ORIF Tibial Plateau Fracture Post-op Normal ROM Questions

[VolFan0927]

@Jamie, with the 120-125 flexion you reference, are folks able to resume pilates reformer? My wife is 4.5 mo PO TPF, a little different surgery, but she hopes to get back to 130 flexion (107 now) and curious your experience and impact TKR has on this. Thanks

 

[Jamie]

@Jamie, with the 120-125 flexion you reference, are folks able to resume pilates reformer? My wife is 4.5 mo PO TPF, a little different surgery, but she hopes to get back to 130 flexion (107 now) and curious your experience and impact TKR has on this. Thanks

@VolFan0927 Let me tag @Pumpkin to respond to you. She will know more about pilates than I do. By "TPF" are you referring to a partial knee replacement?

 

[VolFan0927]

@Jamie
Hi Jamie, I am referring to tibial plateau fracture and meniscus repair 4.5 mo PO. I have read that trauma injuries could take even longer to heal than TKR, but curious if a plate/screw construct would limit ROM gains to 120-125 on avg., or is there less of a limitation, but a more extended recovery period at a slower pace to recover ROM. So ROM return is less impacted than TKR, but time duration for recovery is longer? Thinking of this in the context of being able to do pilates reformer exercise, which may require closer to 125-130 degrees flexion.

 

[Pumpkin]

@VolFan0927 Let me tag @Pumpkin to respond to you. She will know more about pilates than I do. By "TPF" are you referring to a partial knee replacement?

Yes, your Wife can return to Pilates, mat and reformer, working with an instructor who has a clear idea of her limitations, and the skills to modify the exercises so your wife can do them safely.

 

[VolFan0927]

Thank you. I thought so. We did find a few pilates studios with both mat and reformer, and were also PT trained, so sure we can discuss with them about modifications. It is probably early now as my wife is just starting to use the cane, but she is getting better at it and hope in a month or two she will walk without the cane. Thank you again!

 

[VolFan0927]

Looking for advice. Today at PT my wife's PT assistant told my wife, you seem to be stuck around 107-108 flexion (after a 7-8 degree improvement this month) and questioned if her VMO muscle was causing her not to be able to bend. My wife was upset, b/c she felt she was behind in ROM (she is at 4.5 mo post surgery now). She is depressed, and felt they don't know what they are doing. We are leaving the area and going home (Minn) in 2.5 weeks and will transfer to another more experienced group then. I explained that ROM will continue to improve each month, don't worry, but she is upset about her lack of fast improvement. Her other knee had multiple surgeries for ACL, and she never got ROM past 125, and she feels that limits her in pilates. She started telling me the current injured knees feels like the other knee and she is not optimistic about getting ROM back. I do believe traumatic injuries such as hers takes longer, but she thinks ROM should be back. She watches too much TV and Ashley Judd got her TPF ROM back to 130 in a few months. I would think if lesions were present she would not have improved by 8 degrees this month, but this is really more of an issue of trauma and inflammation, tight muscles, and low muscle strength - coupled with age that means a slower recovery. Thoughts?

 

[Jockette]

We all think we should further along in the early months. Here is an article, mostly aimed at TKR, but I think your wife had a surgery that was just as traumatic to the body.

Does she ever come on Bonesmart and look around and read things that she might find encouraging?

TKR: Where are you in recovery?

How many of you have been in a shopping mall or an amusement park and have seen a map that says, “You are here.” It tells you where you are so you can locate what you have to do in order to get to where you want to be. Well, here is more realistic chart of the “You are here” for a TKR. Too...

bonesmart.org

 

[VolFan0927]

Thanks Jockette. The recovery article is spot on. I found a TPF blog last night, and many folks there stated there were in similar ROM spots (90-120) at 6 mo, and that with patience, stretching, and more patience they were closer to 125 by 1 yr, and several hit 130-135 by yr 2 and 3. M wife is still in a PTSD mode given her traumatic injury to place her in this situation, so for now I am her eyes and ears.

 

[Jockette]

M wife is still in a PTSD mode given her traumatic injury to place her in this situation,

I’m sorry your wife is going through this. I did, a little, with my experience with my partial and the way I was treated by my PT and my surgeon post op. I did some reading about PTSD and could relate to the experiences I read about. It’s very real and can take a while to calm down from. I’m better, but no where near ready to do this surgery again.

I also wonder, and this is my own opinion, if our brain remembers the actual surgery somewhere in our subconscious, and contributes to some level of PTSD. Surgery causes trauma to the body and I’m very sensitive, so I wonder how much that has contributed, in my case.

My partial replacement has not gone well. I know there is something wrong, I have more limitations now than I did before my surgery, which was 4 years ago, but 2 second opinions didn’t find anything wrong with my X-ray, so they basically didn‘t look further for a problem. One did order some bloodwork, but that was fine, too.

Even with my problems, my ROM, which wasn’t great the whole first year did improve quite a bit in my second year, as my whole leg continued to relax and heal, and I even noticed a bit more improvement in my third year. While I was thrilled with my increased ROM, it also made me pretty angry that they make such a big deal about ROM in the early weeks/months with their push, push, push, both literally and figuratively. It came in fine, in its own time.

I hope as your wife continues to heal that she will be able to relax, both physically and emotionally. Please tell her that we care and that we’re all rooting for her, and I hope in time maybe she’ll come here herself and look around and read about the support that you have seen here and are getting.

 

[VolFan0927]

Thanks Jockette. Good advice, and like many trying to work through the patience mode, and being scared that slow ROM improvement implies bad ROM improvement, which is of course not true, but sticking in the back of the mind. We will keep at it and update everyone in the coming weeks, as this month has been fantastic from my vantage point, but lets see what another month holds. If my wife could get to the point of not using a walker and just the cane, that would help, as well as cracking the 120 ROM - which is about 10 degrees away.

 

[VolFan0927]

@liam2015

How is the rehab going? My wife is slowly inching forward, flexion at 110, extension at 0 to -1. We should be happy, as she has improved by 10 degrees flexion in 5 weeks. We are moving back to Minn in 10 days and will switch to a new PT group, and hope a new group will continue progress. Patience and fear is still our biggest problem, fear that ROM won't continue to improve. My wife hits 5 mo PO in one week....so hopefully this is still early.

 

[liam2015]

@VolFan0927 ~ thanks for asking. I will update later. That is excellent news that your wife continues to progress. You are so right about the patience and fear (in my case, falling, driving, etc.). My husband had his appendix removed one week ago so I have been the caregiver. I'm walking a lot around the house, up and down the stairs to do laundry, etc. but I still need or prefer the pole as I'm limping.

 

[VolFan0927]

Time for another update, made it back to Minn from Florida and visited new PT today. The new PT has alot of experience with leg fractures, and state of the art ideas. They are going to offer 1x a week of walking on treadmill in pool, and weekly massage. They have some other strengthening and ROM activities planned. Also, my wife was measured at 116 for flexion today. She is beginning to add her ROM slowly, as 14 days ago she was 110 (5 mo PO). Granted there are differences in measurements, but this gives us hope. They also switched her from the 4 prong cane to a single prong cane. Assuming she makes the 120-125 mark I will plot out the monthly gains, given her slow start. Interestingly, they measured her good leg, that has had 6 knee surgeries and an ACL replacement, and it was 139 flexion.

 

[liam2015]

That sounds wonderful, walking on a treadmill in a pool and massage. Wow, your wife's flexion has really improved; good for her and good for you being her support.

How are you doing, being the caregiver? My husband has been in the same position with me through several surgeries ~ now I'm his caregiver. I would love to hear how your wife likes the new p.t. activities. Where does she have the pain when she's walking? Best wishes to you both.

 

[VolFan0927]

@liam2015 Thanks! Her flexion was 116 this tuesday, but a small set back. Our apt in Minn is on the 3rd floor and it a long walk (250+ steps to garage), and my wife had 3 days of 1000+ steps with walker (from being at 400-500 steps/day where we were residing in FL). Her ankle was swollen really big on her Thur PT visit (and assume her knee would be also) and she lost 5 degrees flexion. The PT taped her ankle to help with swelling and we are resting and icing. Think we may need to use wheel chair for some of the back and forth for a few weeks to gradually increase her daily steps.

So that brings us to next week, which will be the treadmill walking in a pool and beginning of leg massage therapy. She is still super tight in her quad muscles and her good leg hip is tilted when she walks and imbalanced (due to raising good leg with NWB for 3 months).

To answer your question, although cleared for full weight bearing, she always walks gingerly and it appears more muscle weakness is keeping her from walking right now than pain. Her incision site is a little sore, and PT gently massaged this week - and thought she would jump out of her chair - although more from fear than pain. Her quad atrophied, and she lost 3kg during this time - which is alot for someone 147 CM in height. I will update next week after she complete her water PT session next week.

 

[liam2015]

Sorry your wife had a small setback. I think it's my quad muscles also preventing me from walking properly without assistance from my urban pole. You've both been so busy from the move, a good rest is probably in order, and the wheelchair will help take the pressure off. Is there an elevator to your 3rd floor apartment?

Best wishes next week with the treadmill walking in the pool and massage; sounds heavenly.

 

[VolFan0927]

Quick update on my wifes therapy work. This is the fist week of more focused PT and massage. She completed aquatic therapy on an underwater treadmill. They raised the treadmill platform out of the water so she did not have to use stairs to get into the pool. They also had 3 cameras on her when she walked to examine her knee biomechanics. The aquatics rehab is also used with the local pro sports team so very high tech. . With the level of the water the PT mentioned she was about 50% weight bearing. My wife was able to walk off and on and do many stretching and strengthening exercise. The most she has walked since her injury 6 months ago. Physically it wore her out, but mentally it was great as she felt she accomplished alot. She was more fatigued, and general overall muscle soreness - similar to starting a new exercise program on day 1. All in all my wife wants to to do more aqua PT than land PT now. The massage therapy helped, but we are finding out to be very selective as she has gone to 2 separate message therapists in the last 2 weeks and knowledge and skill levels are different for sure with her injury. The PT at aqua also suggested my wife purchase a small set of steps to use at home to aid her PT. The PT yesterday felt that if my wife would continued slow activity, with lots of daily stretching that she could obtain 140 degrees flexion over the next several months. More than anything, my wife walked away with more hope than the previous physios provided. She has a 6.5 mo visit with surgeon in 5 weeks so she is trying to make good progress for that visit. May have mentioned she was measured at 117 degrees flexion this week.

 

[liam2015]

What a great report and fantastic aqua therapy clinic with the underwater treadmill. Your wife's flexion at 117 degrees is excellent. Good idea to purchase the small set of steps ~ I wonder if they will be like the ones in the hospital I was in that also had a railing on each side? I'm glad to hear you and your wife and the therapist so optimistic.

 

[VolFan0927]

We purchased small steps, but more like an exercise step that allows adjustment of height. She will probably place in front of her walker to allow use of the rails for safety, but think it will be good to build strength. Today was tough for sure, my wife was super sore from pool therapy - just muscles in body, but not knee area. She will take a long earn rest this weekend for sure. We will go out and do something fun for sure. Have a nice weekend.

 

[VolFan0927]

My wife had a low key weekend, some heal slides at home, stretching, some band work and practice with her walker on good gait mechanics. Well today at PT she did her exercise and measured at 123 flexion. This is an improvement of 5 degrees from last Friday. In 10 days she will hit 6 months PO, and she has picked up 13 degrees flexion since July 1. For those naysayers about ROM late, my wife is a good example of going from about 95 flexion at month 3 to 123 by month 6.