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Friday, December 19, 2014
Lingering pain after tibial plateau fracture
On April 9 I jumped onto a beach and fractured my tibial plateau with intraarticular extension. I also heard a "POP". No surgery just 12 weeks NWB and then PT. My fracture has healed but I am still having medial joint line pain. When I make certain twisting movements I also feel pain and there is a slight bruise along the joint line. I also cannot fully straighten my knee when I walk or even when I just stand. I had a MRI and it only showed some arthritis and a healed fracture. What could be going on? Ankle and lower leg still swell up by the end of the day. I just want to move on from this injury from he**.
The fact your fracture extended to the joint surface unfortunately makes "post-traumatic arthritis" more likely. The reason you have persisting pain could be due to any or all of the following:
- cartilage damage - the cartilage coating over the tibia (or femur), and/or the meniscus on the side of the fracture. This could cause pain due to insufficient shock-absorption with resulting increased forces on the bone underlying the damaged cartilage;
- knee joint instability - which a physical exam should be able to demonstrate;
- slight bony deformity, which could place increased stress on the medial portion of the ligamentous knee joint capsule;
- weakness of the thigh (especially quadriceps) muscles, which would diminish their shock-absorbing capacity;
- altered joint surface weight-bearing patterns resulting from your knee's inability to fully straighten while standing and moving.
The inability to fully straighten your knee may be due to tightness of soft tissue (muscles/tendons/ligaments) from 12 weeks of non-weight-bearing, and/or deformity of cartilage or bony surfaces. Again, physical exam findings - combined with details from your knee X-rays and MRI scan - would sort this out.
Finally, trauma sufficient to fracture bone is sufficient to injure blood vessels, specifically veins - which return blood to the heart.
If there is indeed tightness and/or weakness, stretching and strengthening exercises may be beneficial. If not previously done, you may wish to discuss with your physician the option of referral to a Physical Therapist for specifics regarding this. You are also advised to discuss the above information with your physician, who'd be in the best position to determine how much of this applies to your unique situation, and which treatment options would be most appropriate, such as using an anti-inflammatory medication, trial use of an elastic knee sleeve or other type of knee brace, a knee joint injection with steroid (cortisone) vs. with a "viscosupplement" (such as Synvisc or Hyalgan), cross-training, etc.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University