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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 



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