Rehabilitation of Tibial Plateau Fracture

Rehabilitation of Tibial Fracture
Schatzker Classification
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
Treatment Goals
Orthopaedic Objectives
Alignment
Prevent varus / valgus deformity
Prevent Instability
Prevent future degenerative changes
Stability
Bone Congruity restored
Rigidly Fixed
Treatment Goals
Rehabilitation Objectives
Range of Motion
Restore ROM of knee ASAP (prevent functional
disability)
Restore ROM Ankle and Hip
Treatment Goals
Rehabilitation Objectives
Muscle Strength
Quadriceps (knee extensor)

Rectus Femoris (flexing hip)
Hamstrings (primary knee flexors, assisting hip extension)
Satorius and Gracilis (supporting medial side)
Gastrocnemius (plantar flexor of the foot)
Functional Goals
Normalize the gait pattern and restore the stability of the
knee during stance phase
Treatment Goals
Expected Time of Bone Healing
10-12 weeks (8 weeks Type I)
Expected Time of Rehabilitation

14-20 weeks
Methods of Treatment
Hinged Orthosis
ORIF
External Fixation
Treatment Goals
Special Considerations of fracture
Age
Location (IV-VI)
Injured anatomy
Associated Injury
Weight Bearing
NWB 3 Mos
Treatment Goals
Gait Cycle
Stance Phase (60%)

Heel Strike
Quadriceps ~ Extend ~ Intraarticular Fx ~ antalgic Gait (<<)
Foot Flat
No problem
Mid Stance
Full Weight Tibia plateau not smooth ~ antalgic gait ~ hop off
(reduce pain)
Push-off
Weight bearing << ~ may be painful
Swing Phase (40%)

No problem
Treatment
Early to Immediate (DOI 1 week)
Inflammatory phase
Orth & Rehab Consideration
PE: NVD, Ankle & Foot ROM, Compartement, Wound,
edema ~ elevation
Dangers: compartement synd, Drop foot, even minimal
displaced ~ future degenerative ~ work aggressively
Ro: Alignment , displacement
WB: NWB 3 Mos
ROM: early knee ROM (CPM, Active-Assistive), sitting
edge of seat~ 40-60 increasing 90 after 1 week
Treatment
Muscle Strength: (-), when pain subsides ~ ankle
isotonic w/o resisance, gluteal exercises (help from
sitting to standing)
Functional Activities: NWB
Gait: 2 point NWB using crutches
Crutch + Sick = Healthy
Stairs: up~ healthy 1st, down~sick 1st
Difficult to ambulate in NWB: Toe touch
Treatment
Methods of Treatment: specific aspect
Hinged Orthosis: adequate fit with the knee
ORIF: + Hinged orthosis ~ knee 0-90, no strengthening
exercise, ankle isotonic ex + gluteal sets
Ex Fix: across knee no ROM
Treatment
Two Weeks
Reparative Phase (osteoprogenitor cells
Osteoblast for woven bone
PE: Wound, pain, parasthesia, CRT, Flexion knee ~90

Dangers: risk of displacement / loss of fixation
Ro: if not yet ORIF alignment?, ORIF done Position?
WB: NWB 3 Mos
ROM: active & Active assisted ROM exercise (0-90),
incr. Freq & intensity, ankle (+)
Treatment
Two Weeks
Muscle strength: isometric exercises of Quadriceps at the
end of 2 weeks (prevent disuse artrophy)
Functional Activities: NWB
Gait: two-point NWB gait using crutches. Elderly Px ~ toetouch allowed while using walker
Method of Treatment: Specific Aspects

Hinged orthrosis: accomodate ROM
ORIF: + hinged orthosis remove evaluate wound
remove sutures dressing before hinged orthosis
Ex Fix: signs of Infection
Treatment
Four - Six Weeks
Reparative phase, Bridging Callus, Stable (Confirm
with PE)
Dangers: Fracture displacement, loss of fixation
Ro: loss of correction/displacement, varus/valgus
deformity
WB: NWB for 3 Mos
ROM: active & Active assisted ROM exercise (0-90),
incr. Freq & intensity, ankle & hip (+)
Treatment
Four - Six Weeks
Muscle strength: continue isometric exercise of
Quadriceps + start of Hamstring + continue ankle
isotonics
Fucntional Activites: NWB
Gait: two-point NWB gait using crutches

Hinged orthrosis: accomodate ROM
ORIF: + hinged orthosis remove evaluate wound
remove sutures dressing before hinged orthosis
Ex Fix: signs of Infection
Treatment
Eight - Twelve Weeks
Stable, early remodelling phase, woven lamellar,
fracture line starts disapperaring
Dangers: Fracture displacement, loss of fixation
Ro: loss of correction/displacement, varus/valgus deformity,
callus, fracture line
WB: callus adequate + stable fracture + no collateral lig
tenderness/instabillity Partial Weight Bearing
ROM: active & Active assisted ROM exercise (0-90), incr.
Freq & intensity
Treatment
Eight - Twelve Weeks
Muscle strength: Quadriceps + Hamstring + Ankle
Fucntional Activites: if callus is adequate end of 12th
weeks PWB
Gait: WB regular gait pattern

Hinged orthrosis +/- ORIF: if no varus, valgus, ant, post
instabillity + callus discontinue. If instability (+) 24 weeks NWB
Ex Fix: change to ORIF/Hinged orthosis
Treatment
Twelve to Sixteen Weeks
Stable, remodelling phase, woven lamellar,
Fracture line disappear
Dangers: stiffness
Ro: loss of correction/displacement, varus/valgus
deformity, callus, fracture line & Callus
WB: FWB
ROM: full extension + at least 90 degree of Flexion
Treatment
Twelve to Sixteen Weeks
Strength: Quadriceps + Hamstring, resistive excercise
increase progressively
Functional activities: weaned of assistive devices
Gait: normalizing gait

Hinged orthrosis +/- ORIF: bear weight
Ex Fix: depend on changing to ORIF/Hinged orthosis
THANK YOU

Rehabilitation of Tibial Plateau Fracture

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Rehabilitation of Tibial Fracture

Quadriceps (knee extensor)

Expected Time of Rehabilitation

Stance Phase (60%)

Quadriceps ~ Extend ~ Intraarticular Fx ~ antalgic Gait (<<)

Weight bearing << ~ may be painful

Swing Phase (40%)

PE: Wound, pain, parasthesia, CRT, Flexion knee ~90

Method of Treatment: Specific Aspects

Method of Treatment: Specific Aspects

Method of Treatment: Specific Aspects

Method of Treatment: Specific Aspects

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