(Disclaimer: This article is for scientific purposes only and the information in the following content has been processed to protect patient privacy)
Abstract: The knee joint consists of the patella, the lower femur and the upper tibia, which is also known as the tibial plateau. When a patient falls from a height, the hard femur acts as a heavy hammer that can smash the tibial plateau to pieces. This patient fell from a 2-meter-high fence with no cushioning on the hard concrete floor, resulting in a crushed tibial plateau fracture. The patient eventually underwent surgery, after which the fracture healed well and the knee function returned to normal.
Basic information】Male, 57 years old
Disease Type】Tibial plateau fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】July 2021
Treatment plan】Surgical treatment (fracture incision and internal fixation) + medication (ibuprofen extended-release capsule, Shujianzhi blood tablet) + rehabilitation treatment (active and passive knee joint activities)
Treatment period】20 days, regular outpatient follow up
Treatment effect】Fracture healing, normal knee movement, walking function restored
I. Initial consultation
The patient was a 57-year-old Mr. Wang who accidentally fell over a fence and landed on his feet, resulting in serious injuries to his lower limbs, especially the knee joint. Immediately after the injury, he developed knee pain, swelling, and difficulty moving his knee. The patient was accompanied to the emergency room by his family. On initial examination, it was seen that the patient had a significant valgus deformity of the knee joint, and there was significant swelling of the knee joint and lower leg, and the knee joint was severely injured. Combined with the patient’s injury history and clinical presentation, it was easy to see that there were definitely problems with the knee joint.
II. Treatment
Further radiographic examination revealed that the patient had primarily damaged the tibial plateau. The tibial plateau was collapsed and split, with fractures on the medial, lateral and posterior aspects of the plateau. Due to the severe swelling of the lower leg, blisters had appeared and surgery had to be postponed until the swelling subsided. The patient was treated with anti-inflammatory and anti-swelling treatment, ibuprofen extended-release capsules, and relaxing tablets with traction for about 1 week, and the patient eventually underwent internal fixation surgery with skin folds. Postoperatively, the patient was given passive activities of the knee joint to avoid disuse atrophy and limited mobility of the joint; as the incision healed, active knee flexion and extension exercises were given.
III. Treatment effect
The patient was operated under general anesthesia, and the patient’s symptoms were relieved on the night after surgery. On the 5th postoperative day, the swelling of the lower leg was significantly relieved, and the incision healed and the stitches were removed 2 weeks after surgery, at which time the knee joint could be moved to 90° of flexion. After 20 days of hospitalization, the patient’s tibia basically recovered and could do simple movements in bed, and the patient was discharged. After discharge from the hospital, the patient was reviewed on an outpatient basis. 3 months after the operation, the patient was helped to walk on the ground. 1 year later, the fracture healed and walking basically returned to normal.
IV. Notes
We are glad that the patient regained basic mobility, but we still need to remind the patient that due to the early stage of fracture healing, the lower extremities should not bear weight and avoid strenuous activities, so that a gentler form of exercise can be performed. During the period of bed rest, attention should be paid to diet and nutrition. It is recommended that high protein and high calcium food should be the mainstay, and oral calcium can also be taken to help the rapid repair of fracture.
V. Personal insight
Tibial plateau fractures often manifest as collapse and compression of the bone, and surgery is required not only to reset the fracture, but also to restore the height of the plateau. In the early post-operative period, the joint surface can only be maintained by the support of the internal fixation plate, and the bone itself does not form a support. If the bone is lowered prematurely, it will easily lead to the collapse of the bone surface again. Therefore, after tibial plateau fracture, the patient can walk on the ground relatively late, which needs to be decided according to the fracture healing situation, usually 3 months, or longer. During this time, although they cannot go down to the ground, they need active rehabilitation exercises to avoid disuse atrophy of the muscles.