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8/15/2019 Rehabilitation of Tibial Plateau Fracture
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8/15/2019 Rehabilitation of Tibial Plateau Fracture
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l a s s i f i c a t i o
n
S c h a t z k e r C
8/15/2019 Rehabilitation of Tibial Plateau Fracture
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8/15/2019 Rehabilitation of Tibial Plateau Fracture
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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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
8/15/2019 Rehabilitation of Tibial Plateau Fracture
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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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
8/15/2019 Rehabilitation of Tibial Plateau Fracture
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Treatment Goals
• Special Considerations of fracture
– Age
–
Location (IV-VI) –
• Associated Injury
• Weight Bearing
– NWB 3 Mos
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
8/15/2019 Rehabilitation of Tibial Plateau Fracture
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Treatment
• Early to Immediate (DOI – 1 week)
– Orth & Rehab Consideration
• 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Early to Immediate (DOI – 1 week)
– 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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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 (+)
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
8/15/2019 Rehabilitation of Tibial Plateau Fracture
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Treatment
• Two Weeks
– Orth & Rehab Consideration
• 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Four - Six Weeks
– Reparative phase, Bridging Callus, Stable (Confirmwith PE)
– Orth & Rehab Consideration • PE: Wound, pain, parasthesia, CRT, Flexion knee ~90°
• 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 (+)
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Four - Six Weeks
– Orth & Rehab Consideration
• Muscle strength: continue isometric exercise of
Quadriceps + start of Hamstring + continue ankle
• Fucntional Activites: NWB
• Gait: two-point NWB gait using crutches
– 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Eight - Twelve Weeks
– Orth & Rehab Consideration
• Muscle strength: Quadriceps + Hamstring + Ankle
•
weeks PWB
• Gait: WB regular gait pattern
– Method of Treatment: Specific Aspects
• 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Twelve to Sixteen Weeks
– Stable, remodelling phase, woven lamellar,Fracture line disappear
– Orth & Rehab Consideration • PE: Wound, pain, parasthesia, CRT, Flexion knee ~90°
• 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
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Treatment
• Twelve to Sixteen Weeks
– Orth & Rehab Consideration
• Strength: Quadriceps + Hamstring, resistive excercise
increase progressively
• Functional activities: weaned of assistive devices
• Gait: normalizing gait
– Method of Treatment: Specific Aspects
• Hinged orthrosis +/- ORIF: bear weight
• Ex Fix: depend on changing to ORIF/Hinged orthosis
Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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Hoppenfeld S and Murthy VL. Treatment and Rehabilitation of Fracture. Philadelphia: Lippincottt Williams & Wilkins. 2000.
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THANK YOU