*Note: this website is not intended to provide medical advice. Your doctor is a much better source for medical advice. This information is based on first-hand personal experience and research*

Healing / Recovery

• How long does the bone take to heal?

  This depends on many factors like age, nutrition, medical situation, and varies from person to person. The bone will usually regain 80% of it’s strength within 3 months, but many processes will still be taking place after this, and it may take up to 5 years until the bone is completely healed.
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• How do fractures heal?

  In the process of fracture healing, several different stages of recovery facilitate the proliferation and protection of the areas surrounding fracture. There is a gradual replacement of the injured tissue by living tissue which then differentiates into the different types of tissue (bone, muscle etc.).
  There are three major phases of fracture healing, two of which can be further sub-divided to make a total of five phases;

  • Reactive Phase
    • i. Fracture and inflammatory phase
    • ii. Granulation tissue formation
  • Reparative Phase
    • iii. Cartilage Callus formation
    • iv. Lamellar bone deposition
  • Remodeling Phase
    • v. Remodeling to original bone contour

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  Reactive

• After a fracture, the first change to occur is the presence of blood cells within the tissues adjacent to the injury site. Soon after fracture, the blood vessels constrict, stopping any further bleeding.Within a few hours after fracture, the extravascular blood cells form a blood clot, known as a hematoma. All of the cells within the blood clot degenerate and die.Some of the cells outside of the blood clot, but adjacent to the injury site, also die.^[3] Within this same area, the fibroblasts survive and replicate. They form a loose aggregate of cells, interspersed with small blood vessels, known as granulation tissue.
• ReparativeDays after fracture, the cells replicate and transform. The cells closest to the fracture gap develop into chondroblasts which form hyaline cartilage. The cells further from the fracture gap develop into osteoblasts which form woven bone. These two new tissues grow in size until they unite with their counterparts from other parts of the fracture. These processes culminate in a new mass of heterogeneous tissue which is known as the fracture callus. Eventually, the fracture gap is bridged by the hyaline cartilage and woven bone, restoring some of its original strength.The next phase is the replacement of the hyaline cartilage and woven bone with lamellar bone and then trabecular bone. Eventually, all of the woven bone and cartilage of the original fracture callus is replaced by trabecular bone, restoring most of the bone’s original strength.Remodeling
• The remodeling process substitutes the trabecular bone with compact bone. Eventually, the fracture callus is remodelled into a new shape which closely duplicates the bone’s original shape and strength. The remodeling phase takes 3 to 5 years depending on factors such as age or general condition.
  ^{Note: *Answer adapted from wikipedia*
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• Will I heal completely?

  This very much depends and varies from person to person. With enough Physiotherapy and rest you should be able to resume all the activities that you were doing before the injury. No healing can really be 100% and you might be left with slightly limited range of motion or suffer some some kind of discomfort or pain. However, in most cases, you will be able to forget about your injury and live your life as before. People who have suffered a Tibial Plateau fracture, even when healed completely are more likely than other people to develop osteoarthritis at a later stage in life.
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• What are adhesions and why are they sore?

  Adhesions are caused by scar tissue binding together different internal parts of the knee and leg like tendons and ligaments. Adhesions are a common complication of Tibial Plateau fractures and can be quite painful. Easing the adhesions and getting the joints moving again requires stretching of the adherent tissue which can cause pain and an uncomfortable feeling. Adhesions are formed If the joints have been immobilized for a period of time. Stretching of the adhesive tissue to recover movement function in the joint is helpful and yet it is one a common inducer of repeated pain.
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• should I use ultrasound or electric stimulators?

  Of all the different types of electric stimulation to the knee, ultrasound is the only to have been proven in some initial studies to reduce the amount of non-unions and make recovery faster. This however, is not yet widely accepted and is not common medical practice. In most cases you will not need any kind of external stimulation and you should just let you body go through the recovery process. The best way to help is by eating well, resting, and avoiding harmful nutrition and harmful activities. If you are interested in an ultrasound machine you can buy one here: (link)
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• How Can I speed up recovery?

  Rest, nutrition are physiotherapy are the three sure ways to help you go through a good recovery. It will also take some time. There are also some things you should avoid like caffeine or smoking. You can find more information about diet in the recovery page, and more information about physiotherapy in the physiotherapy page. If you are looking for supplements, you can find some here: (link)
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• How long will it be before I can practice contact sport?

  This is something you should discuss with your doctor. Generally speaking, within 3 months the fracture itself should be well consolodated which means you are no longer in danger of reopening the fracture, but depending on your situation there might be other risks and you should consult with your Operating Surgeon or medical professional.
  
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• what is nonunion?

  nonunion is failure of the body to complete the recovery of the fracture, leaving the bone still broken. Nonunion is not a common complication, but your doctor will be monitoring the union process by having periodic xrays taken to insure everything is moving on as planned. Non-union can be cause by several factors:

  • Inadequate blood flow to the bone may prevent crucial nutrients and oxygen from arriving to the fracture site
  • Separation of the fractured ends of the bone caused by an external trauma, walking too early or different reasons will prevent full healing
  • Inadequate stabilization of the fracture may mean that the bones are moving preventing or delaying healing
  • Infection in the fracture site can also be a cause of nonunion

  The treatment of nonunion is to remove the causes of nonunion and then let the bone heal. Allow a new blood supply to flow in, immobilise the fracture if needed, and in some cases a bone graft to give the process of healing a good start. This usually means another surgery. Electrical stimulation or ultrasound has also been shown to help. The best treatment is prevention by eating well, supplementing, mobilizing the joint and taking blood coagulants to insure a good blood supply. Avoiding caffeine, and smoking an alcohol will also go a long way. Also, you should avoiid putting stress on the fracture (walking, for example), without getting the go ahead from your doctor.
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• When Can I expect to start wallking?

  It depends. This is something you shuould talk to you OS about. A rough estimation would be 6-8 weeks until you are allowed to put pressure on your leg and another 8 weeks until you feel that you can really walk again. Even once you are walking you might still have a limp, either visible or very light and undetectable, which will go away over time. As time progresses you will also be able to walk longer and longer distances.
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• Does Smoking harm Healing?

  The short answer is yes. Studies have shown that smokers have a 15% higher chance of suffering a non-union and also take longer to heal. The science is clear, and it is well accepted that smoking harms the healing process. The mechanism by which this is thought to occur involves the constriction of blood vessels caused by nicotine which can lower the blood flow to the fracture site, preventing oxygen and crucial nutrients from getting where they need to get.
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• Should I take glucosamine and chondroitin?

  The evidence regarding these supplements is non-decisive. There has not been much evidence that these supplements help osteoarthritis after a fracture, but many people claim that it helps them with their pain. I fyou are interested in purchasing this supplement it can be found here (link)
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• Should I take supplements?

  Supplementation owith multivitamins and calcium has been shown to reduce the chance of nonunion and speed the healing process. That being said, if you eat well you do not need supplements. Relevant Supplements can be found here(linke) and here (link)
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• Do Anti-inflammatory medications inhibit bone healing?

  medications from the NSAID familty (non steroidal anti inflammatory drugs) may inhibit bone healing, and may be taken by mistake because they are quite common as off-the-counter pain medication. Consult your doctor before taking these drugs and regarding which pain medication you should be using.
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• Can improvement be expected after one year?

  Absolutly! After one year you should be walking around and doing all your daily activities, often forgetting you ever had an injury. This, however, does not mean that your recovery process has finished. In most cases you will continue recovering and feeling some symptoms even after the 1- year mark.
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• What is post traumatic osteoarthritis?

  “Arthritis” is defined as inflammation of a joint. The most common for this inflammation cause is wearing out of joint cartilage (osteoarthritis). Post-traumatic osteoarthritis is caused by the wearing out of a joint that has had any kind of physical trauma. After a tibial Plateau injury and surgery the mechanics of the knee joint change slightly, making cartilage wear out more quickly. The wearing-out process can gradually lead to osteoarthritis.

  The symptoms of this situation include pain, swelling, fluid accumulation in the knee joint, and decreased tolerance for walking, sports, stairs and other activities.

  Diagnosing weather you have post-traumatic osteoarthritis is something your doctor can do, this often involves having an xray, CT scan and/or MRI. it could also involve a blood test.
  The best way to treat osteoarthritis ad well as the best way to avoid or minimize it include maintaining a healthy body weight, low intensity weight exercises and strengthening of the muscles around the joint, as well as the initial operative treatment for the fracture being done well. If you get osteoarthritis, non-steroidal anti inflammatory medicines might also help, and the knee joint can also be injected with cortisone or special substances which act like artificial joint fluid. All of these measures are capable of helping you so that the joint is more comfortable and functional, often relieving all the symptoms. If, over time, these measures loose their efficacy and are no longer helping, surgery to can offer long-term relief. Unfortunately, there is no complete cure for arthritis, but some studies are starting to show that a new treatment called Apostherapy(link) may prevent osteoarthritis. I am trying this solution myself. Judges are still out on weather it’s effective and it is pricy but I think it’s worth a try.
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• What are the risks and benefits with nonsurgical and surgical treatment?

  Your Operating surgeon should be the one to advise you on weather you should be having surgery and explaining the details of your specific surgery. In very general terms, non-surgical treatment is usually recommended if the Fracture is very minimal or if there has been no movement of the tibial plateau surface. One of the main reasons that an operation needs to be done is because changes to the the surface of the bone have occurred. If not treated, this can cause pain and wearing of joint cartilage treated. During the operation the doctor will realign the bone, and put a metal rod in to hold everything in place.
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• How might this injury affect my long-term expectations for daily living activities, work, and recreational activities?

  Unfortunately, this type of injury can have long-term results It depends very much on your personal recovery, and you will most likely be able to walk, run and participate in any type of sport, including as a professional athlete. However, a Tibial Plateau fracture carries with it an increased risk of osteoarthritis in a later stage, as well as  the possibility of limited range of motion in the injured leg and different limitations and pains, and in rare cases can have complications. It is very important that you take care of yourself and do your PT early in the recovery so that you may enjoy the benefits in later stages and reduce the impact of these long-term issues

• How will my medical or social history (smoking, recreational drug use, alcohol) have an impact on my treatment or outcome?

  Your medical history can have an effects on recovery, and can be a factor mostly in determining how long it will take you to recover. You can’t do anything about the past, but It is a good Idea to refrain from generally unhealthy habbits such as smoking and over-drinking during the first 3 months of recovery, which is the major stage during which bone is healing.

• If I get arthritis, what can I expect and what are my options?

  The best way to treat osteoarthritis ad well as the best way to avoid or minimize it include maintaining a healthy body weight, low intensity weight exercises and strengthening of the muscles around the joint, as well as the initial operative treatment for the fracture being done well. If you get osteoarthritis, non-steroidal anti inflammatory medicines might also help, and the knee joint can also be injected with cortisone or special substances which act like artificial joint fluid. All of these measures are capable of helping you so that the joint is more comfortable and functional, often relieving all the symptoms. If, over time, these measures loose their efficacy and are no longer helping, surgery to can offer long-term relief. Unfortunately, there is no complete cure for arthritis.
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• After treatment begins (surgical or nonsurgical) when can I expect to bear weight and bend my knee?

  Weight bearing ususally starts at 6-8 weeks, but depending on your situation might take up to 12 weeks. At first you might only be allowed partial weight bearing(PWB), but you will very quickly progress to full weight bearing(FWB) or weight bearing as tolerated(WBAT).
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• How will the recovery phase affect work and family responsibilities?

  Since you will be Non Weight bearing for a period of about 6 weeks, and will have mobility and medical issues for months to follow, your work and other responsibilities will undoubtedly be affected. Initially you will need to stop almost everything you were doing as for several days you will be mostly in bed. As the recovery progresses  you will be able to do more and more. A good strategy as far as work goes is to prepare everyone for the worst and then see how it goes. It’s important to remember that during the recovery process there will be many ups and downs. It is very tempting to go back to full activity as soon as you start feeling better, but you should take your time, allowing your body to rest and your situation to settle before announcing that you are all better. When people ask how you are doing, “progressing, slowly” is usually a good answer.

• What kind of help, if any, will I need during my recovery?

  The help of family and friends will be very useful and in some cases neccesary. This is true for all of the recovery period, but mostly for the first three months. Limited mobility will mean that there are a lot of things that will be hard to do yourself. This includes day-to-day house work as well as things related to the injury. Its also good to keep in mind that the injury will tire you out, and that you will need quite a lot of rest when you come home from surgery, meaning other people might need to do some things instead of you. A non-comprehensive list includes: shopping, preparing food, taking the kids to school, rearranging the house so that everything is accessible, doing the washing, getting to physiotherapy etc.
  During the very first weeks will be the hardest and you might also need help with things like washing the injured leg, or changing your socks and bandages on a leg that you are unable to bend.

  Its a good idea to get somebody to organize the house so that things will be easier for you to do, such as taking the doors off some cabinets, leaving cutlery and kitchen utensils on an easily rechable place, setting a shower-stool in the shower etc.

  Don’t be shy and don’t refuse help. If someone is offering their help, they mean it and there are so many ways in which other people could help make your life a little more comfortable as you are recovering.
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• If I have surgical treatment and a “bone filler” or substitute is used, what are my options? What are the risks and benefits?

  In some cases, your surgery may include using a graft or substitute. This is a procedure that replaces missing bone. bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are called osteoconduction, osteoinduction and osteogenesis. You should consult your medical professional regarding your options, *adapted from wikipedia*

• Will I be on anticoagulation medications (“blood thinners”)? If yes, which one and for how long?

  People who are immobilized for substantial periods of time are at a higher risk of developing blood clots which could be dangerous. Your doctor might prescribe blood thinners as a preventative precaution in order to avoid this complication. They are completely safe and are usually administered by injecting yourself with a special syringe. It is almost completely painless, and you will get used to it in not time. An example brand is clexane.
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Pain

• How much pain will I be feeling?

  Unfortunately pain is a part of the healing process. It is there to let your body know that you have suffered an injury and need some rest. During the first days after surgery (or injury if you didn’t have surgery) you will most likely be experiencing continues pain. This pain should not be a disabling pain, but it is recommended that you use pain killers to manage the pain (as recommended by a doctor, and don’t use NSAID type medications). A good painkiller regimen can keep you practically pain-free.

  After the first few days the pain will subside, but you will still be feeling different types of aches and pains for a few weeks which will slowly subside.

  After the first few weeks you will likely not be feeling regular pain anymore, but still some discomfort or pain might arise from time to time (during Physiotherapy for example, or if you accidentally put too much pressure on your leg).

  It is very much recommended to use pain medication to manage your pain. Some people don’t like using this type of medication but it can go along way for a more peaceful recovery period and also has positive effects on the recovery itself (by letting you be more active, and take better care of yourself). If at any point you experience very strong or sharp pains, this can be normal, but you should check it out with your doctor immediately just to be on the safe side.

  And remember – pain is one of the most subjective things, and you shouldn’t be suffering. if you feel uncomfortable or painful ask your doctor what he can do to help you with that.

Surgery

• How do I find an orthopaedic surgeon?

  This is an important decision, so you will want to make it wisely. You are looking for orthopedic surgeon(“OS”). This is a doctor who is  an expert on both surgery and orthopedics so any orthopedic might not be good enough. It’s best to shop around if you can, asking friends and family, or a your family to find out who is good in your area. It is very important that you find a doctor that you can trust and that is open and generous with information, letting you know everything you need and want to know. Your  OS does not have to be a knee specialist, as this is considered a fairly simple operation and is often performed by surgeons who specialize in knees, in trauma or in any other field of orthopedics. It is more important that it is someone you trust and that you are able to verify he is a good surgeon. Don’t hesitate to ask for a second opinion before the surgery if you are not sure of something. Taking all this in mind, also remember – you generally have to have the operation within 2 weeks of incurring the fracture, and the sooner the better. So don’t take too long!

• How does the broken bone connect to the graft?

  In some cases, your surgery may include using a graft. This is a procedure that replaces missing bone. bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are called osteoconduction, osteoinduction and osteogenesis. *adapted from wikipedia*

• what does the surgeon do during the surgery?

  In general terms, the reason  surgery needs to be done is that the fracture has taken the bone surface out of alignment. This surface is usually perfectly aligned, and when misaligned it will gradually cause tearing of cartilage in the knee. During surgery, the OS will slightly move parts of the bone aligning them better so that there is no danger to cartilage. The surgeon will cut as small an opening as possible, and then perform the manipulation while using x-ray to make sure the alignment is good. The surgeon will then connect a plate and screws to hold the fracture in it’s aligned place, allowing it to heal properly. Finally the surgeon will sew the cut up and secure it with medical pins or thread. This is a very general description, and each surgery is different. During your surgery the OS might also be using bone graft, or more then one metal plate and might perform some filing of the cartilage or one of several other techniques. Consult your doctor for the gruesome details and specifics. This type of surgery can be done under regional anesthesia or general anesthesia and will usually include at least two medical proffesionals – the OS and an anesthesiologists who will either be a doctor or a nurse.

• Should I remove my hardware

  About one year after your initial surgery, you have the option to remove your hardware (your doctor might not tell you about this. If this is the case- ask him or her). Medically speaking, there is in most cases no harm in leaving the hardware in your leg, and another surgery will result in a little more recovery time as well as some pains and discomfort. Doctors will usually recommend against it, unless there is a specific reason to remove it. On the other hand, for many people it is very much an emotional or psychological issue, and you might want to get the hardware removed. Aside from a few weeks of recovery, aches and pains there is no real danger in doing so.

• What material is the hardware made of ?

  Modern medical plates and rods are usually made from stainless steel, cobalt or titanium. If you had surgery many years ago, the materials may differ.

• Will the hardware beep in airport security metal detectors?

  It might, depending on the exact material and the types of sensors used. Airport security personnel are trained to identify these situations and this should not cause any issues.

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General

• Can I drive with a cast on?

  Technically speaking, it is possible to drive with a cast on using an automatic car, if the cast is on your left leg. It is also legal in most countries, but it is highly recommended that you don’t. Several main issues should be considered: sudden breaking , insurance, and legal issues.

  Sudden Breaking (or even deep turns) may put unhealthy pressure on your leg or pressure that you are no accustomed to

  Insurance might fail to pay up in the case of an accident, if you are wearing a cast.

  And of course, you should make sure that it is legal to drive with a cast in your country of residence. In some countries it will be legal but will require a lot of bureaucracy rendering driving too much of an uncomfortable luxury.

  In any case, you will not be in a cast for long (max. 2 weeks), so consider getting someone to drive you around, using taxis or staying at home picking up all those missed seasons of your favorite TV show.

• what is PTSD?

  Posttraumatic stress disorder(PTSD) is a psychological condition that may develop after a person is exposed to one or more traumatic events, such serious injury like a car accident or a sudden injury. The diagnosis may be given when a group of symptoms such as disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal (high levels of anxiety) continue for more than a month after the traumatic event.

  Most people who experience a traumatizing event will not develop PTSD. Children are less likely to experience PTSD after trauma than adults, especially if they are under 10 years of age.

  If you think you might have PTSD, or are just feeling under the weather, consider contacting a mental health professional.

• I see Affiliate links on the site. What are they for? Do you make money from the site?

  In the site there are embedded affiliate links, These are only to products which I recommend, and the proceeds go to covering the maintenance costs of this website, as well as advertising to help more people find the site. To the date of writing, the revenue is less then 10 USD per month, and I have made no personal benefit except for the knowledge that I was able to help others who suffer from the same injury as myself.

At home

Is this Normal?

• Itching

  Yes, for the first several weeks, you might experience itching. This will lessen but not disappear once you remove your cast. Scratching is not recommended. To lessen the itch, try washing the affected area and/or using anti-itch creams (but not on the open wound). washing down the itchy area wish a wet towel might help.

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• bruising

  Bruising is absolutely normal and may take up to 2 months to dissappear. Bruising is not necessarily limited to the surgery area and might appear in different parts of the leg. Icing goes a long way to help with bruising as well as rest, elevation and compression (“RICE”). If you feel or see something looking like a lump of water accumulating under the skin, and does not grow smaller with time then this is not bruising but rather edema
  which should be treated by wearing a medical pressure sock

• limp

  It is completely normal to have a limp when you initially become weight-bearing, the limp will gradually become less noticeable, and will eventually disappear completely. First other people will stop noticing it, then you will stop noticing it but it might come back at the end of long days or on long walks, and eventually it should diminish completely.

• heat waves

  It is normal to have heat waves during the first few weeks after the injury. This is actually caused by stress and sleep deprivation, and not by the actual fracture or surgery.

• dry skin

  It is normal to have dry and rough skin during the first few weeks after the injury. This is caused by the bandages and trouble showering and cleaning the affected area and leg as well as by the fact that you are non-weight bearing. A good prevention and treatment is keeping good hygiene and using moisturizer for dry skin. I’ve found U-lactin to be very helpful (link)

• Very itchy Feet
  If you’re feet are overly itchy, and the sensation persists it might be because of  the development of bacteria or fungus. The best treatment for this is an anti-fungal treatment,. I’ve found that an anti-fungal soak (linkl
  ) is more manageable, as it can be hard to rub cream on your leg when you can’t bend it very much.
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• edema

  Edema is an accumulation of fluid under the skin tissue, and will look like swelling of your leg in a specific spot or all over. Edema can be caused by a low level of movement of the leg, Non-weight bearing as well as bandaging that covers only the injury area. To prevent and lessen edema, make sure that your bandages always go all the way down to the foot and don’t only cover the affected area, make sure to keep your leg moving as much as possible, and try to keep your leg raised. Reducing your salt intake will also help. If you already have edema, there are two main treatment options: you can wait for it to pass, using aforementioned actions to help, or you could use compression stockings which greatly will assist in removing the edema (link).

• cracking sound

  cracking, grinding, or popping sounds result from leg instability. They are especially common when climbing up and down stairs. They should lessen and hopefully disappear as your leg strengthens. If this is happening a lot, contact your medical professional, just to be on the safe side.

• sudden pain

  Sudden, sharp pain can happen normally, but might also be the sign of a complication. Start with pain killers, if the pain is very strong or persists, contact your medical professional or a nearby medical center.

• My cast is so heavy

  This is normal. The cast is not actually so heavy, but your leg muscles have weakened by inactivity making the cast feel heavy. but don’t worry, the cast will be taken off and replaced by a hinged knee brace very soon.

• The doctor left a Protruding stitch

  This is completely normal and is not a cause for alarm. The stitch should dissolve on it’s own. If the area gets read or extra painful to touch, it might be a sign of infection and you should visit your doctor.

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legal – Insurance claims

• how Can I find a good lawyer

  This very much depends on where you are currently living. Some good options include asking friends and family if they know anyone who has suffered an injury and used a lawyer. Another good option is asking a lawyer you know weather they can refer you to someone with expertise in this kind of case. You should usually use someone with expertise in insurance claims and/or traffic accidents.
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• how Can I help legally

  Consult your lawyer about the specifics in your case. Some good advice is to keep all injury-related receipts and document any troubles you are having, including work-related and personal issues, so that you may later remember all this and use it in a future trial.
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• When should I start?

  If you think might need to file an insurance claim, you should talk to a lawyer as soon as possible as there might be something that you can do at this stage already  that might help the case later on (Such as documenting everything properly).
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• How do I find a physiotherapist?

  Usually your doctor will be able to point you in the right direction. Often the physiotherapist and the doctor will be exchanging information so it’s might work better if they have worked together before.
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• Where can I find exercises?
  You should consult your physiotherapist. Ideas for exercises can be found in the physiotherapy section,as well as here.

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• What are some suitable exercises for the ankle?

  Ankle exercises are also very important, as your ankle will be losing strength and stamina just like the rest of your leg and is very important for day-to-day activities like walking. You shouldn’t forget or neglect your ankle during all stages of your recovery. A list of good exercises can be found here.

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I hope you find this information helpful,

Shlomi