Rehabilitation after Tibial Plateau Fractures
The tibial plateau is the flat area of the top of the shin bone, the lower half of the knee joint, which expands up from the shaft of the shin bone. The tibial plateau is a very important weight bearing area and any disruption of this area affects the stability, movement and alignment of the knee. This means that the diagnosis and correct management of this fracture is extremely important if the patient''s chances of future knee disability are to be minimised. Older people, typically over fifty years of age, are more frequent sufferers from this fracture, especially in women after the menopause who may have a degree of osteoporosis which makes the plateau more fragile.
In older people the forces involved in the fracture are usually low, such as a fall of some kind, and the fracture is often depressed which means squashed downwards. Younger people suffer more high energy fractures from motor vehicle accidents or being hit by a car as a pedestrian, with split type of fractures. Depressed fractures may require operation to bring the flat plateau surface up the right position with a bone graft and internal fixation to hold them in place. Cast braces are often employed, a brace around the thigh and calf with a knee hinge, with the brace limiting any sideways forces on the knee which might worsen the fracture.
In the cast brace the physiotherapist will assess the patient''s ability to contract their quadriceps muscle and work on flexion of the knee which is the main potential limitation after this kind of fracture. The physio will instruct the patient in the correct gait, which is often non weight bearing initially, progressed to partial weight bearing as the surgeon is happy with the healing of the fracture. Many patients are elderly and find non weight bearing only possible for very short distances or transfers whilst using a wheelchair and a frame.
Once the brace is removed the physiotherapist will work on mobility of the patella, strength of the quadriceps and flexion of the knee. Mobilisation techniques can be used to increase the accessory movements of the knee and the physio will encourage hamstring work against resistance such as an exercise band or gently resistance from the other leg. Gradual progress through active ranges of movement towards resisted movements is encouraged, with the physio instructing the patient from partial to full weight bearing and functional work as appropriate.
Author: Jonathan Blood-Smyth