Upper end if tibia fractures usually involve the joint. Most fractures involving the joints are consider to be unstable, meaning weight bearing can only be allowed once solid union is confirmed clinically.
Fig. 1 Xray showing proximal tibia fracture.
#1. Know what the physician is thinking:
If the fracture is minimally displaced and elderly people with multiple comorbidities, conservative management is an option.
In most active people with a displaced fracture operative management is a better option.
Fig. 2 X-ray showing a plate fixation.
#2. Five Ways joint involvement can affect you.
Incomplete recovery of joint range of motion.
Joint stiffness.
Instability with involvement of ligaments.
Onset if early osteoarthritis is a common complication.
Residual parmanent deformity, like a flexion deformity.
#3. Four Main Goals of Rehab.
Protect the fracture till union
Restore joint motion
Strengthening and prevention of muscle wasting.
Faster recovery.
Most patients with joint involvement should avoid weight bearing on the operated leg for a period of 3 months.
#4. Three Important factors to be considered before therapy
Complexity of the fracture.
Implant used (playing/nailing)
Stability of fixation.
#5. Rehab for proximal tibia fracture with stable plate fixation.
1-2 weeks
Continue Range of motion exercises. (Goal is to reach 30 to 45 degree of flexion ROM in first week, then beyond 45 deg to 90 deg in the second week.)
Quadriceps strengthening exercises helps with preventing loss of muscle mass in front of the thigh and getting full extension of your knee joint.
Non weight bearing to protect the implant and prevent fracture collapse.
3-8weeks
Continue ROM exercise. ( goal is to reach upto 90 deg of ROM).
Quadriceps strengthening exercises.
Non weight bearing crutch walking.
8-12 weeks
Non weight bearing crutch walking /Toe touch weight bearing(as recommended by your doctor).
ROM exercises.
Quadriceps strengthening exercises.
After 3 months post op
Full weight bearing is uasually allowed. (Note: physician consultation is required.)
Knee Squats to improve knee ROM beyond 90 deg.
#6. Physio therapy
1-3 repetitions of sets of 10 , twice a day.
Note :
Rehab protocols have to be discussed with your treating physician, all recommendation given here are for educational purposes only and they can differ from one person to another.
Post op diet plays a very important role in preserving muscle mass, kindly ensure adequate protein intake.
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References:
1.Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature
October 14, 2020.
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