Tibial plateau fractures involve the upper part of the tibia and include the joint surface. Surgery may be done to align the joint surfaces in the case of uncomplicated fractures, and more severe, high-impact fractures may require the use of surgical fasteners. Surgery takes anywhere from two to three hours and patients spend two to four days in the hospital. Patients are on crutches for up to six weeks following the repair. Physical therapy begins shortly after surgery and continues for up to eight months.
Rehab
For the first six weeks following surgery, no weight may be placed on the affected leg. That doesn't mean, however, that no physical therapy is done during this period. Range of motion exercises -- if not in a solid cast -- strengthening and pool therapy may be prescribed. Rest, ice, compression, immobilization and elevation are important during this period to reduce inflammation and pain.
R.O.M
Range of motion exercises promote flexion and extension of the knee to regain pain-free motion. The knee should be iced before and after these exercises to reduce swelling and pain. Examples include heel slides and supine leg hangs. To perform heel slides, lie on your back with your legs straight out in front of you. Slide the heel of your affected leg toward your buttocks. When you feel tension, hold for one to two minutes, then slide the heel back to the starting position. Do 10 repetitions. To perform supine leg hangs, lie on your back with your affected leg bent so that your upper leg is perpendicular to the floor. Grasp your upper thigh and relax all the muscles in your leg and let your knee bend naturally so that your lower leg hangs down. Hold the position for one to two minutes and then straighten your leg out. Do five reps.
Strengthening
Strengthening exercises are performed to maintain or recover strength in the muscles that support the knee, such as the hamstrings and quads. Only perform strength exercises as prescribed by your physical therapist. Ice the knee upon completion of the exercises. Static inner quadriceps contraction exercises help maintain quadriceps strength. Sit on the bed or floor with a rolled up towel underneath your knee. Tighten your quadriceps muscle and press your leg down into the towel. Hold for five to 10 seconds and release. Do 10 repetitions as powerfully as you are able to do without pain. Do this exercise three times each day. Static hamstring contractions help maintain hamstring strength. Sit on the edge of a bed or chair so that your affected leg is bent to approximately 45 degrees and your heel rests on the floor. Press your heel into the floor by contracting your hamstring muscles. Hold this position for five seconds then release. Do 10 reps as powerfully as you can without pain. Do this exercise three times each day. More advanced moves are performed as strength increases.
Pool Therapy
Pool therapy provides impact-free resistance and support for people recovering from tibial plateau surgery. Pool therapy generally begins two weeks post-surgery and may continue for the entire duration of the rehabilitation period. The exercises are done in deep water so no weight is ever placed on the affected leg. Examples of moves performed in the pool are half jacks, jogging and high knees. To do half jacks, perform half-jumping jacks. Simultaneously flex the hips and knees, bringing the knees up to the sides and then back down. The upper thighs should be parallel with the bottom of the pool at the top of the move. To do jogging in deep water, simulate jogging as if on land. For high knees, you may use buoyancy devices in your hands or use the edge of the pool at your back as support while you hold the edge. Bring your one leg up so that your knee bends as completely as possible, while your other leg straightens out. Repeat the move on the other side, keeping up a continuous motion.
