happen, yes?
And once I'm allowed to put weight on my leg, I think it'll take a few days to get used to walking, right?
That will be part of your rehab/PT.
I've asked my surgeon about all this as all he said is that I'm going to need help for at least the next 10 weeks.
Even that is optimistic. I'd have said 12 at least followed by this Phased return to work.

So what kind of metal-ware did they use in your knee? Did it look something like this?

tibial plateau ORIF.JPG


Please feel free to ask any questions you want to. I have some considerable experience in trauma surgery.
Just put an @ in front of my name and it will call me to this thread.
 
Hello @lilmom21

I feel so sorry for the pickle you're in! Hugs!

Congratulations on still breast-feeding your baby and I understand why you want to continue doing that.

Do you have a wheelchair, or can you hire one? That would at least make you mobile enough to be able to change and feed your little boy, and give him cuddles.

I'm glad one of your relatives can come to help for a short while. Perhaps, when she sees how much help you need, she will be able to persuade someone else to come after her, or to stay a little longer?

I wish we could give you more practical help, but we can listen and encourage you, giving you some moral support.
 
I hope I’m not out of line to ask this, since it’s not for me, but I’m curious, what kind of things in PT are good for a case like this? What would not be good?
 
Therapy, pure and simple. With trauma cases the whole picture changes because there is a fracture involved.
 
Thank you all for your responses. I go back and forth between feeling optimistic and just feeling worried, but I am reading every word.

@Josephine the image you put on your post looks very similar to what the surgeon showed me.

I'm a very "compliant" patient so I immediately agreed to stopping pain medication but I've never dealt with an injury or pain on this level. I guess that I figured that he's the doctor and I'm just the fool who broke my knee.

I see a family nurse practitioner as my primary-- I'm really healthy and haven't ever had any health issues beyond a difficult pregnancy. But I can certainly see if she can help me further. Should I tell the surgeon that? I don't want to seem sneaky or anything. But she knows me a bit better and i think she might empathize a little more about my situation in general.

I certainly don't want to make anything worse so non weight bearing it is.

I'm not terribly impressed with my surgeon's office. He's at a super fancy office for traumatic sports injuries. I don't fit the mold for one of his typical patients. But he's the guy who the hospital assigned to my case, one of the only trauma orthos they have. I do think/ worry that he thinks I'm being a wimp.

Practically speaking, he told me I could take a real shower but once we got home, we realized that we have no way to safely get me into the shower/tub combo. It's probably not super safe for me to try and balance on my good leg for the duration of a shower either. We're going to go to try and pick up a medical shower chair thing today.

We returned Christmas gifts and purchased an inexpensive wheelchair so that I could at least attend Mass. It's made a few things easier. I have a great church but I don't think I can bring myself to beg for help. We don't know a lot of people here and have only been going to this parish since October.

It's good to know that PT shouldn't hurt. Do you have any tips for politely declining to do something that causes pain? I'm expecting discomfort and I'll work hard, but I don't want to be miserable.

Thank you all for your help.
 
lilmom21,
We have an article in the library about saying NO to PT.
Saying no to therapy - am I allowed to?
Some of our members have set limits for the PT during the first visit. If you do not feel the PT is a good fit for you, you can ask for someone else, or go to another clinic.
Remind yourself that the PT works for you not the other way around.

Even though you have not belonged to the church for very long, you can ask if they have a program in place for ill, recovering, or disabled members?

It is a good idea to talk to your nurse practitioner, she knows you better. It is OK to switch your pain meds to her.
 
I guess that I figured that he's the doctor and I'm just the fool who broke my knee.
He's a doctor who is more interested or fearful of getting the FDA come down on him for 'over prescribing' than caring about his patients.
I see a family nurse practitioner as my primary. I can certainly see if she can help me further. But she knows me a bit better and i think she might empathize a little more about my situation in general.
Jolly good but can she prescribe? Opiods and similar usually have to have an MD sign for them.
Should I tell the surgeon that? I don't want to seem sneaky or anything.
Why? It's none of his business! And remember who is employing who here! Would you report it to your plumber if you got information from somewhere else?
but once we got home, we realized that we have no way to safely get me into the shower/tub combo.
There are lots of aid in this article Recovery Aids: A comprehensive list for hospital and home. I used a bath shelf to get into and out of my tub to shower.

bath board.jpg


You back up to the bath and sit on the edge of the shelf. Then swing your legs around into the bath and sit while you shower. Do the reverse to get out. Luckily by the time I had knee #2 done, I'd had my tub removed and a nice shower cubicle installed so I didn't have that problem!

If you have problems getting your leg over the bath side, get a leg lifter to help it over. Or you could just use a belt or something strong.

leg lifter.jpg
 
I have a great church but I don't think I can bring myself to beg for help. We don't know a lot of people here and have only been going to this parish since October.
I think you should ask for help. That's what the church is for - giving help to people who need it. Read this article and see if it helps you to feel better about asking for help:
Nurturing mother: how to let go and accept help
Remember that, by asking for help, you are giving someone else the opportunity to be of service. I bet there are at least a few women who would love to help you, especially if they can get smiles from your lovely baby!

It's good to know that PT shouldn't hurt. Do you have any tips for politely declining to do something that causes pain? I'm expecting discomfort and I'll work hard, but I don't want to be miserable.
As Pumpkln said, just say (politely but firmly ) "I'm not going to do that. It causes too much pain and my knee isn't ready for that yet."
 
Let me agree with Celle. I think any good church would be devastated to know that there was someone in desperate need for help and they didn't know so they couldn't help. Christianity is all about helping and nurturing and doing what one can to help. They don't seek to convert you or ask you to pay - faith given help is free. It comes from the Father. Don't be too proud to ask.
 
We're going to go to try and pick up a medical shower chair thing today.

Hi @lilmom21

So glad you found us. I wanted to add my 2cents about the shower chair. I had both knees replaced in September, and I have used a shower seat and it has been great. I wanted to suggest that you purchase a hand held shower attachment and have your spouse install it as well. That way you can sit throughout your shower, and use the hand held to shower off the soap. Then when finished swing your legs over and sit and dry yourself off. My shower seat extends over the side of the tub, so that two legs are inside the tub and two are outside the tub. My son was able to pick up a hand held shower attachment at Lowe's for about $80, but I know there are cheaper ones out there (more expensive ones as well). He had no trouble installing it, and we put the original shower head under the sink so we can replace it if and when I move.

Also, I know it is embarrassing and uncomfortable to think of asking for help from your church. Just think about it and pray on it for a while. You don't have to do anything yet, because you have help for ten days in January. Maybe your husband could make the phone call or contact the church to inquire without making any kind of commitment.

Also check online to see if there are any moms groups in your area. I remember when my daughter in law and son moved to a new city with a very young baby (my beautiful grand girl) my dir in law found a moms group online, and they had meal chains etc for when members were sick or in your kind of predicament. Of course they had face to face meetings too, but the group was registered online. Maybe check out meet up. Just always be careful about releasing your personal information to anyone online, which I'm sure you know about, but I bet there are moms groups in your area.

So sorry you are in such a predicament. So glad you got the wheelchair. Also, instead of purchasing the shower seat, see if there's a medical supply store in the area that will rent you one. The rental for a couple of months would probably be less expensive than the purchase.

Sending good thoughts and healing thoughts as well. What a story you are going to have to tell to your grandchildren. :)

All best,

Mary Lou
 
My church is always looking for opportunities to help within the community. Put yourself on the other end, I’m sure you’d be disappointed if you were able to be of help to someone but didn’t even know help was needed. Give the church a call, explain your problem and if they can, great. If they can’t, then you’ll know one way or the other. Most of us here on BoneSmart have had to learn to ask and/or accept help after our surgeries. It can be a new experience to be on the receiving end, but just as edifying as giving.
 
Thank you all, again. I am grateful for all your thoughts and advice.

I will be better about asking for help. This has been an incredibly humbling and humiliating experience but I won't let my own pride prevent our child from receiving adequate care. I promise.

I do actually belong to a mom's group and did put the word out a few days ago but I don't know any of the moms very well -- friendly acquaintances and so I understand the lack of response.

We did get a secondhand shower bench and I was able to take what was probably the most glorious shower of my life. I did need help getting in and out of the tub -- my right leg feels like a limp noodle when out of the brace. The knee feels like a marble loose in a sock. It is disconcerting.

I'm sure that I will continue to have questions. Thank you all. I promise we are considering everything. I'll update as I am able. May blessings come to you and yours in 2018!
 
Yes, please let us know how you're getting on.

I hope someone from your church can help you. Would it be a good idea to contact your priest/church leader? Some prayers and a message during the service might be helpful. There might even be someone at the church who co-ordinates parish support.
 
I was on the receiving end of help from my church. I am alone and with my right tkr, was unable to drive for 7 weeks. Someone from my church family was available to help me with my first shower, pick up meds for me and take me to the doctor. I was hugely blessed by their help and they were blessed to be able to be a help to me. Give people a chance to be blessed by helping you!
 
My personal experience has been that giving my time to help others is gratifying. As a contractor I went with my church and helped post Katrina. I also had a neighbor and fellow church member whose wife was working and I was honored to be able to drive him to his chemotherapy appointments. Please give your fellow church members the opportunity to give you some help.
 
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Hi everyone, I hope your New Year is getting off to a wonderful start.

I have just started PT with a wonderful DPT who completely listens to all my concerns and is experienced with my injury. She assured me that I'm not being a wimp -- that she knows I'm in considerable pain-- and agreed with all of you that I need to take my prescription as written instead of bearing through without it. So I will. Because y'all were right (again): ibuprofen ain't cutting it.

She was also concerned to discover that I have no dorsiflexion in my right foot. I'm stuck at 0 degrees. I still have tingling in that foot too. I mean, I told the surgeon all this and was dismissed with a "you probably have damage in your calf muscle" when I told him I was worried about foot drop. My affected knee can get to 50 degrees flexion so far and almost 0 degrees extension.

I intend to show up in person at his office this afternoon to drop of FMLA paperwork and to inquire about getting a temporary disabled parking placard as my phone calls have not been returned. I get very tired using the walker and will be non weight bearing for at least the next 7 weeks.

My family is amazing. I have a train of family members flying in for a week to 2 weeks at a time so I have help until the 2nd week in February so far. I've been in contact with my church and the pastoral associate told me to let me know what l need and when and they can help make it happen.

My husband is having a hard time getting a hold of the appropriate HR person at his work. He has been with the company over a decade and has accrued plenty of leave but after asking for FMLA and who he needs to speak with, he's been completely ignored. He's sent a paper trail of all his concerns to his boss's supervisor.

I'm feeling a little bit more positive today, but I'm just so up and down. I'm not sleeping well and the pain is pretty constant still, though certainly getting better-- very slowly!

It appears that my baby's getting ready to start crawling. I desperately wish I could crawl around with him. I get pangs of terrible sadness when he gets a bath (that used to be our nightly ritual), or is being swayed, or when he suddenly cries and i cannot get to him quickly or when I have to hand him off because he's kicking too much and hurting me. But I am doing my best to try to remember that he won't remember this and he is so very loved. We should all be so lucky.
 

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