ORIF Tibial Plateau Fracture Post-op Normal ROM Questions

[Jaycey]

We will continue to focus on slow but steady progress.

That's exactly the approach you need to take. Yes, it does take tons of patience. But we see many members who continue to improve ROM years out from surgery. Hang in there!

 

[liam2015]

Sounds like a great report and fantastic that the x-rays look good. Your wife finally got to use that special treadmill and her r.o.m. 100 degrees flexion is super.

How lucky she got to go to hairstylist ~ we're still locked down here and I have Covid hair, but healthy, so that's the main thing.

I understand how she is frustrated, but best to take her time in recovering as she heals properly. Hang in there, both of you.

 

[VolFan0927]

Thanks. Today's PT was lighter after treadmill yesterday. Still some swelling, so lots of ice, elevation and slow walking till next PT on Tuesday. This was a super busy week, so hopefully slower pace next week. We have about 8 wks PT left here and then fly back to our apt. in Minn. Hope my wife will make enough recovery to travel adequately. Hope to transition to a cane by then and improve ROM another 10 degrees.

 

[VolFan0927]

A little odd question for group. Using walker so much, my wife seems to have a hip imbalance, or pelvic tilt. We notice that one hip is higher than the other - I think from her posture using the walker the last 3 mo. Has anyone had this issue? And more importantly did massage therapy or other PT help?

 

[liam2015]

I used the walker for 3 weeks after TKR 4 years ago and recently for several weeks after broken femur when I was non weight bearing. Approx. 3 weeks ago my p.t. recommended using an "urban pole", actually a set of 2, one for the right and one for the left as there are specific grips on them for each hand. I only have used one for around the house and walking from the car into physio clinic and I like it much better than the walker. I can stand up straight and I can carry things in my left hand. I tried using 2 at physio but found it a bit awkward, but eventually I'll try using 2 for hiking and I can wear a backpack.

At first, I still used the walker for getting up in the night to the bathroom, but once I got more used to the pole, I don't use the walker anymore, other than as a towel hanger beside my bed lol! I don't think I have any hip imbalance. Because my lower back gets "weak/sore" from standing too long doing chores in the kitchen, I have started doing some of my back exercises: laying down on a bed, pulling knees to chest, pelvic tilts I think they are called, and bridge (this one recommended by p.t.) but it's hard to do on bed. I'm looking forward to getting down on a yoga mat to do those exercises, once I am confident I can get up on my own.

As far as massage therapy, the p.t. only does massage on my leg, so I can't speak to that. That's my experience. Hope your wife can get some answers and advice from her p.t.

 

[VolFan0927]

Thanks liam2015! Walker poles are a good suggestion. We skipped exercises yesterday, as we are building a home in FL and spent the day picking out interiors. My wife used her walker at the design center, but we were there for 8 hrs - most time she has been out since her surgery. We go back to PT today. We are planning to stay here with the local PT for another 6 wks and then go back to Minn. We do have a more specialized PT group that deals with orthopedic injuries she will work in Minn.

 

[VolFan0927]

We went to PT yesterday. My wifes ROM is about 98, still constant over a month. She has not changed much this month, but she is using her walker alot more and some leg strength has returned. She can stand on both legs, she can walk 75 feet with walker as two weeks ago she could not. She is doing about 300-400 steps a day now with walker. Her ankle and knee were swelling alot, and hamstring super tight. I know we have to be patient, but still concerned about ROM since we just passed 4 mo PO on her leg break near the knee. This week has especially been tough, as we are building a new home, and at least 3 days we were out picking interiors, visiting cabinet shops, etc. where my wife stood for 30-45 min at a time at least 3 days this week. I hope to get her more into a normal routine next week. My question, could swelling be blocking 5-10 degrees of actual ROM movement? Should we stick to very light non resistant cycling and hamstring stretches, heal slides?

 

[liam2015]

Hi ~ it's hard to say how much r.o.m. the swelling could be blocking. The recovery from these fractures is so different from TKR (I'm at 5 month post op). Your wife has been out and about way more than me, which is a good thing except for having to stand for 45 minutes at a time; I'm sure that's uncomfortable for her (my back feels weak after standing in kitchen 45 min.).

98 degrees flexion is a good improvement and she's getting there. In my opinion, I think she should stick to the lighter activities without pushing past the discomfort level. (pushing into pain only causes the swelling and limiting r.o.m. which I learned here.) I think she's doing great with her walking and the number of steps she's achieving. I was at the 400 steps a day for quite awhile until I started to do more chores around the house, walking back and forth, only having the one hand free to carry things and re-tracing my steps over and over. Now my goal on my Garmin is 1220 steps and I have achieved that on most days recently. p.t. wants me walking outdoors more but I just haven't.

I understand you are busy with building your new home and your wife wants to be involved; as long as she doesn't overdo it, then you both have to be patient with the gradual recovery. I don't think there's anything exercise-wise that will speed up recovery and r.o.m. but adequate rest and mild exercising will help. I'm not sure if your wife is recommended to ice and elevate. my p.t. recommends heat on my thigh and knee. Maybe someone on here familiar with this injury could advise.

 

[VolFan0927]

Thank you liam. You are a voice of reason. This fracture is the toughest recovery we have ever encountered. My wife tore her ACL and had 6 surgeries on her other leg, but this is much worse. I do believe ROM will come. There are probably multiple issues, as my wifes hamstring atrophy (which is super tight) has been a big issue. The PT told us yesterday we should massage every day. She is slowly regaining strength, and can stand close to 100% weight bearing, but there is a big psychological aspect, as fear of falling. Biggest difficulty is patience. She seemed to not improve on ROM the last month, but has improved in other areas - such as leg strength, gait. Although she is swollen most nights due to greater amounts of walking. We will keep at it and try to stay positive.

 

[Jaycey]

My question, could swelling be blocking 5-10 degrees of actual ROM movement?

Definitely - that's why ice and elevation are so effective. Reducing the swelling will allow the ROM to increase.

 

[VolFan0927]

Thank you Jaycey. I am convincing my wife to go slower now, light activity, and more ice and elevation.

 

[liam2015]

I remember when your wife was non-weight bearing and look how far she's come since then. the psychological aspect is real and hopefully she'll overcome that. funny but my hubby is probably more worried about me falling than I am lol, although I dread next winter walking the dog. Once your new home is built and organized, that will lift both of your spirits. Great that her strength is improving. Happy Memorial Day weekend. Stay safe.

 

[Celle]

A little odd question for group. Using walker so much, my wife seems to have a hip imbalance, or pelvic tilt. We notice that one hip is higher than the other - I think from her posture using the walker the last 3 mo.

The walker itself won't cause a postural imbalance, but it would be a good idea to ask your wife's PT to check this.
As your wife starts to walk more, having her hips level will be an important part of having a correct gait.

ROM is about 98, still constant over a month. She has not changed much this month, but she is using her walker a lot more and some leg strength has returned. She can stand on both legs, she can walk 75 feet with walker as two weeks ago she could not. She is doing about 300-400 steps a day now with walker. Her ankle and knee were swelling a lot, and hamstring super tight. I know we have to be patient, but still concerned about ROM since we just passed 4 mo PO on her leg break near the knee.

Swelling will still be restricting ROM. Icing and elevating will help to reduce swelling.

There's no deadline by which good ROM has to be achieved, since ROM can continue to improve for a year, or even longer , after surgery. The article below applies equally to a tibial plateau fracture.
Myth busting: the "window of opportunity" in TKR

This week has especially been tough, as we are building a new home, and at least 3 days we were out picking interiors, visiting cabinet shops, etc. where my wife stood for 30-45 min at a time at least 3 days this week. I hope to get her more into a normal routine next week. My question, could swelling be blocking 5-10 degrees of actual ROM movement? Should we stick to very light non resistant cycling and hamstring stretches, heel slides?

Yes, you bet that swelling can block ROM movement. I'm not at all surprised that your wife's flexion hadn't improved after a week like that.
When you visit shops, you can help your wife by asking for a chair so she can sit, instead of having to stand for so long.

If you're going to spend a lot of time looking at things for your new home, try to have a restful day between days when you're out a lot. On the rest day, help your wife to spend as much time as possible resting, icing and elevating, and only doing a few gentle exercises.

She is slowly regaining strength, and can stand close to 100% weight bearing, but there is a big psychological aspect, as fear of falling. Biggest difficulty is patience. She seemed to not improve on ROM the last month, but has improved in other areas - such as leg strength, gait.

As long as your wife has a fear of falling, she needs to be using the walker. It's too soon to be thinking about using sticks instead. She needs the walker until she is 100% weight-bearing, with confidence.

Forget the lack of increase in ROM this month - more ice and elevation and fewer long days out will help with that.

It's great that her le strength is improving and she's walking with more confidence. While ROM may not have improved, she's making progress in other areas.

 

[VolFan0927]

Thanks Celle. We are slowing down, at least the last 2 days. I do believe the other areas of improvement are great. I will report back in a couple of weeks. Have a nice holiday weekend.

 

[VolFan0927]

Another quick update. 16 weeks PO TPF surgery with meniscus repair. My wife has continued light ROM activities at home, massage to the affected area, including about 15 minutes on recumbent bike with no resistance. AT PT today, following similar warm up she got 106 degrees flexion - and she had been around 100 last week. Extension is real good. She also used a cane for first time in PT. This was a big achievement. They asked us to purchase a cane for use at home. Some light at end of tunnel, and hopefully she can ditch the walker by her 6 mo PO visit to surgeon. Now if we could only work out that pelvic tilt which elevates her right hip - from compensating using walker.

 

[VolFan0927]

A few questions for the group -

1) My wife is still PWB at 16 weeks post TPF surgery. Do folks think being able to put full weight on the leg/knee when doing ADL will improve ROM than PWB? So does limited weight bearing limit ROM gains?

2) My wife has some tightness near the plate implant site (near tibia plateau), is this like the knee tightness similar after TKR?

3) My wife had Grafton massage near her incision this week at PT. It really loosened things up during her session, when she got 106 flexion. Have others used PT near incision site, and how much of a difference did it make? We are concerned about any adhesions.

4) Secondly, did massage like lymphatic massage help in your recovery?

Thanks!

 

[liam2015]

Hi ~ do you mean Graston technique with the stainless steel tool? I have never had it ~ how did your wife feel the day after? I do like the massage that my physiotherapist does on my knee, thigh and along the incision ~ I will ask her next time what it does to help as I've forgotten when I had it 4 years ago for TKR. I did the stationary bike for 10 minutes last week at p.t. and funny enough I found it easier to get into the shower later that day but the next day I was a bit of a wreck ~ so tired and sore. hubby said the bike helped my r.o.m. and that was why I could get my leg over the tub easier, but then I paid for it the next day.
It's so hard to tell if one thing works better than the other, ie. ADL's or specific exercises. Like your wife, I still have tightness in the knee area. I think my barometer for healing is the pain level, which doesn't seem to be letting up, with some days being less painful than others (when walking).
Sounds like the treatments at p.t. are helping your wife ~ these fractures seem to be taking a long time to heal.

 

[VolFan0927]

Thanks @liam2015. I do mean Graston. We are going to focus on adding more massage to my wife's PT. I suspect this is still swelling present, although not visible until late in the evening until she has put in 400-500 steps. Are you full weight bearing? My wife is still using walker/cane and not 100% weight bearing yet, and trying to get an opinion and if full weight bearing in the context of ADL contributes to ROM improvement? So if non weight bearing makes it tougher to get ROM advances.

She is doing about 15-20 min light cycling a day, with no resistance which seems to help. The hardest part is patience of recovery for her. I dropped her off to a restaurant for dinner with a friend last night, and she made coffee for her self unaided last week for first time - nice improvements - although she has a hard time seeing these small wins!

 

[liam2015]

That is amazing your wife can do 15 -20 min. light cycling a day ~ 10 min. once every 2 weeks at p.t. does me in the next day. Does your wife have pain after the cycling? I'm doing approx. half of the time total weight bearing and half of the time using the "urban pole"; however, I'm limping which isn't good ~ I try to walk straight without limping, but I quite often don't bother using the pole just getting around the house. I was averaging around 450 steps; just looked at my Garmin and I've been averaging 1,572 steps daily in the last couple weeks.

It's my thigh that aches when I walk and after the 10 min. stationary bike ride, doesn't seem to be getting better but I'm doing almost all the chores I did before, which probably tires me out, back gets achey standing too long. Hubby does the laundry and walks the dog ~ I fold the laundry and feed the dog.

Great that your wife got out with a friend and making the coffee ~ there will be more small wins that add up.

 

[VolFan0927]

@liam2015, My wife can ride daily without pain. She enjoys the riding and I have to remind her she is not training, but working on ROM. PT told her to keep daily recumbent rides around 15 minutes for now. She is up to about 500 steps a day now, but her knee swells up each night and we ice and elevate. I assume it is b/c she was NWB for 12 weeks, still partial WB now and her leg muscles are very early in their build back. We are in a daily routine where I massage her thigh, hamstrings and calf, as they seem super tight and we are trying to loosen them up. She did some squats today for first time, and really sore tonight. They also asked her to bring a cane to next PT session and to try to use it more around the house. She was at 106 flexion last Monday, with a little help from PT. Today she got 106 all by herself on heal slides. She has a 7 mo followup first week of Sept., so we hope to be around 115-120 by then, but we will see. We are focusing on building her strength and getting to the point she can fully weight bear first! 1500+ steps is great. My wife walks more with a peg leg, but tries to do a march with her knee when she uses her walker and really think about walking form. Know it is still a tough time now, patience is key here, you will do it!