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Tibial Plateau Frx: Post Op Care and Complications

- Post Op Care:
    - consider keeping the knee in 45-60 deg flexion;
    - for the first 5 postop days, the pts leg is maintained in a CPM machine, and the ROM is increased to a range of 15 to 70 deg;
    - POD #3: active assisted ROM exercises are started & continued BID;
           - later quadriceps exercises are added;
    - before discharge, patients should be fitted w/ a hinged knee brace;
    - for 6 weeks emphasize ROM exercises;
    - at 6 to 7 weeks, SLR and use of a station bycycle are introduced;
    - at 8-12 wks, pt starts toe touching & then incr. wt bearing by 25 lbs qwk, depending on the level of comminution;

- Complications: 
    - Loss of Reduction:
    - Delayed Union:
    - Limited motion & lack of knee extension:
          - immobilization w/ knee in extension < 3 weeks prevents contracture;
    - Instability (see ligamentous injury)
          - instability of > 10 deg after plateau frx occurs in 10% of pts;
          - 3 causes:
                - uncorrected articular depression;
                - healing of torn collat. ligament in a lengthened position;
                - loss of articular cartilage as traumatic arthritis develops;
    - Angular deformity
    - Traumatic arthritis;
    - AVN:
          - Local or Split compression frx have centrally depressed fragments;
          - AVN is diagnosed when serial X-ray show a gradual shrinking of the eleveated fragments until a defect remains; 
    - Infection:  
          - this case involves a 40 year old male who had had ORIF of a tibial plateau frx 5-6 years previously;
          - while in prison, he noted a spontaneous protrussion of one of the K wires thru the skin;
          - this first developed a superficial skin abscess and subsequently developed a septic knee 

Early weight bearing of lateral tibial plateau fractures.

The significance of early motion in the treatment of tibial plateau fractures

Increased neurologic complications associated with postoperative epidural analgesia after tibial fracture fixation.