Tibia Plateau Shattered – Experience and Questions

[Jon-D]

I did a search and it was comforting to see others have been through this before and come out on the other side and able to function normally again.  This is a bit of a long post but I thought I would include a little more detail than what others posted in case some bit of my experience will benefit others.

 

The injury occurred on September 13, 2015, last surgery was on September 18, and I am currently non weight bearing with a doctor’s appointment scheduled for this Wednesday (Nov 4^th).

 

Overall experience – mirroring some other posts from people who have had the same injury without question this has been the most depressing and the most painful experience of my life.  So far I missed out on two Boy Scout outings with my son and a Halloween, which we have done as a father-son routine since he was born.  To combat the depression I sit outside when the weather is good and work out my upper body daily (on the floor of course).  My son and I also review his Boy Scout merit badge requirements prior to the weekly meetings.  I also have been reading books and taking the free on line courses. I think the key is to keep busy within the doctor prescribed limits.  I also have a calendar next to my bed and check off the days to when I think I can start walking again as a way to show progress.

 

How it happened - I destroyed my tibia plateau in a sweeping corner.  My rear tire walked out from under me due to an over watered section of the track and I tried to instinctively save it by extending my leg out.  It was at Glen Helen during an SRA race on the trophy tuck section of the course if you happen to be familiar with the layout.  Just to frame myself as a rider, I am careful and have no issues backing off of a jump, or other situations that appear a bit sketchy.  A piece of plastic is never worth an injury in my mind.  I wear don joy knee braces, top of the line boots, and all other quality safety gear available.  In this particular race I was riding slower than normal with no real drive to make passes or pull away from the riders around me that I normally am faster than.  I just was not “feeling it” so I thought I would simply cruz during the race.  I still cannot believe this happened.

 

ER, first, second surgery – my first clue on how serious this was is when the EMT said he had never seen anything like this and had to take me to a trauma hospital.  Once in the ER three docs formed a semi-circle around my leg and debated on how to fix it and none of them were sure.  Very depressing but I was too drugged up and in pain to put a lot of thought into it.  The docs first checked my toes for movement (I could move them) and then put me out to reset my knee and put on a brace before sending me to x-ray.  The x-ray tech removed my brace and I could feel my knee fall away.  The pain was indescribable even in a drugged up state.  After returning to the ER the doc asked why she removed the brace and I said she insisted it had to be done.  A quick check of the toes and I could no longer curl them up and I lost feeling in parts my leg and foot.  The doc said it was temporary but I later figured out that she damaged the peroneal nerve.   Two hours later off to surgery where they sliced open both sides of my calfs to prevent compartment syndrome and installed external fixaters.  After surgery I spent two days in ICU before transferring to a regular hospital bed.  The second surgery (6 days later) the external fixaters were removed and internal ones installed.  None of the docs in my health plan felt comfortable performing the surgery so it was contracted out to a doctor who felt he could do it.  I spent a little more than two weeks in the hospital before I was released.  BTW, I saw the bill for the first surgery and it cost 94K.  So glad I have insurance that covered it.

 

Post hospital – Two weeks after surgery my surgeon removed the bandages and staples and the next day my foot felt like someone was stabbing a knife in it.  I could not sleep.  Turns out due to the nerve damage they were firing like crazy.  Also, anytime I get out of bed my leg below the knee fills up with blood and becomes a very dark shade of purple.   The doc prescribed Gabapentin to help with the nerve pain.  The drugs have taken the edge off but I still feel a lot of nerve pain.  So far I am 6 weeks post surgery and still in bed but will bring up the possibility of at least starting water therapy so that at least Ii feel that I am making progress.

 

Humor – through this very unpleasant experience there were events that when I step back and look at them they were a bit funny in a humiliating way.  To humanize this experience I thought I would share a couple of stories of what normally would be embarrassing. The first situation is when the nurse had to re-insert my catheter because I was not able to pee after they removed it.  My bladder was full and I looked a few months pregnant.  The nurse that was to perform the task was a young attractive Asian girl.  So during the procedure I attempted to cover up my inadequacies with a little humor by commenting on how cold it was in the room from which she responded “it seems OK to me but I can turn it up for you”.  The second story is bit more personable but I am willing to bet not uncommon.  About a week after my first surgery the nursing assistant asked when I had my last BM, from which I responded at least a week ago.  Laying on your back and ingesting pain killers 24/7 will stop anyone up.  She immediately used the word “enema” and I franticly began coming up with excuses and reasons to wait like a school boy attempting to avoid his chores.  I never had one before and I would do anything not to have it done.  Sensing the fear in my voice I think she felt sorry for me and gave me six hours to have one on my own or she would be back to give me the hose.  Six hours later knowing I made no progress she and one other girl burst into my room and very enthusiastically said “congratulations Mr. XX, tonight you will have a BM!”.  She performed the task and within ten minutes I rushed to the bed side toilet and pooped soft balls for 20 minutes.  Under normal circumstances I would never let anyone do that to me but I can’t tell you how good I felt afterwards and I even thanked her for it.

 

After my hospital stay experience I have tremendous respect for the tech’s and nurse assistants.  They have the job of cleaning up messes and dealing with people when they are at their lowest in life and all for not much pay.  I really cannot thank them enough for the positive attitudes and humor they displayed during my hospital stay.  When I left they came to say goodbye and wished me a speedy recovery.  Very nice.

 

Questions – I have several but thought I would start with these: (1) those that have similar injury to this extent, when did you start riding again and how long has it been since your surgery?  Can you provide a road map to your recovery?  (2) I was told to expect an artificial knee in 5-10 years, did your doc tell you the same or something different?  (3) Has anyone experienced nerve damage where you could not lift your foot (drop foot) and did it ever come back?

 

 

 

[DrMark]

The medial TPF, especially when there is a compartment syndrome is a very bad actor.  The workmanship looks, pretty good, and if no infection occurs, a TKA probably isn't on the menu right know.

 

If you are able to bring your foot and toes somewhat upward, then the nerve will recover somewhat.  If there is no motor function at all, then a tendon transfer should be done.

 

At any rate, you are over the worst of it.

 

God Bless.

[delirious]

I had the same injury 3 yrs ago and took 1 yr before I rode a duel sport very carefully not to fall off.

[Jon-D]

met with the doc, I have another 6 weeks of non weight bearing fun ahead of me.  seriously bummed about that.  but, he gave the go-ahead for PT.  the earliest appointment is almost 2 weeks away which really sucks because I want to get going and make some progress.  my ROM is about 110 degrees and I try to stretch it out more occasionally while watching TV.

 

the doc was willing to clear me to go back to work with the restriction of only working at a desk.  but one of my biggest hurtles is the blood rushing to my leg when I get up to get around with my walker which really impairs my ability to be independent.  for example going to the bathroom is painful, and I cannot get my own food due to the time it takes to retrieve anything from the fridge or pantry.  is this common and how long does it typically last before it goes away?

[Jon-D]

i found a site like this one but is for knee injuries.  my type of injury is the minority on the site, which makes me feel a bit alone but glad not that many people have to suffer through something like this.  anyway, for future searching to answer my question normal blood pressure could return in about 4-8 months (different for everyone). 

 

i can see why not many riders responded to this post because its an injury that really prevents a person from riding again (delirious you are certainly the minority).  the doc says a knee replacement is in my future and when is the only question so i want this one to last as long as possible.  he also said i should never run so the only exercises he recommends is non impact of course (swimming was the first suggestion). 

 

i am transitioning to crutches now and working on my ROM although with limited success.  since i am a bit more mobile i am prepping my bike for sale.  i love that bike it had the best suspension i ever rode and it handled great.  so its a bit depressing to accept that this is it for me when i had so may moto goals.  it is what it is i suppose.    

[DrMark]

I have had patients with injuries way worse that this one return to riding and sports.  Its never about the knee, or the whatever.  Its about heart.

[jay bird1138]

I'm almost done with a spiral fractured tibia, so not too relatable. The only similarity is the blood rushing down. I am far from qualified to provide any explanation, but my thought was it was the compression from the casts and boot that caused more blood and now with no compression... I'm probably wrong. Are you in a cast or anything?

Best of luck, and why selling the bike?

[kneehurts]

Hopefully you are off the Gabapentin by now? It's disconcerting to know your knee brace did not help.

[Jon-D]

still on the Gabapentin but the "shocks" seem to be less frequent.  if i dont feel the nerve pain for a few weeks or so i will start to decrease the dosage.

 

my foot still swells up when i stand but not nearly as much as before and i do wear a compression stocking to help.  oh, ya, forgot to mention...a few weeks ago the doc cleared me to be weight bearing.  when i place weight on the leg my knee hurts a bit (as expected) and at first my ankle hurt like crazy when i put pressure on it but it has improved.  i just keep trying to work through it.  over the last few weeks of PT and working on my own the leg has improved to the point where i have transitioned to one crutch but still cannot put all my weight on the bad leg.  one thing i wanted to mention, its very important to keep ALL your body parts moving, not just the broken ones.  the time i was in bed i was focused on my knee's ROM and during that period my ankle atrophied to where it would not go past zero degrees up which is making it difficult to take a full step.  no one mentioned any of that to me and if they had i would have been all over it.  

 

for good news, i have regained the ability to lift up my ankle so i dont need an AFO to support it.  its weak, but it moves.  the doc was really surprised when he saw me move it and told me that from what he witnessed during the surgery he was sure it would not recover.  i guess he told me 25% chance of recovery to give me some hope.

 

heading off to PT now....   

[Jon-D]

still on one crutch although it seems that i can place more weight on the bad leg.  I was taking the nerve pain meds three times a day and skipped over the afternoon dose in an attempt to ween myself of the drug.  while doing this, within a day or two in the evenings i would get that shooting pain down my leg so i went back to taking the pills three times a day and the pain subsided.  my leg still fills up with blood, although no nearly as bad as before.  i sometimes dont wear my compression stocking but i plan to when i return back to work.  I expect to return to work this week (submitted my doc release letter today), working half days for the first week then full days.  but because of blood pooling in my leg i will have to figure out some way to keep my leg elevated, or periodicity elevate it.  one thing that does help is walking.  using the muscles help pump the blood out of my leg and the exercise is good for the recovery.

 

PT seems easy for me so most of the hard work i do at home.  since i am currently not working every day i do some form of PT, stretching followed by muscle strengthening.  i am almost up to the same level on my stationary bike as i was before the mishap, which is nice to show some progress.  yesterday i was able to walk around the block although afterwards i was done for the day.  i am really looking forward to camping trips with the little guy as soon as i can get around unassisted.

 

everything i read about this type of injury and the different doc's and PT's i have worked with all independently tell me that a knee replacement is in my future.  is it because the meniscus is thinned out from the injury?  i dont really understand the mechanics as to why.   

[Jon-D]

OK, just to keep this thread updated for future reference for those unfortunate riders that join the TPF club...

 

late last week I finally transitioned to a cane and ditched the crutch.  felt real good to see some progress.  yesterday I felt strong and could "almost" walk without the cane although I am limping.  today feeling weaker but I worked out last night so I am sure that had something to do with it.  I also returned to work last week which is a nice change of scenery from Netflix.  PT and co-workers commented that my leg bows in like I have been riding horses, which could make sense since the injury is on the inside of the knee.  Hopefully that wont affect normal walking but if it does I will call it "character".

 

I would not be surprised if others with similar injuries experience this but every now and again I have dreams about racing.  The nice thing about that is at least I don't crash and I think I even race in a higher class. 

 

Recap:

9/13/15 TPF

9/18/15 last surgery

12/9/15 weight bearing (walking with two crutches)

12/28/15 down to one crutch

1/14/16 started using a cane

[obgod3]

I have been through a pretty bad TPF, it's hard work, but you have to keep pushing it. Make sure you got a good PT and one that can push you. It's going to take IMHO a year or so to normalize, not that mine was ever normal again. That doesn't mean your not going to be able to do things just that where you end up takes a long time to discover. I still have parts of my leg I don't really feel kinda like a weird numbness....that's almost 6 years now. I eventually had the knee replaced and while it's better it isn't normal like my other knee and won't be so don't be in a hurry for that bucks it isn't going to get things back to a non-injured knee, I don't regret it but I still wouldn't rush it. I ride a lot still so as the Doc said it isn't about the bones and tissue, it's about what you have in your heart and head. Keep up the work.

[mtgraves]

Had a similar experience almost 13 years ago. Ended up with a plate and 7 screws along with some nerve damage. I didn't have the drop foot, but all of my toes curled up and basically locked that way. I'm guessing this was due to compartment syndrome but I never really got answers. I was in the military at the time and I just wanted to get put back together so I could get back to work.  I could straighten them out by hand but they would just go back. The bottom of my foot was hyper-sensitive for a few years after that, and it's still kinda weird but I think that I just deal with it now. Before it was almost painful to step barefoot on a cold floor or concrete. Now it still feels different than my other foot I just think I'm used to it. I had to have surgery on my toes a few times to have them lay flat. They did what they called a tendon release, they cut the tendons on the bottom of my toes so I can't curl them but I can still move them up and down and now they lay flat. I don't know how old you are, but I was only 23 when I did my knee in. Doc told me there was no way they would replace it for quite a long time. I was told to never run again since cartilage was removed which of course I didn't listen to so I'm told there are signs of arthritis in my knee. I wasn't a knee brace guy at the time, but when I started riding again there was no way I'd ride without them. Still that way. I don't remember exactly how long it took before I rode again but I know it was over 6 months. Riding at that time really wasn't my concern, I knew that I wanted to again but I also wanted to keep my job. I think besides the pain and stuff one of the obstacles that got me was I was thinking it would go back to no pain and 100% strength and be like it never happened. In my case, that didn't happen, and once someone told me that it wouldn't I decided I would do the best with however it's going to be. My leg atrophied a lot from that accident and I can still tell that it's a different size than my other leg. I work out and try to keep in shape and not let it bother me too much. I figure a replacement is going to have to happen eventually but I don't want to go that route until it will actually improve my quality of life. 

 

My biggest issues since then have been in my mind. I know what a hassle that was and the pain.  I also know that it's not normal and that it won't be. I still race motorcycles so that's cool. I wish I could still run distance without causing more damage and jump like I could beforehand but those are things I can live without. I got more into cycling as a result which isn't a horrible thing.

I would listen to your doc and PT and ask questions. Keep working at it and I'm sure you'll be able to get back to doing what you want to do at some point. 

[Jon-D]

hey thanks guys for sharing your experiences.  its interesting to see how each of us has had different outcomes in regards to how our nerve responded to the accident.  

 

mtgraves I know exactly what you mean by this injury getting in your head.  In some situations I notice I am much more carful than I need to be, then I remind myself I need to keep pushing and go forward.  were you full time military or part time when you had your accident?  full time I would think the VA would have been taking care of you, although now that I am thinking about it I have a buddy who had knee issues (different than ours) and it seems that the VA did not give him very good care.

 

so what did you guys do to regain your strength and mobility?  I tried swimming last night (joined the Y, heated pool!)  but I don't think at this point it is as beneficial as the stationary bike or an elliptical.  in addition to swimming a little lopsided I also walked along the bottom pushing myself through the water - basically did anything that made the bad leg work.  

[mtgraves]

I started out mainly using the elliptical machine. I remember my PT having me do it for X amount of minutes forward then switch to going backward for X amount of minutes and going back and forth with that for 20 or 30 minutes to begin with. That was a workout at first. Really seemed to help with my stabilization. Then I started cycling. From there I got normal enough to do weights. I used to run a lot, wish I still could but I think I might keep some future pain at bay a little longer if I stay away from that. I keep going back and forth with rowing. I'll get into it for a bit but then it'll bore me to tears. 

 

As far as the VA goes, I was full time active at the time of my injury so I didn't deal with them. I stayed full time active for another 9 years. I returned to flight duty 18 months after my surgery and for the most part remained on it for the rest of my time. Besides basic pain I haven't felt the need to have my knee looked at anymore. I'm sure the day will come but for now it's all good!

[Jon-D]

thanks for the responses I really appreciate hearing about your personal experiences and what you did to recover.  I have tried using the elliptical but only in the forward motion so next time I will go back as well as forward.  thanks for the tip!

 

this last week I ditched the cane and forced myself to walk on my own.  not pretty by any means with the sever limp, but I get around.  initially I was focusing on tensing my knee muscles as I was stepping, but today while walking into work I noticed I was not even thinking about it so there is some progress taking place.  this type of injury is very depressing but the small increments of progress is what keeps me motivated.

 

I noticed some sharp pains in the knee when walking occasionally and when taking the stairs.  did you guys experience this as well and did it eventually subside?  the other thing I noticed is the occasional "cracking" in the joint, like when cracking your knuckles.  did you guys experience this as well? 

Edited February 8, 2016 by Jon-D

[mtgraves]

The cracking has never stopped, I get a good amount of that, but it's not painful so it hasn't concerned me. I did occasionally get an extremely sharp pain just below my knee cap center of my leg when I was going down stairs. It was usually the fist descent of the morning and it cleared up after that. It was bad enough that I felt like I was going to fall more than once so I went and had it looked at. The only word I got was that it was arthritis. This was 2 years ago. I've been hitting the gym more regularly since then and I haven't had it happen that much since. It never was an every day event and now I can't pin point the last time it happened so my plan is to keep working and forget about it!

[Jon-D]

thank you mtgraves, I really appreciate the info!

[KawaZukiMike]

The medial TPF, especially when there is a compartment syndrome is a very bad actor.  The workmanship looks, pretty good, and if no infection occurs, a TKA probably isn't on the menu right know.

 

If you are able to bring your foot and toes somewhat upward, then the nerve will recover somewhat.  If there is no motor function at all, then a tendon transfer should be done.

 

At any rate, you are over the worst of it.

 

God Bless.

Hey Dr. Mark,

 

Just wondering, do you see any correlation between more plateau injuries and riders wearing braces? I've noticed that the "rear wheel slipped out from under me"  being the a common situation.  This is how I cracked my tibial plateau, as well as several others I've seen posting about the same type of injury, with almost all of us mentioning we were wearing knee braces.

 

Just seemed to stand out to me.

 

Thanks!

 

Mike

 

PS I'm in the Austin area...wish you were in my insurance's network. I need some old fixaters / hardware that's come loose removed from my foot.

[DrMark]

Even though most riders are wearing braces, the incidence of TPF has not gone down.  Bracing will protect knee ligaments from angular and torsional stresses.  TPF occurs because of tranmission of impact.