- Post Op Care:
- consider keeping the knee in 45-60 deg flexion;
- for the first 5 postop days, the pts leg is maintained in a CPM machine, and the ROM is increased to a range of 15 to 70 deg;
- POD #3: active assisted ROM exercises are started & continued BID;
- later quadriceps exercises are added;
- before discharge, patients should be fitted w/ a hinged knee brace;
- for 6 weeks emphasize ROM exercises;
- at 6 to 7 weeks, SLR and use of a station bycycle are introduced;
- at 8-12 wks, pt starts toe touching & then incr. wt bearing by 25 lbs qwk, depending on the level of comminution;
- Complications:
-
Loss of Reduction:
-
Delayed Union:
- Limited motion & lack of knee extension:
- immobilization w/ knee in extension < 3 weeks prevents contracture;
- Instability (see
ligamentous injury)
- instability of > 10 deg after plateau frx occurs in 10% of pts;
- 3 causes:
- uncorrected articular depression;
- healing of torn collat. ligament in a lengthened position;
- loss of
articular cartilage as traumatic arthritis develops;
- Angular deformity
- Traumatic arthritis;
-
AVN:
- Local or Split compression frx have centrally depressed fragments;
- AVN is diagnosed when serial X-ray show a gradual shrinking of the eleveated fragments until a defect remains;
- Infection:
- this case involves a 40 year old male who had had ORIF of a tibial plateau frx 5-6 years previously;
- while in prison, he noted a spontaneous protrussion of one of the K wires thru the skin;
- this first developed a superficial skin abscess and subsequently developed a septic knee;
Early weight bearing of lateral tibial plateau fractures.
The significance of early motion in the treatment of tibial plateau fractures.
S Gausewitz and M Hohl.
CORR 202: 135, 1986.
Increased neurologic complications associated with postoperative epidural analgesia after tibial fracture fixation.
