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Having swelling and pain in the knee. MRI showed Tibial Plateau Fracture. Suggest

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Practicing since : 1973
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I had fell and hurt my knee. It immediately swelled up, had severe pain and I could not bear weight. It was late, so I tried to just go to sleep and hope for the best. I couldn't sleep all night, the pain was horrible. Finally I went to the ER where the doctor said the swelling was too much to see anything and hopefully it was a sprain. He gave me crutches and pain pills. After a couple days, I was still so swollen and the pain had not subsided at all. I called my doctor and they schelduled me for a MRI. The MRI was not schelduled till just a day shy of 3 weeks later. By then I was able to put some weight on my leg but not for long. Still swollen and not able to bend. Went to the MRI and the next day was told I had a non-displaced Tibial Plateau Fracture. I went to the Ortho Doctor two days later where he gave me this brace that locked me out at 40 degrees and told me to stay off of it! This big old brace was causing me pain, similar to XXXXXXX splints! Not only that my swelling on the top of the knee has increased! I went back to the doctor because I am now feeling a burning short sensation on the inside of my right knee and the swelling on top of my knee had me concern. He told me I had a new effusion and sent me for a new X-ray but everything looked fine. I am now 5 weeks out and my swelling has not gone now. Am I missing something?
Posted Mon, 10 Jun 2013 in Bones, Muscles and Joints
Answered by Dr. S. Jegadeesan 9 hours later
Thanks for your query,

A Tibial Plateau Fracture (diagnosed later as non-displaced) can easily be diagnosed by an X-Ray Knee joint in AP and Lateral position and MRI is indicated to assess whether the fracture is limited injuring the bone alone or is there any injury to the Soft tissues. Soft tissue injury is injury to the Meniscus inside or Ligament around the joint. Because of the injury of the soft tissue there may be cortical interruption, depression or displacement of the articular surfaces.

The fracture is always associated with knee effusion, swelling of the knee joint and inability to bear weight. There may be deformity of the knee joint. Because of injury of bone and soft tissue there may be Hemarthrosis leading to further swelling which may cause pressure over the vascular and nervous structure around the knee joint.

On the First examination, with the history of injury and swelling, X-ray should have been taken and the joint should have been immobilized with an "ankle traction" only and not by any other means + Antibiotic + pain killers to prevent the complications. With MRI and observations fracture depression and displacement, degree of injury to ligaments and menisci, vascular and neurological compromise (later) can be assessed so that the need for surgery can be assessed. If surgery is indicated, after control of swelling and infection, Plate and Screw technique can be planned.

Associated soft tissue injury plays an important role in recovery.

Wishing you a speedy recovery

With warm personal regards
Dr. S. Jegadeesan

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