A tibial plateau fracture involves the cracking at the top portion of the shin bone, otherwise known as the tibia. These fractures are caused by an injury such as those from automobile accidents and falls. However, they are also linked to osteoporosis, a condition that causes the loss of bone tissue, thus resulting in organ becoming fragile and prone to breakage. Patients suffering from tibial plateau fractures can experience painful swelling and have a hard time moving the knee. It is also typical for patients to sense a feeling of numbness or coolness in the foot area. While a tibial plateau fracture can result in severe complications, there are several strategies for treating the condition. Read on for further details.
Knee Brace And Splinting
One way to treat a tibial plateau fracture is by using the knee brace and splinting technique. Knee braces and sprints are worn around the knee to help support them in cases of damage. While casts are considered to be more effective for supporting the knee, they are not adjustable. Thus, splints are more convenient in terms of applying them, and though they don't offer as much support, they are especially useful if swelling occurs.
Several studies document the use of knee braces for tibial plateau fracture. A study from 1989 revealed a high percentage of participants who wore a knee brace saw less pain following exercise routine as well improvement in flexion. Full extension was achieved in most patients as well. Another study, which lasted two and a half years, followed the treatment of twenty-nine patients with a knee brace. The results showed united fractures and improved movements with the knee. More research from the current era would be necessary for further support.
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Surgical Realignment And Stabilization
In some cases, surgical realignment and stabilization is necessary. The procedure that involves alignment is referred to as osteotomy. In this procedure, a portion of the bone is removed so the bone can be better aligned. The research for osteotomy as a treatment for a tibial plateau fracture is ongoing. However, information from several studies suggests the procedure could be helpful. In one study, seven men who received open wedge osteotomy saw greater knee function and stability.
Surgical treatment for tibial plateau fracture can also involve open reduction and internal fixation. In this procedure, the doctor cuts into the area where the affected bone is housed, realigns it, and stabilizes it into place using nails, plates, pins, screws, rods, and metal wires. A review from 2018 reveals that of forty-eight cases involving treatment with open reduction and internal fixation surgery, forty got results classified as either excellent or good.
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Medication For Pain
Analgesics are considered as the primary medication in treating pain from a tibial plateau fracture. These medications refer to opioids, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs).
The usage of analgesics is controversial as some researchers believe they may delay bone healing. Though NSAIDs can reduce inflammation, they can also interfere with intramembranous ossification, which is necessary for bone formation. As of now, there is little data regarding this theory. In addition, it is said taking opioids could even increase the risk for developing fractures. As it is not known how opioids are linked to increased risk for fractures, research is ongoing.
Furthermore, side effects may occur with taking these medications. Patients should, of course, always stay with the dosage their doctor recommend and if they experience any side effects, inform the doctor immediately.
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Physical rehabilitation includes methods such as early range of motion, which involves moving the knee around to assess its full ability to advance in whatever direction without difficulty. This treatment can be done alone or with a physical therapist.
The physical therapy routine should consist of as much stretching as possible. Patients can discuss specific techniques and exercises with their physical therapist. As part of physical therapy, however, patients must allow the affected tibial plateau time to heal on its own. This means patients have to keep a brace around the injury, preferably for at least six weeks. Plus, patients will have to use a wheelchair or crutches to get around. Non-weight bearing activities will also be instrumental during this period, as they require no pressure on the affected area.
Depending on the severity of the injury, healing could take a little bit longer than expected so individuals should be patient. The leg should be able to advance at a flexion angle of ninety degrees by the end of the six-week course.
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Return To Exercise Timeline
While patients can return to exercise immediately following the completion of their physical rehabilitation course, they should not take on anything too intense with first getting back into exercising. Also, they should keep in mind returning to regular physical activity depends on the progress of treatment with rehabilitation and surgery.