Tibial Plateau Fracture: Recovery Time and Physical Therapy Tips!

Do you have a fracture of the tibial plateau? You probably want to know first and foremost the recovery and healing time for a broken tibial plateau.

But also, what you can do to maximize your chances of recovering quickly and well. And how to treat a fracture or cracked tibial plateau.

In this blog post, I answer all the questions that people have after a tibial plateau fracture, regardless of its type. To answer them, I rely on:

• 👩🏽‍⚕️ my experience as a physical therapist for over 11 years;
• 📚 the available data in the international scientific literature on the subject. All references are at the end of the article.

More questions? Don’t hesitate to leave them in the comments, I will be happy to answer them.

What is the recovery time for a tibial plateau fracture?

Several factors will determine your healing time:

• The severity of the fracture (especially if it is displaced or not, and if there are multiple bone fragments)
• Associated injuries (such as a torn anterior cruciate ligament, or other soft tissue injuries, meniscus damage)
• Your general condition before the accident
• Genetic predispositions to recover more or less well
• The delay between the fracture and the operation, if you have surgery
• Whether or not you smoke (smoking delays fracture healing)
• And probably other unidentified factors!

That’s why it’s very difficult, if not impossible, to give you a precise prognosis for your recovery. Not to mention that different things can be meant by “recovery”!

⏱️ Here’s a table summarizing the different stages of recovery and healing after a displaced or non-displaced tibial plateau fracture, with or without surgery. As there is little data in the literature on this subject, I mainly based myself on my own experience as a physiotherapist with people who have had this type of fracture.

Stage	Timeframe from day of fracture
Less pain	Within a few hours to a few days
Bones are well healed (healing time)	After 6 weeks to 3 months
Knee swelling disappears	Within a few weeks to a few months (often)
Walking with crutches	Immediately
Walking without crutches	2 to 6 months
Driving a car 🚗	2 to 6 months
Returning to work	Varies depending on your activity. Generally, 3-4 months. Between 10 and 700 days (Kraus 2018)
Return to sport 🏃‍♂️	Varies depending on the sport! Between 3 and 18 months, on average 7 months (Robertson 2017)
Full functional and muscular recovery	4 months to 1 and a half years

When can you drive after a tibial plateau fracture?

You will find very different opinions on the subject of resuming driving after a tibial plateau fracture.

In United-States 🇺🇲, the law varies by state. Some states do not have specific regulations regarding resuming driving after a fracture, while others do.

In France 🇫🇷, The Highway Code does not provide any specific guidance on this matter. It is up to the driver to ensure that their condition is compatible with reactive driving.

If you have a strict contraindication, the use of pedals is not recommended, even if you will put much less weight on the pedals than when walking.

In an academic publication dedicated to resuming driving after a tibial plateau fracture, the following delays are given: wait 18 weeks or 6 weeks from the moment full weight bearing is allowed for the right side, and no delays for the left leg.

In practice, my patients resume driving much earlier, from a few days to a few weeks after plateau tibial fracture.

Upcoming article: When to Drive After a Fracture or Surgery?

When walking & weight bearing after tibial plateau fracture?

Regardless of the type of fracture and treatment you have, you can start walking right away! However, you will likely need to adapt your walking style and put more or less weight on the broken leg.

There are 3 scenarios:

🪨 Your fracture is stable enough and healing will occur even with weight bearing (rare). The (para)medical team following you informs you that you can bear weight on your leg as much as you wish. However, pain may limit you a bit, and you may need crutches for a few weeks, but you can put your foot down and bear weight on it.

⚡ Your fracture is unstable. There is a risk of improper healing if you bear too much weight on it (most often). In this case, there are 2 possibilities:

• You are advised to use partial weight-bearing for 6 to 12 weeks: you can put your foot down but without putting your body weight on it (about 10 kilos maximum). So you will walk with crutches or a walker. Your physiotherapist will show you how to do it. You can practice putting a maximum of 10 kilos on a scale.
• You are recommended to strictly avoid weight-bearing. You cannot put your foot down until the follow-up X-ray shows good healing, which usually takes 6 to 12 weeks. You can walk with crutches but only on one leg.

You can start walking with crutches right away. Depending on the stability of your fracture, you may be able to put more or less weight on your foot.

How long does swelling last after tibial plateau fracture?

After a knee injury, it is very common for the knee to swell. This is referred to as knee edema in medical terms. The swelling can persist for a long time.

The knee remains swollen for at least a few weeks after a tibial plateau fracture, and this can last several months.

Here is this blog post to learn more about the causes and treatments of knee swelling.

Is it normal to experience pain after a tibial plateau fracture?

It is usual to have pain in the days and weeks following a tibial plateau fracture. Normally, this pain should be relieved by the usual means:

• Stay as active as possible, taking the pain into account;
• Identify and adopt positions and movements that relieve the pain;
• Apply cold if it helps;
• Possibly take pain-relieving medications. In general, the medical team that diagnosed your fracture will also prescribe various medications to relieve pain as needed.

Even though it may seem counterintuitive, pain is not something to panic about, nor should it make you think there is a “problem,” or that the tibial plateau fracture is very serious and will take a long time to recover from.

Pain is a complex phenomenon, related to many different factors, including in the case of a fracture. Some people will have more pain than others after a tibial plateau fracture.

What is the treatment for a tibial plateau fracture?

Most often, a tibial plateau fracture requires surgery.

Less commonly, the treatment will be conservative: treatment without surgery, but with simple immobilization or restriction of weight-bearing.

Tibial plateau surgery

Within hours or at most days following the fracture, you will probably undergo surgery. The goal of the surgery is to:

• stabilize the fracture;
• maximize the chances that your bones will heal well to limit the risk of complications.

Depending on your fracture and the practices of the team taking care of you, different types of procedures will be performed and different materials may be used to reduce and stabilize your fracture (osteosynthesis with screws or plate-screws, external fixator, bone graft, knee replacement…).

You will get an overview of these techniques by reading the operation report 🗒️ (often included in your discharge letter, or that you can request to retrieve).

The (para)medical team who operates on you or follows you during the post-operative period can also provide you with more detailed information about the procedure performed if it is important to you.

You may also have a brace to limit knee flexion, as well as instructions on how much weight to put on your foot.

🛠️ The hardware can usually be removed about 1 year after it was placed after broken plateau tibial.

Compression socks or stockings are typically prescribed to reduce the risk of blood clots (which occur very rarely in any case).

Non-surgical treatment for tibial plateau fracture

If the fracture is not displaced, sometimes you may not need surgery.

You may then have a cast (often a lower leg cast, up to mid-thigh) or a brace (or knee immobilizer) limiting knee flexion for a few weeks, as well as instructions to partially weight bear on your foot.

It is the medical team who has seen your X-ray and knows your overall health and medical history who determines this.

Do you need a brace after a tibial plateau fracture?

The prescription of a brace (or knee immobilizer) is not systematic after a tibial plateau fracture.

If no one has prescribed it to you, you probably don’t need it!

When a brace is prescribed, it is generally for one of these 3 reasons:

• the surgical team thinks that the consolidation will be better by limiting the flexion of your knee;
• or you have a loss of strength in the quadriceps, one of the muscles that helps prevent your knee from “giving way” with each step,
• or you have instability of the knee joint. The brace in this case reduces the risk of your knee buckling when you take support on your leg; the people who are following you think that limiting the mobility of your knee will relieve some of the pain.

A knee immobilizer may be prescribed for the same reasons. But it limits knee mobility less and stabilizes it less. It is often better tolerated.

The brace (or knee immobilizer) can be removed when you are lying down (at night, during the day). It is kept for a few days to a few weeks at most.

Tibial plateau fracture rehab protocol & physical therapy

Most of the time, one of the main goals of physiotherapy will be to help you regain good knee flexion to avoid stiffness, while also preserving the opposite movement, extension.

Generally, the flexion can be gradually sought from the day after the surgery.

Sometimes, post-operative instructions are to wait a few weeks (sometimes 3, sometimes 6, rarely more) before starting to work on flexion.

Your physiotherapist will show you exercises to work on knee flexion independently and safely.

Often, it is better for you to frequently solicit knee flexion and extension throughout the day, rather than doing one large session per day. Hence the importance of learning to perform this mobility work on your own.

Other goals of rehabilitation will be to:

• reassure you and answer your questions;
• give you advice to better relieve your pain and limit the risk of complications;
• help you gradually resume your daily activities;
• encourage you to remain as active as possible;
• find the appropriate technical aids and walking pattern for you;
• provide exercises to maintain your muscle strength and cardiovascular capacity, so that you are deconditioned as little as possible;
• help you gradually resume all your pre-injury activities through progressive reconditioning, including leg muscle strengthening.

Can you experience complications after a tibial plateau fracture?

There is a high likelihood that you will fully recover from a tibial plateau fracture. After a few months, you should not have any complications.

After non surgical plateau tibial fracture, 100% return to sports if they were doing it before.

For those who had surgery, 70% of them return to sports, on average, after 7 months. (Robertson 2017)

In rare cases where there are complications, they may include:

• stiffness in the knee (to bend or straighten it);
• delay or absence of healing;
• residual pain (not necessarily constant and continuous!);
• early arthritis in the knee.

Complication after a tibial fracture are rare. When they occur, they may include stiffness, delay in consolidation, pain, or arthritis.