ORIF Tibial Plateau Fracture Post-op Normal ROM Questions

[VolFan0927]

Thanks Jockette. My wife did say no last session to another round of heel slides and trying to stand with the hand rails. Mayne tomorrow she will try try to stand and weight bear.

 

[Celle]

Thanks Celle. We have been pressing this point about going slow. A couple of times we had to slow PT down, so a good suggestion. Trying to gauge how much of an impact this will have, but we are estimating things are slowed down at least 25%. OS told us for example, that most by 8 weeks PO can consider full weight bearing after surgery, but with my wife it will most likely be 12-16 weeks PO.
I assume similar improvements in ROM, although OS has a reputation for being aggressive, but mainly to minimize flexion contracture.

I'm sure no one wants to have your wife break any more bones during her recovery, but it is a possibility if post-op exercises are too aggressive. That's something everyone should bear in mind.

I know that progress must seem terribly slow, but it's worth being cautious, to get a good result.

 

[liam2015]

My wife is 8.5 wks PO from TPF, and going to PT 2-3x a week. She is doing heal slides at home, pushbacks, peddles, calf raises, and leg lifts. PT suggested she do exercises with a couple small blow up balls for hip flexors and abs also. It is challenging for her to get ready for PT (non weight bearing, brace to move also), but I have arranged my work schedule to make sure we have time to go to PT. She is anxious as the PT showed her the Alter G Treadmill yesterday (which allows body weight to be reduced) to accommodate partial weight bearing. She is nervous, but wants to use it if it will allow her to begin walking slowly without having to use her upper body to support her (shoulder issues from over use with walker).

That's interesting about the Alter G Treadmill ~ I had not heard of it before. I hear your wife about being challenging getting ready for p.t., anxious and exhausting. Glad she has your support.

 

[VolFan0927]

The Alter G treadmill requires wearing a seat harness, and and a lower body suit (https://www.alterg.com/) and adjusts your weight bearing to walk on the treadmill at 25, 50%, etc. body weight. She hasn't started yet, getting courage right now. Will let you know once she starts.

 

[Jamie]

The AlterG treadmill is a wonderful addition to a therapist's tool box and I hope your wife decides to try it soon. Years ago my husband was recovering from some major surgery and had mobility issues. The rehab center where he was an inpatient had just gotten one of these machines and he was the first to get to use it - the guinea pig. It enabled him to walk when he was unable to do so with either a walker or crutches. His legs got stronger and he was able to walk again with some time and effort on his gait and strengthening. The machine was not painful and enabled motion that he would not have been able to do otherwise. It's VERY safe and gentle.....perfect given your wife's bone health issues.

 

[liam2015]

Thank you for the link. That is fantastic technology.

 

[VolFan0927]

Hi all,
new PT measured wife flexion w laying heal slide at 78, and with sitting pushback flexion around 90. He told her sitting did not count. Her quality of ROM has improved, but not total. Extension is very good (-1 or -2).
She was in tears b/c we have 10 week visit with surgeon next week. She stood for 10 minutes at 50% weight bearing also. I told her continued improvements. PT did work her hard this time, so we iced, but her hip flexors were really sore. Still trying to convince her that ROM will come, as PT did not think lysions were the issue.

 

[sistersinhim]

new PT measured wife flexion w laying heal slide at 78, and with sitting pushback flexion around 90. He told her sitting did not count.

Her PT has it backward, the bend laying on her back doesn't count, sitting up and bending does. Afterall, does anyone walk on their backs?!

PT did work her hard this time, so we iced, but her hip flexors were really sore. Still trying to convince her that ROM will come

Working hard works against healing not toward it. Her bend will improve as the swelling goes down. You can't bend a water hose full of water with the nozzle closed. Open that nozzle letting the water out, then you can easily bend that hose. The knee is the same way. Get that fluid out and her bend will increase. It takes lots of time and patience. Please try not to worry about it. The body knows what it needs to do.

 

[VolFan0927]

Thanks. Trying to get a good idea about swelling. Her knee swelled externally last night after PT and we iced. How long does internal swelling take to go away. As I have read that as little as 2 tablespoons can inhibit ROM. My wife is extremely petite, lost 8 pounds down to 80 during this process and believe her knee capsule is very small to begin with. She is 9 wks post TPF (and meniscus repair). Also, her tightness is more medial, but the repair was a lateral sided plate/repair. Any thoughts welcome.

Right Leg Lateral TPF Repair 2/12/21
Right Leg Lateral Meniscus Repair 2/12/21
Left Leg ACL Repair ~ 1988, long lasting Gortex Ligament Survivor

 

[Jockette]

Working hard works against healing not toward it.

I totally agree!

new PT measured wife flexion w laying heal slide at 78, and with sitting pushback flexion around 90. He told her sitting did not count.

I don’t understand why he would say this. A bend is a bend, no matter what the position. My bend was always less laying down, and still is 4 years after surgery.

When you say pushback, does that mean the PT moved her leg? There is no need for them to do that, as they tend to go further than our knee is ready for, and unfortunately, too many of them are fans of doing this. Even my surgeon did this to me at all my early check ups. But, I will never allow anyone to do this to me again.

 

[VolFan0927]

I agree a bend is a bend. He kept telling us that the official way to measure ROM is laying on back and doing a heal slide - and that he would put an asterick by the measure. I don't agree with him, but as a PT he is much better than the other PT we were going too. Our problem is that we were visiting family in FLorida, away form our home in Minn - so we are staying in central FL until my wife is rehabbed enough to travel back home, and our PT options are limited in the area we are staying - although we traveled more than hour away to go to best trauma surgeon in area.

 

[sistersinhim]

You don't have to go to PT. Many of us did our own rehab just by using our knees the way they were intended to be used by doing our daily activities.

I was blessed to have a surgeon that never pushed PT. He gave me a prescription for it, which I threw away and never went. When I went for my 3 return checkups, all he wanted was to see what my knee would do. Never one question about PT! Of course, he knew I was a single lady that had to take care of myself, so obviously he trusted that I would not be just laying around all the time.

After 12 knee surgeries, I know that I do not need PT, and neither does anyone else if they do their own daily activities. My knee recovered just fine all on its own with only my daily activities. I didn't have the terrible swelling, agonizing pain, and worry that so many have after taking formal PT either. I knew the Bonesmart way worked before Bonesmart was even thought of. My surgeries started in the early 80s and I never went to PT even back then. I just didn't see the need for it. Bonesmart was formed around 2004. By then I had already had 6 knee surgeries and rehabbed the Bonesmart way!

 

[FCBayern]

I'm one of those that didn't do formal PT for my TKR recovery @VolFan0927. Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. I've been hiking over rough terrain for good distances, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.

 

[VolFan0927]

Thanks @FCBayern. Do you mind if I ask how your ROM progressed early to later time?

 

[FCBayern]

I was around 117 degrees of flexion and 4 degrees short of full extension at 12 months. I could do pretty much anything I wanted to at that point. During the course of the second year my flexion increased to 135 degrees and my extension one degree backwards.

 

[VolFan0927]

Well, wife is entering 11 weeks postop TPF and meniscus repair. Flexion is 95+. Her surgeon last week told us the xrays look very good, and she can progress to 100% weight bearing as tolerated. PT has her doing different things - small step ups, her first cycle revolution, heal slides, using walker to do gait training, regular massage of muscle. At home we are adding ADL items. She ambulates in kitchen with aid of walker and took her first assisted shower. Slow progressing with ice as needed, and dosage of advil/tylenol. We are seeing about a 2-3 degrees ROM improvement each week. We hope in another 4-6 weeks she can try a cane, but realize it may take longer. Curious if anyone has tried rehab pilates? My wife had been doing pilates before her accident, and there are a couple of places with PT/pilates - mainly for stretching, etc.

 

[liam2015]

I'm so happy to hear that your wife is making gradual progress and she's now allowed to put 100% weight as tolerated. I'm around 4 months post op and a couple weeks ago my p.t. suggested buying urban poles (says "activator" on the side). For in the house and going from car to physio clinic, I just use one pole so I can carry things in the other hand plus it's easier than using 2 poles at the moment. It feels so much better than walking with the walker because I can stand up straight. I still use the walker when I get up to the bathroom at night.
There's certainly no rush to go from walker to cane or pole, and it takes some practise. That's super that your wife was able to do her first cycle revolution ~ I did that just a couple weeks ago also ~ huge step. btw did your wife use the Alter G Treadmill yet and how was it?

 

[VolFan0927]

Thanks liam2015. Very interesting about use of the poles. Do you find they provide adequate stability? My wife is just now using walker with wheels. Her first cycle revolution was with the seat way back, just so she could complete it, so not sure ROM on that. She hasn't tried alter G treadmill yet, as since she has moved to full weight bearing as tolerated, they have her walking using the parallel bars. She did 3-4 back and forth trips (about 60 feet round trip for each trip) on the last visit and the PT mentioned that they may not need to special treadmill since she can weight bear. She was doing some lunges and step ups on her last visit also. We are trying to patient on ROM, as we are focusing on strengthening her leg muscles and being able to walk short distances with walker. How has your ROM progressed? Is there any specific daily activity at home which seemed to help there? From my best assessment, it looks like a tibial or femur break - that daily weight bearing and ROM maybe 2 mo or more behind a knee replacement, which just means one has to go slower and expect more time for recovery.
Thanks and best of luck.

 

[Celle]

Well, wife is entering 11 weeks postop TPF and meniscus repair. Flexion is 95+. Her surgeon last week told us the xrays look very good, and she can progress to 100% weight bearing as tolerated.

Great! She's passed the landmark flexion of 90 degrees, after which very few surgeons even consider doing a manipulation (MUA).

Her first cycle revolution was with the seat way back, just so she could complete it, so not sure ROM on that.

We are trying to patient on ROM, as we are focusing on strengthening her leg muscles and being able to walk short distances with walker. How has your ROM progressed?

Your wife's knee is making steady progression with bending, as it continues to heal.
Now is the time to forget about ROM numbers and let your wife's knee continue to improve in its own sweet time. What she can do with her knee (function) is far more important than the numbers.

PTs tend to get obsessive about ROM numbers, because showing a fast progression is one way they can prove how effective their ministrations have been. Just because they're hooked on the numbers game doesn't mean you have to join it.

Really, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

My surgeon doesn't want to know what ROM numbers are. He can tell, just by looking at the knee, how well flexion and extension are progressing. He looks at me knee and says "Show me what you can do."

 

[liam2015]

I agree with you, in my case, that recovering from femur break is taking a lot longer than the knee replacement as far as walking goes. I was walking with no assistance 3 weeks after TKR, but my r.o.m. took a lot longer. Today the p.t. estimated my r.o.m. at 115 degrees, which has come faster than after TKR. As far as exercising at home, I am terrible. I only do them sporadically and today she gave me 2 new exercises. I am supposed to do heel slides (I don't push past what is comfortable any more), leg lifts to the front, leg lifts to the side (easy), up and down tip toes (easy) and today, very mild squats around a foot away from the wall until my butt touches the wall, and also bridge, but on the bed, which I am hesitant about. I would rather do it from the floor but p.t. is worried that I might twist getting up. We'll see how it works on the bed. It's actually one of my "go to" exercises prior to this injury. I did 10 minutes on the stationary bike at physio today.
Regarding the poles: yes I do find them very stable. I'm only using one at the moment in the house. I'm not going outside or anywhere other than physio, but when I do, I will practise the rhythm of using 2 poles. With one, I can carry things in my left hand, so I don't have to wait for hubby to bring me a coffee lol! I do walk around a lot in the house, getting up and down and doing whatever chores I can. I think walking is probably the best thing I can do.
Continue to be patient for your wife; sounds like she's improving gradually. That's impressive that she was able to walk with the parallel bars for 60 feet plus back and forth.