Rehabilitation of Tibial Plateau Fracture

8/15/2019 Rehabilitation of Tibial Plateau Fracture

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l a s s i f i c a t i o

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S c h a t z k e r C


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Treatment Goals

• Orthopaedic Objectives

– Alignment

• Prevent varus / valgus deformity

• Prevent Instabilit

• Prevent future degenerative changes

– Stability

•

Bone Congruity restored• Rigidly Fixed

Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.


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Treatment Goals

• Rehabilitation Objectives

– Range of Motion

• Restore ROM of knee ASAP (prevent functional

disability)

• Restore ROM Ankle and Hip



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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



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Treatment Goals

• Expected Time of Bone Healing

– 10-12 weeks (8 weeks – Type I)

•

Expected Time of Rehabilitation – 14-20 wee s

• Methods of Treatment

– Hinged Orthosis

– ORIF

– External Fixation



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Treatment Goals

• Special Considerations of fracture

– Age

–

Location (IV-VI) –

• Associated Injury

• Weight Bearing

– NWB 3 Mos



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Treatment Goals

• Gait Cycle – Stance Phase (60%)

• Heel Strike – Quadriceps ~ Extend ~ Intraarticular Fx ~ antalgic Gait (


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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 minimaldisplaced ~ future degenerative ~ work aggressively

•

Ro: Alignment , displacement• WB: NWB 3 Mos

• ROM: early knee ROM (CPM, Active-Assistive), sittingedge of seat~ 40-60° increasing 90° after 1 week



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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



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Treatment


– Methods of Treatment: specific aspect

• Hinged Orthosis: adequate fit with the knee

• ORIF: + Hin ed orthosis ~ knee 0-90° no stren thenin

exercise, ankle isotonic ex + gluteal sets

• Ex Fix: across knee – no ROM



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Treatment

• Two Weeks

– Reparative Phase (osteoprogenitor cellsOsteoblast for woven bone

– Orth & Rehab Consideration • 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 (+)



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Treatment

• Two Weeks


• Muscle strength: isometric exercises of Quadriceps at the

end of 2 weeks (prevent disuse artrophy)•

• Gait: two-point NWB gait using crutches. Elderly Px ~ toe-touch 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



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Treatment

• Four - Six Weeks

– Reparative phase, Bridging Callus, Stable (Confirmwith 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 (+)



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Treatment

• Four - Six Weeks


• Muscle strength: continue isometric exercise of

Quadriceps + start of Hamstring + continue ankle

• 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



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Treatment

• Eight - Twelve Weeks

– Stable, early remodelling phase, woven lamellar,fracture line starts disapperaring

– Orth & Rehab Consideration • : oun , pa n, paras es a, , ex on nee ~

• Dangers: Fracture displacement, loss of fixation

• Ro: loss of correction/displacement, varus/valgus deformity,callus, fracture line

• WB: callus adequate + stable fracture + no collateral ligtenderness/instabillity Partial Weight Bearing

• ROM: active & Active assisted ROM exercise (0-90°), incr.Freq & intensity



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Treatment

• Eight - Twelve Weeks


• Muscle strength: Quadriceps + Hamstring + Ankle

•

weeks PWB

• Gait: WB regular gait pattern


• Hinged orthrosis +/- ORIF: if no varus, valgus, ant, post

instabillity + callus discontinue. If instability (+) 2-

4 weeks NWB

• Ex Fix: change to ORIF/Hinged orthosis



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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



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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



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THANK YOU

Rehabilitation of Tibial Plateau Fracture

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