Postoperative tibial plateau fracture
1.The first day of admission Introduce the doctor as well as the nurse in charge to the patient, introduce the ward environment, and introduce the treatment orientation.
2.Required examination items
(1)X-Ray film of knee joint
(2)Blood routine, urine routine, stool routine.
(3)Selective check of liver function, kidney function, blood sugar, electrolytes, coagulation function, blood sedimentation depending on the patient’s condition.
(4) Electrocardiogram.
3.Optional examination items: depending on the condition, erythrocyte sedimentation rate, C-reactive protein, etc.
4. vas score, muscle strength score, joint mobility score, ADL score.
The rehabilitation program changes depending on the type of fracture, the degree of fracture, surgical technique and fixation method.
5.Phase I: The duration is 1-6 weeks, the main goal is to control pain, strengthen muscle strength, joint mobility training, and prevent bedside complications.
Phase 1: Maximum protection period
Specific treatment items: computerized orthopedic treatment instrument for the knee joint, medium-frequency pulse electrotherapy for the affected limb, cold therapy for the affected knee, and intravenous pump for both lower limbs. Contraindication: knee joint application of internal and external rotation stress, passive joint mobility training of the knee joint.
Objective: To reduce pain, control swelling, gradually restore knee mobility (0°-90°), prevent deep venous thrombosis and pulmonary complications, and restore the patient’s ability to transfer position. Patients are able to get out of bed with the help of others to enter the next small stage.
Rehabilitation contents.
1. Elevation of the affected limb above the heart.
2. Ankle pump.
3. Deep breathing and coughing exercises.
4. Icing of the knee joint
5. Hip and ankle active joint mobility training, knee active
6. Long muscle contraction training for quadriceps, N cord, gluteus maximus.
7. Gentle ankle joint isotonic training without resistance
8. Correct body position placement.
9. Sit up and stand in bed.
10. Strength training of upper limb and healthy side limb.
11.Functional activity: the affected limb can walk with a walker or crutches with two-point gait without weight-bearing.
3 days – 6 weeks
Objective: To restore knee mobility to 90° and muscle strength. 6 weeks x-rays show good healing of the fracture point to the next stage.
Rehabilitation components.
1.Keep ankle pump.
2.Joint mobility training: knee active joint mobility training, assisted-active joint mobility training; reach 90 at the end of 2 weeks, if the target is not reached, increase the intensity and frequency of exercise.
3.Quadriceps femoris, N cord muscle, gluteus maximus and other long muscle strength contraction training.
4, functional activity: continue to walk with a walker or crutches two-point gait without weight bearing on the affected limb.
Phase II: Moderate protection period
6-8 weeks
Contraindicated: no internal or external stress is applied to the knee joint.
1. Joint mobility training:: active joint mobility training, assisted-active joint mobility training and passive joint mobility training of the knee joint at least (0°-90°).
2. Muscle strength: gentle resistance training of the quadriceps and N cord muscles
Phase III: Minimum protection period
8 weeks – 3 months
1.Start quadriceps and N cord muscle progressive resistance plyometric training.
2.Knee joint flexibility training.
3. Functional activities: weight-bearing transfer and walking with a walker at the end of 12 weeks.
4. Weight-bearing: partial to full weight-bearing (to be decided by orthopedic surgeon depending on fracture healing).