Biker395 

Went skiing last weekend and managed to get a compression fracture of the tibial plateau in a crash.

Sux.

So one orhto is recommending no surgery, and another is recommending it. Based on Medscape research, it looks to me as if surgery is a better long term solution, but I guess we'll see.

*Sigh*

OldsCOOL

Ugh! Sorry to hear this. I hope your treatment and recovery goes well. And just when the riding season is getting started.

RonH

Sorry to hear this. Before you have the surgery, I recommend you talk to a sports medicine doc.

qcpmsame 

Jeese Vic, sorry other about this. No experience with this one thankfully, and I slept at home last night, not at a Holiday Inn Express, so I have absolutely nothing to suggest other than to take the time to let it heal completely, what ever course you use. Please keep us informed as to what happens.

Bill

locolobo13 

Sorry to hear this. Heal well!

Biker395 

Thanks, everyone!

Oh, trust me.

The first doc (no surgery) is the Dodgers and Kings team doc. The second doc is one that he recommended for a second opinion. I'm going to see that doc for a personal consult and examination today. I think part of the first doc's recommendation was because I'm not overweight, not a runner, and so am probably not going to stress the knee too badly. The second doc doesn't know all that yet.

The real bummer in all this is that it may well impact doing RAAM this year ... a once in a lifetime opportunity.

But I'm in this for the long term. God willing, I plan to ride into my 80s, so whatever it takes to maximize the long term health and stability of the knee is what I'll do.

No MRI yet. Once that is done, I'll have another chat with both docs and decide from there. In the mean time, it's crutch time.

GadgetGirlIL

Sending healing thoughts. Hope you settle on the right course of treatment so that you can get back to riding sooner rather than later.

OldTryGuy

Professional Team Sports docs are the way to go. My shoulder/knee guy had me back riding 3 days after total right shoulder replacement. He had 10 years with Cincinnati Reds.

Hope you get through everything just fine and complete RAAM. I had a 24Hr. RAAM Qualifier last month at Sebring and bombed out. Night before the ride my right knee, bone on bone, gave out and started giving me fits 60 miles into the ride. Had to abandon at 266 miles and am totally ticked.

GOOD LUCK

Biker395 

Going under the knife today.

I got all sorts of opinions on whether surgery was recommended. Two were on the fence, with one on either side. Another strongly recommended surgery.

For me, the big factor were the CT scans. I just can't help thinking an asymmetrical tibial plateau is a bad thing in the long term, and the best time to fix it is now. All the docs are good with my decision.

Another factor is that my conditioning and activity level indicate both a greater need for the surgery to keep the knee stable for non-cycling activities (skiing and hiking), and a better prognosis (good upper body strength for hobbling around on crutches, less weight, penchant for doing PT and knee friendly exercise, like cycling). All the docs felt that if I was a more typical sedentary overweight person my age, surgery would not be recommended.

So off I go into the world of Percocet and betadine. Wish me luck!

Just for yuks, here is the CT, and a video of the crash. My last words before the crash were

"It's a great day actually."

qcpmsame 

Good luck Vic, keep us updated when you feel up to it.

Bill

JanMM

Good luck!
If you can, just before you go under, shout out "Did you all wash your hands?"

Biker395 

LOL ... a friend of mine had a similar suggestion: "Measure twice and cut once."

The surgery went well. I have have a stiff splint right now immobilizing the knee. The nasty part is that it goes all the way up my leg, so it's really hard to do anything. Even sitting on a toilet seat is a challenge.

They did a "nerve block" for the pain, and oy ... was that disconcerting. Not only did it numb the pain, it paralyzed my leg to the point where I was wondering if the surgeon mistakenly cut nerves.

But the feeling and motion came back slowly, and with it, the pain. It came on so slowly ... like a growing discomfort instead of pain ... that I didn't realize I was in serious pain and wasn't taking the pain killers. They gave me some opioids, but I'm finding 600 mg of Advil is doing the trick nicely, so I'm sticking with that.

I get this splint off Thursday, and will get one with a joint so I can start PT to work on the range of motion. Looking forward to that. Having this thing is like trying to walk around with a 3 foot erection. Interesting for sure, but not fun!

qcpmsame 

Wishful thinking I guess, on both aspects. Kind of depends on your definition of, A.)"a joint", and B.)"interesting"

Bill

Biker395 

Well ... finally went to the doc to get the split off, and I got a look at the hardware. I am now splintless, and free to work on range of motion, so long as there is no weight bearing. I'm at almost 90 degrees already, which isn't bad.

Without the splint, I can soon drive, change clothes myself, shower, and all sort of good things I never knew I would miss until I got that splint on.

JanMM

The 'F' in the image means that there is a 'Foot' way down at the end of that tibia.
Good luck!

metalheart44

Looks as if you have a good supply of cartiledge in your knee ... that will serve you well in the future. Good luck with your recovery, you will certainly do well and get back to the bike as soon as possible

Biker395 

Yea, I was frankly surprised at that!

The docs said that with this kind of crash, you either get soft tissue damage or bone damage but not both. That makes about as much sense to me as saying that if you crash your car into a wall, either the plastic parts or the metal parts get damaged. lol

But they were right. A had an MRI, and there wasn't a lot of discernible damage to the soft tissue. I had my meniscus trimmed some years ago, and the MRI was good enough for them to notice that, so I guess the structures are in tact.

I feel really, really lucky.

The goal in the first few weeks of PT is to achieve a 90 degree bend angle, and without PT, I'm already approaching 100 degrees. So far so good.

metalheart44

"The goal in the first few weeks of PT is to achieve a 90 degree bend angle, and without PT, I'm already approaching 100 degrees. So far so good."

Off to a running start! I found that something like a skateboard -- I used some drawer slides and a board -- while sitting was a good addition to PT: just keeping things moving and it seems a good compliment to normal PT exercises for range of motion, although it seems what constitutes "normal" varies from PT to PT. As I progressed, I found it was easier just for me to lay on my stomach and use an elastic band wrapped around my ankle and gently pull and hold. And, using an ankle weight, laying on your back with the surgery leg up against the wall and sliding the leg up and down helped too. For me, the best was just getting on the trainer and at first rocking back and forth until I could make a full revolution and then doing easy load pedaling. Good luck and you will be back on the bike soon!

Biker395 

So far so good on the range of motion. I dunno how much this is, but it's surely more than 90 degrees. The stairs are still daunting, and I've joined the ranks of those with cankles.

Biker395 

Well, here it is 8 weeks after the fracture and I finally have the next followup appointment and X-ray. In my wildest dreams, all the broccoli and cottage cheese and non-weight bearing self-PT will make a difference the doc will say:

"You're healing amazingly well. So well, you can go back to riding your bike without restrictions!"

In all likelihood, the doc will say:

"Looking good so far. Stay off of it and see you again in another 8 weeks."

And my fear is that the doc will say:

"OMG ... it's not healing well at all. Have you been staying off of it? What kind of PT have you been doing?"

CAT7RDR

I have a gut feeling you are a quick healer who will be treating us with a your amazing pics of the Eastern Sierra soon.

Biker395 

Well, I wouldn't call it a miracle, but it's close.

The doc said I was healing very, very well. We didn't discuss the Xray, but I could see that there was a significant amount of healing, in particular at the top of the tibial plateau. There is good news and bad news. The bad news first:

1. I am still to avoid weight bearing. That means more crutching around for the next 4 weeks at least.

Now the good news:

1. I can start using a stationary bike. He suggested I use pain as my guidance, and make sure that whatever I do, I back off if I feel any pain. That's easy ... comes naturally to me. lol

2. I asked if it was possible to get an appointment with him before the RAAM and whether there was any likelihood I could stay in the race. Astoundingly, he was available before the RAAM and the answer to whether I would be cleared was "very likely." I have an appointment with him 2 days before the race, and at that point, I may well be cleared to ride. He knows I am on a team, which helps a lot. No guarantees, though.

So I set up a trainer last night. No issues with the knee so long as I keep the resistance light. But oy ... sitting on a bike seat after not doing so for 2 months? It feels like a dull knife up my arse. I'm going with a woman's seat for a while.

The X-ray

big john

So if the doctor clears you to do the race, how are you going to get in shape for it? It doesn't seem like there will be enough time.
btw, I saw Steve M. at Red Box 2 weeks ago when I was mtb'ing. He had high hopes for you to make the race.

Biker395 

Time will tell! I'm already spinning an hour a day at light resistance, and plan to increase the resistance over the next four weeks.

Biker395 

So I was chastised Monday by my PT for touching my foot when crutching around. That made no sense to me, since I was given the green light to spin using pain as my guide.

There are apparently the following weight bearing statuses of patients with similar injuries:

NWB (no weight bearing),
TTWB (toe touch weight bearing),
WBAT (weight bearing as tolerated), and
WB (full weight bearing).

She thought I was on NWB, and I thought I was on TTWB. She called the doc to clarify, and the doc sez I am on WBAT.

That means I should be riding the bike for real soon ... I'm gonna give it a go with double sided pedals.

Yea, baby.