ORIF Tibial Plateau Fracture Post-op Normal ROM Questions

Thanks Liam2015. ROM is impressive. I know it is so hard to gain that back, as well as at home exercises.
Wall squats are super impressive. My wife is still nervous about putting significant weight on her TPF leg.
We will look into poles. We did have a great PT workout with parallel bars on wed. However, we had a set back yesterday. My wife was trying to clean a counter in wheel chair and it flipped forward and she hyper flexed her surgical leg (planted on floor) - with weight of entire wheel chair on her leg. We spent today in ER, with lots of swelling and pain medially (TPF on lateral side). Xrays came back negative, and her surgeon (who happens to be at same hospital) reviewed films and found no problems with TPF. They didn't think there was ligament damage, but wanted to wait on MRI. Our concern is meniscus. Surgeon PA met us in ER and thought we performed a default manipulation, and pops we heard during injury may have been scar tissue - since her ROM is slow going. She is a special case as she has a brittle bone disease diagnosis, and surgeon wants to go slow on PT. She has had over 20 bone fractures, so we are always extra cautious. We are icing, elevating, taking Advil....and will see. So we have cancelled PT for rest of week and hope to get back on track next week.
Hope you continue to progress.
 
I'm sorry to hear that your wife had an accident, @VolFan0927 .
I'm glad she didn't fracture anything.

Please try and help her to be careful and not to do anything where she runs a risk of hurting herself.
She really should be taking her recovery very slowly and gently.
 
Oh darn ~ I am so sorry about the accident; sounds like no damage was done as far as the surgery goes. I fell on my operated elbow 4 weeks after surgery and luckily, no damage, but set me back. I understand your wife wanting to do things but it's really difficult from a wheelchair, unless you're used to it. I could only do little chores from the walker. These accidents make one more aware, as I can attest from personal experience.:blackcloud:

Good decision to take a couple weeks off from p.t. to recover. Hope she can feel comfortable, maybe with icing, elevating, massage (if allowed) and back support. My back gets stiff with all this sitting around; try to find best position. Sending best wishes to your wife and you.:console2:
 
Thanks liam2015. My wife is slowly getting better after her knee hyperextension in wheelchair tip last tuesday. We are still seeing some swelling which is helped with ice, and she is getting the lost ROM back slowly. She seems to be able to weight bear in the am, but by the time we get to evening it is a bit more swollen and more difficult to weight bear. Yesterday we want to a local cafe for her to sit outdoors for a meal, first time in several weeks. We are debating whether to skip PT tomorrow, depending on how she feels. We try not to worry about ROM gains, but she was doing so well in PT last monday with lunges and step ups. Our concern is the set back over this time. We did notice that massaging behind the knee cap in the joint really seems to loosen things up when she is tight. She was wondering if this gets better with time, if ADL on a regular basis loosens things up or will we always need massage. Also, did others in the group go to formal massage therapists and how long after injury? Thanks
 
These types of surgeries/recoveries are long and slow, with a lot of ups and downs. “Set backs” are par for the course. ROM fluctuates dependent on swelling, and swelling flucuates dependent on our activity level.

My medical team was so focused on ROM they had me a nervous wreck the whole first year of my recovery. My ROM improved very slowly that first year, but I had a lot of improvement in my second, and even my third year, as my whole leg continued to heal and relax. It made me angry, looking back, at how much they stressed me about the ROM, because it did come in fine over time.

I also found that my PTs had a cookie cutter plan for rehab, and my body didn’t fit into it. If I could do 10 of something, they told me to do 20. If I could do 20, they told me to do 30. There was no need for me to do 20-30 reps of anything. If I were your wife, I wouldn’t do any lunges, and maybe not even the step ups. She’ll step up on something in everyday life when she’s ready.

PT can be helpful, but it can also be a problem, if our particular body isn’t up to their protocol. With your wife’s fragile bones, she needs to be really careful what she does, at home and at PT. PTs don’t always look at the whole picture. My husband experienced that. Long story short, he had a disease that limited his movement and compromised his posture, and his PT couldn’t even be bothered to look at his X-ray to see why he couldn’t stand up straight, and the things they had him do only exhausted him, rather than helping.

We did notice that massaging behind the knee cap in the joint really seems to loosen things up when she is tight. She was wondering if this gets better with time, if ADL on a regular basis loosens things up or will we always need massage.
Many members think PT is needed to alleviate tightness. Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing...and full healing takes a full year or more.
 
Your wife should be doing only what doesn't cause pain and swelling. Pain and swelling slow down recovery. She has to recover from the pain and swelling until she can get back to healing from the surgery. That makes it counterproductive.
 
Thanks all. Agreed that should take it easy. We will go easy this week and see how her body feels and let that guide us.
 
We are debating whether to skip PT tomorrow, depending on how she feels. We try not to worry about ROM gains, but she was doing so well in PT last monday with lunges and step ups. Our concern is the set back over this time.
I think you should skip PT tomorrow.

Honestly, it's fortunate that your wife didn't injure herself more seriously.

This accident was a temporary set back, so don't worry about it. Just try to make sure that she doesn't do anything else that could cause an accident.

It's not even 3 months since your wife's surgery and complete recovery, even for people who don't have brittle bones, takes as long as a full year. That means that she has at least 9 months for improvement.

There's absolutely no need to rush and no need to fret about progress. ROM can continue to improve for at least a year and we've had people on BoneSmart who noticed an increase in ROM for several years after that.

Tortoise forward.PNG
 
Hi ~ that must have been nice for you and your wife to get outdoors to a cafe for a meal. To touch on your question about massage ~ I can only speak for myself. My favourite part of p.t. is the massage, (leg/knee/thigh), laser treatment (only takes a minute or so) and TENS with hot packs on my knee and thigh for around 20 minutes (with lights turned down low) and the bed now in a sitting position after I mentioned how sore my back gets laying down flat. It just feels good.
The physiotherapist doesn't have me do any exercises there, other than the stationary bike for 5 min. and last time 10 min. She does bend my knee to check on r.o.m. and has me walk a few steps unassisted to see if there's progress. She doesn't want me to walk unassisted yet because I'm taking baby steps and limping; also has me show her how I'm walking with the pole. She did demonstrate one of the new exercises, which she has added to the ones she recommends I do at home. I would be happy to just have the massage and treatments and forget the exercises.:) :-) (:
Hopefully a bit of a break from p.t. and your wife will regain her strength back and swelling and pain lessened.
 
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I had a full body massage a week after my TKR. I generally go for massage every 2 weeks since I think it’s one of the healthiest things you can do for your body. It was a slight challenge turning over onto my stomach so soon after surgery, but we took our time and managed it. Felt so good to have my back and the back of my leg worked on. Fortunately, my massage therapist is also my physical therapist, so she knew exactly how to treat my new knee. I highly recommend massage for relaxation and increased circulation.
 
Thanks for the insight about PT and massage. We ended up going to PT today, as my wife felt it had been a week since her last session. She participated lightly, and the PT spent more time on massage, laser therapy, and non weight bearing ROM. She did not seem to have big reduction in ROM from last time (95-100). She was pretty exhausted afterwards. Her knee swelled up, and we are icing now. She did not have pain after the session, but it was painful to try and weight bear. We still believe she has either strained or sprained low grade. She is better than last week following her injury, but not recovered. We discussed that it may take several weeks to recover. I asked to skip PT on wed., but she would rather wait and see over the next 2 days. We will see....
 
Hi all,

We are trying to figure out difference between a knee sprain or something more severe such as meniscus tear, or ligament tear requiring intervention. My wife had her knee hyperextension in wheel chair a week ago. They performed an Xray in ER and ruled out any broken bones or hardware on operated tibia plateau (PO 11 weeks TPF).

Swelling has gone down, but returns after too much partial weight bearing. She can maintain her ROM (although only up to 90-95) without pain, and no clicking or catching. There is discomfort medially (opposite of lateral side of knee surgery) below patella if she tries to full weight bear. No noticeable bruising, but a tightness in knee. They did not want to do MRI as felt it would not be helpful being this close to previous surgery. We have two more weeks before a planned followup with surgeon. I am hoping it is a low grade sprain - and we do our diligence of resting, icing - but wanted to see if there are tell tell signs of something major we should be mindful. Realize that sprains take time to heal also. Thanks
 
Did you tell your wife's surgeon about her accident, @VolFan0927 ?

If not, I think you should. It may be possible for him to see your wife sooner than the planned appointment. If nothing's wrong, that will reassure you both and if something is wrong, the sooner your surgeon knows about it, the better.
 
Thanks Celle. We actually went to the ER associated with the Trauma hospital where he is affiliated. He was in surgery, but his PA met my wife in the ER to evaluate her and took her xrays to him to review while we were there. No problems with surgical side of knee thankfully. Although they did not perform an MRI.. We did go to PT today, and PT evaluated and thought she was not symptomatic enough for meniscus or ligament tear - at least serious enough to warrant intervention. Possibly a stretch and self mini manipulation. She felt better today, and doing light activity managed to go without pain beyond her ROM last week (100-105 today). Although he told her to use ice regularly. We hit 12 weeks post op this Thursday, and more than anything we want to be cautious. We have a surgeon visit in 12 days.
 
I'm glad your wife is feeling better today and wow, her r.o.m. has improved. :SUNsmile:
 
Thanks, hope the ROM is permanent. Although she didn't test via typical heel slide, and PT mentioned it when she was doing a lunge. She is still weight bearing in limited amounts - as PT felt she over stretched in wheel chair accident last week, and we are doing non weight bearing ROM activities at home. She did cycle a few revolutions today. Swelling is down more today, and PT tried several tests yesterday and felt she was negative for soft tissue injury which is a plus. She is still down about being able to limited weight bear, as she felt she was making progress to finally be out of the wheel chair.
I think with patience in another 10-14 days she will be progressing in that direction.
 
An update following my wifes injury 2 weeks ago. Looks like no damage with her wheelchair accident.
She is continuing PT and focusing on trying to walk with walker. This last weekend we went to salon and for first time walked from car to inside. I think she overdid it. At PT next day she hit 100 degree ROM (same as 2 weeks ago), but she walked alot for first time, and she is tighter in knee area. She is 13 weeks PO now. We visit surgeon for 14 week PO visit tomorrow. My main q, is how much swelling did others have after early ambulation and I am sure it impacted ROM. Tks
 
Good luck tomorrow at surgeon. Sorry I can't answer your question about swelling because mine always looks the same, although I'm sure there is inflammation. Pedalling on the stationary bike for 8 minutes at physio causes stiffness and soreness, so I take a couple days break from doing any exercises at all after physio, other than walking around the house doing chores. I do try to sit down in between chores ~ I'm sure too much walking and I'd feel the same as your wife. p.t. wants me to walk outside a bit and on different surfaces now with my pole (and hubby).

Encourage your wife to take it a bit easy for a couple days after overdoing it, also whatever home therapy recommended, such as elevating, icing, heating, massage and whatever meds are prescribed.
 
Thanks @liam2015! She took it easy yesterday, with some light ROM and icing. We have a small pedal device at home (no resistance now) and she felt it was a little easier to peddle. She is in that stage where she can barely peddle a complete revolution. She is getting stronger to move around house. She tries to use her new 4 wheel walker to move around. Probably a few weeks more before she gives up wheel chair for longer exertions though. Her quads are still super week, with difficulty in doing sitting leg raises for a whole set of 10, but she is working to improve. PT told her this week that if she tried to stand unaided on her bad leg unassisted she would probably fall due to muscle weakness. I still think with a TPF injury (or other large bone fracture) that the recovery curve is a couple months behind TKR. I try to encourage my wife that she will get there, but due to trauma her 3 mo recover period now is similar to being at month 1 of TKR due to her non weight bearing status for about 10 weeks. Any way, just my speculation. Hope your recovery is coming along!
 
We visited surgeon this week. Wife just hit 14 weeks PO PTF and Meniscus repair. Her xrays were good, but still slow on ROM. Surgeon mentioned MUA and surgery for knee stiffness - but does not want to consider either. He felt my wife's brittle bone disease would put her at risk for fracture with MUA. He mentioned continued work on ROM (100 right now) - and a story about a recent ski mobile accident patient returned at 3 yr with 130 degrees ROM, which was better than her 1 yr ROM.

We had a good day at PT, wife walked for 10 minutes on Alter G Treadmill (anti gravity TM with seat harness to elevate walker), which allowed her to walk at 60% total body weight. So I think even though she is cleared to walk at 100% weight bearing, she can't tolerate 100% yet. The PT mentioned adding 10% weight bearing a week to get to 100% over the next month. My wife did 10 min light cycling with no resistance. However, she was stubborn and went to salon right before PT for a blowout, and with all the walking with walker/TM resulted in her being really swollen in knee last night. We rested, iced, and she took a tylenol. I know she has to take things slow, but she is really frustrated by lack of quad muscle strength - leg muscle atrophy, and reduced ADL is frustrating to her. PT will not allow her to do any wall squats, as strength is not there, and still too early post injury.
It is also hard for her to come into PT being in a wheelchair, and seeing other knee patients walking in - possibly in 3-4 weeks she could walk in on walker alone!

We will continue to focus on slow but steady progress.
 

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