Tibial plateau fracture

[Mike Andrew]

Any experience with this malady here? Wife had a cheap stool break spilling her onto a rock garden and fracturing her left TP which is displaced.
Ortho strongly suggests total knee vs. repair based on her age (66) and likelihood of future replacement anyway with probability of complications as a result of repair. Been reading online papers and med stuff and this seems to be the general conclusion of various studies.
Weighing advantage of a 2nd opinion as I am a big proponent of such but the films show a pretty bad fracture with several fragments which tells me lots of screws and other hardware.

[pavulon]

Fewer surgeries = fewer rehabs sessions/less time lost/less pain/less opportunity for complications = better life.

[HardDrive]

Mom had her knee done. Recovery took a few weeks, but 100% worth it.

[Crowbob]

TKR (Total Knee Replacement) @ 66 might need a redo in 20 years or so but I’d advise she do it, anyway.

Not being a degenerative knee problem she probably won’t notice any difference pre/post once she gets through the rehab. Having painless knee(s) increases activity levels which becomes more important as we age.

[vash]

zero clue. but i wish your wife the best!!

[Tobra]

Probably TKR is the way to go, especially if the joint is involved. Make sure she gets measured afterward to be certain she is even.

[john70t]

Not a doc, but the condition of the remaining cartilage and her expected exercise level might be the determining factor.

Bone loss and density gets worse with advanced age, especially 70-80+ when surgery can create more complications, and sometimes new replacement joints will not bond easy to existing structure.
(think of welding a new thick muffler extension to a rusty paper-thin exhaust pipe.)

It the break was splintered enough, the existing bone end is crap and won't heal regardless of what is done.
That could possibly create it's own problems.

Get a few other opinions.

[aigel]

What type of TP fracture is it? Can you post some x-rays? And how bad was the knee before the accident? Was it already on "watch" for a replacement?

You want to make sure the conservative approach (fixing the fracture) gets full consideration. Unless the knee was shot anyway, is it possible to try to fix the fracture first and if it fails, then get the total knee replacement? Anything to loose but time?

It isn't easy to get a "second opinion". The next guy you see will also be an orthopedic surgeon and may have the same approach. For them a total replacement is likely the most straight forward approach with predictable results. None of them may want to "experiment". I have had good luck getting second opinions by word of mouth. Send x-rays around my friends in the medical field and they can get input from their network. Also don't underestimate your GP, have them take a look. Not perfect, but you get opinions that can be valuable if the people are not the ones having to do the fixing.

I am not a doc but I did have a nasty tibia shaft fracture that most orthopedic surgeons would have pinned. I was lucky I had an ortho that gave me all the options and I was able to give a cast a try. Had to be patient, but the deal was that one can always break it again get it pinned if the cast doesn't take. Happy to report that I am back 100% with no surgery. The cost to me was months of disability on crutches with series of casts and boots and over a year of intense physical therapy. But not having to cut my leg open was worth it to me. Most pins need to be removed ... The ortho made very little, compared to surgery, so I commend him for giving me all the options.

G

[Tobra]

That may not be an option though. If there is too much disruption of the joint, even if you do a good job putting humpty dumpty back together perfectly, the cartilage will be too messed up to give you a good knee.

[aigel]

Hence I wondered if there were images and / or type information. All we know it is a TP fraction that is displaced. Could be an "easy fix".

G

[Mike Andrew]

I will try to post a screen shot of an X Ray that she took. It's ugly and appears the last meniscus is on the displaced portion.
Scheduled appt with my Ortho Monday for a second opinion and, if the same, will use him as I like his work keeping this old rugby player skiing, biking and in the gym.

[Mike Andrew]

https://photos.google.com/direct/AF1QipMLVercEAOgonttbnMSoJsRaIVoF2PnBJwauyQ5Xxo_an tgtY-KV4JFXMdFrbd0AQ/photo/AF1QipMQqRGImCvqdkFtRh0NQJr7cz076CXmBMpCeHqH

Try this link for a photo.

[Tobra]

403 error on link

[aigel]

Link is BROKEN.

[Crowbob]

Limb is BROKEN, too.

If TKR is the most straight forward approach and has the most predictable outcome, it seems to me to be the best choice. I’m not sure I’d agree to some fancy staged reconstruction possibly with grafts, etc. just to see if it works. And then go under yet again.

[Mike Andrew]

[img]http://forums.pelicanparts.com/uploads26/tibial_x_rau1594342401.jpg[/img

Work now?

I hate Android.

[Crowbob]

Negatory.

[HardDrive]

[Tobra]

Lateral aspect of tibial plafond appears trashed, and it looks like she broke off the proximal end of the fibula too. I suspect it would be pretty challenging to screw that back together.

Be more blatant about taking the picture next time maybe

[gchappel]

I had a badly displace lateral tibial plateau fracture myself 12 years ago. Mountain bike wreck. I was 55.
I know all the local ortho docs, and talked to all of them. They all said this is difficult surgery, and recommended the same guy, about 3hours away. Long difficult surgery. 8bolts. I was told I would walk with a cane the rest of my life- my outcome was much better. Rehab was a *****. 14weeks no weight bearing, then real rehab could begin. Took about 6 more months. It was hard. My knee is now essentially normal. I lost 2-3degrees of flexion and a little bit of leg strength. 12 years later I can still hike, climb, cycle. I walk without limp. Certainly better than a TKR.
Surgical repair is much more difficult and specialized. Rehab is MUCH worse with repair than tkr. Outcome can be better. If she is really active I would go for repair, but knee replacement is easier and more predictable.
Good luck
Gary