Crushed tibia plateau and fractured tibia post op

@rodney79 Hi Rodney. Let me welcome you to Connect. I think you are absolutely right about pain being caused from surgical plates. I broke my ankle involving the tibia and fibula in a compound fracture, and I became the owner of 2 titanium plates and 7 screws, one of which was put inside the fibula from the bottom up. At 7 months post op, you're at about the same time frame of when my issues started. I had pain and throbbing from the surgical site at rest, and 6 months after the surgery, I was getting chronic hives. It would start with extreme itching anywhere on my body and was worse where my clothing compressed my skin such as at a waistband. It was masses of hives in huge patches. I had to take an antihistamine at least every third day because as soon as it wore off, I had hives again. It's hard to pinpoint the cause of hives, it could be anything, so my surgeon wasn't convinced that it could be coming from the metals in my body. I had other data that seemed to suggest this because I had just been through some dental procedures that removed old dental work that contained metals, and as soon as my body was metal free, my asthma improved significantly. I had reactions to pierced earrings years earlier and had the give that up, but I had metals in dental fillings and crowns for many years because of breaking my teeth as a kid.

After years of having asthma that got steadily worse, I had all the old dental work removed and replaced with ceramic Zirconium bridgework and zirconium implants, and all of the old silver fillings had been replaced with safer composites by a biological dentist. I felt so much better, but just 3 months later, I broke my ankle and had metal reintroduced in my body and my asthma got worse again. I have lots of allergies to pollen, dust, weeds, grass, etc and can get lots of phlegm. I was also getting extra pigmentation forming on my skin over the surgical plates.

I had to wait at least a year for bone healing, but I had the surgical hardware removed and it has made a big difference. I don't have throbbing pain and my ankle doesn't get hot anymore. The ankle is still more tender than it used to be and aches a little now and then. Allergy inflammation can make a previously fractured bone hurt more according to a PA at my environmental medicine doctor's office. I don't have chronic hives anymore. I have some pain now and then, but it is more related to pain from the ligaments and tendons and muscle weakness from the injury. My asthma improved again when I returned to a metal free existence. My surgeon told me that about 20% of his patients choose to have surgical hardware removed. That had been part of our discussion from the beginning because I suspected that this would be an issue for me.

You can work with an environmental medicine doctor and treatment may include treating allergies that are adding to inflammation that puts a load on the body. You can find information at the American Academy of Environmental Medicine at where there is a provider search.
https://www.aaemonline.org/

There is also information about treatment at the Environmental Health Center of Dallas which you can find at
https://www.ehcd.com/

There is a lab in Chicago that tests for immune reactions to surgical implant materials, but it is expensive, and I think you already know the answer. The lab is Orthopedic Analysis and this is the website:
https://www.orthopedicanalysis.com/

Would you consider having the hardware removed after the fracture has healed enough?

I think the hardware needs to be removed. I feel like my leg should have some natural flexing ability of my bones. Now my tibia is restricted from flexing. The times it hurts so bad is when it typically would flex. Ex.... standing or walking. I'm not 100 percent sure as I'm not a Dr but I know something isn't right. I hurt in the bone and it hurts the entire length of the tibia and that part never hurt with the injury. I had a 5cm crushed tibia plateau and a spiral fracture on the tibia. So the put a plate that was bent on top and a small plate along the side of the tibia. My xray showed, proper alignment and post op changes, no fractures. I'm still in pain but only when weight bearing. Idk I'm going to schedule an appointment with my surgeon and hopefully he will get me fixed up. I will post results when I find out more.

@rodney79 Thanks for your response. I would expect the surgeon will make you wait at least a year before hardware removal. A spiral fracture sounds like it was significant. I know the pain you describe. It's like constantly being kicking in the shins with every step you take. I do still feel a slight ache when I take a step, but it's minor, and a lot of times I don't feel pain when I take a step, unless the calf muscles have gotten tight and are yanking on the tendons and ligaments and slightly alter ankle alignment.

You know your body best. The recovery after hardware removal wasn't as bad, but there will still be a recovery, and when they do take out the hardware, you are at increased risk for fracture because of the screw holes that are left, so you'll need to be careful just like healing a fracture, but you should be able to bear weight on it. I will look forward to your updates.

Jennifer

I don't know Rodney's age but 36% of the people in the U.S. with osteoporosis are men. I wonder how many bones are slow- or badly-healing because of it. And, if osteoporosis is a factor, addressing it can have a positive effect on healing and protecting bones. If it's a factor and unaddressed, it's like overlooking the elephant in the parlor.

A few years ago I injured my leg resulting in a complex tear of the meniscus and surgery for repair.
On June 21st of 2022 I had my TKR. Right after the surgery they got me up and waled me. The next day MAJOR pain began and percocets were my saving grace..... I was running out of pain pills, crying every day from the pain, suffered terribly at night after the nurses and Physical Therapist paid their weekly visits. I begged the surgeon for more pain pills but I think he was thinking I was addicted and it was tough getting some extra relief... Finally he caved and gave me an RX telling me "NO MORE".... Physical therapy continued and I thought I would die each night after the Pt's visit. FINALLY, 2 weeks later post op... I went to the dr and he sent me to xrays... While I was hobbling back to the room where my husband and dr were..... I heard the dr say "This is really bad". I walked in and he said.... "Now I know why you were crying and needed more pills".... he said i had a "FrACTureD tiBIA".... So I spent two full weeks of physical therapy on a Fractured Tibia. The surgeon said we had to get this fixed asap and put me in the hospital that day for surgery the following day.
The next day I woke to 46 staples and a whole new set of problems.
Still crying, still in pain... what in the world was going on... How did the tibia get fractured... I had NOT fallen and was beginning to think it happened during the surgery.
The dr's last visit ended with him saying you can come back in six weeks. WHAT? I asked him for an MRI but he said I didn't need one.
So here I am 2 months later and I KNOW my body and KNOW something is wrong. I can hardly walk and when I do... it ends up in pain
Has ANYone experienced anything like this? I am totally homebound... cannot drive.. still have the nurses and PTs coming out to the house.
WHAT DO I DO? Please help me....

Hi @onwillowbay and welcome to Mayo Clinic Connect. I wanted to move your post here:
Crushed tibia plateau and fractured tibia post op
https://connect.mayoclinic.org/discussion/crushed-tibia-plateau-and-fractured-tibia-post-op/
so that I could introduce you to @rodney79 and @jenniferhunter, both who have been in similar situations as you.
We aren't medical professionals, but everyone who can relate can definitely lend their own personal experience and what they went through.

I broke my tibia, fibula and all 5 metatarsal bones in Arkansas and once I returned to Florida, I had to go to Mayo Clinic to get it reset or I would have never walked again according to the doctor. Have you considered getting a second opinion?

@onwillowbay You have been going through a lot. It is very painful to have a leg fracture and have to bear weight on it; even during the recovery phase after you've been 6 weeks in a cast, it still hurts a lot to try to bear weight. You are dealing with swelling, aching and throbbing, and muscles that are too weak and the tendons and ligaments get stressed and complain. I had a bad fracture of my ankle of the tibia and fibula that was compound, dislocated and was a bad sprain of the tendons and ligaments during the injury. Obviously something was missed if you are waking up from a knee replacement with a fractured tibia or if that fracture could have happened when you started to bear weight on it. I agree with Amanda that a second opinion would be a good idea.

The pain from breaking my ankle was far worse and for a lot longer than the pain I had from cervical spine surgery. Hardware and implants may cause cause pain too or immune responses from foreign materials in your body. That doesn't happen to everyone, but it can happen. I had titanium hardware on my ankle, and 6 months after the fixation surgery that placed them, I was getting pain and chronic hives. I had to stay on antihistamines all the time because when that wore off, the hives came right back with a vengeance. I had to wait at least a year to have the hardware removed and I still have weakness and some pain. When I do too much or walk too much on uneven ground, my ankle fatigues and starts to hurt and I have to get off if it and I am 2 years past the injury.

I think the recovery from fractures is much longer than we think it is supposed to be, and recovery is in baby steps and you can't rush it. Your body is doing a lot to try to heal itself and rebuild bone. If you suspect an immune problem, there is a lab in Chicago that does a blood test for reactions to orthopedic implant materials called Orthopedic Analysis that you can find at https://www.orthopedicanalysis.com/. There is treatment for immune responses and you can find information at this environmental medicine practice in Texas. https://www.ehcd.com/

I know 6 weeks time sounds like a long time to wait to see your doctor again, but that is kind of standard in healing bone because healing is beginning on the cellular level, but it takes longer to start to deposit minerals like calcium to harden the bone. It forms first as cartilage and converts to bone. With my spinal fusion, it took 3 months until there was visual evidence of bone deposition and when there was no movement of the fused area with flexion of my neck on an X-ray where they measure it on the computer screen. This was evidence that the fusion had begun and that would continue over the next couple years to add more bone and strength. As far as imaging goes, MRIs show not only bone, but soft tissues like cartilage, ligaments, nerves, blood vessels, etc. Bone shows up well on X-ray because of the density of the tissue due to mineral deposition. I haven't had a knee replacement, so I don't know that recovery. Your doctor should be answering questions about why this happened, but it is possible that they do not know that answer. You do need information as to what is best and advice on how you can help improve your healing from this point forward.

Yes I would get second opinion if you feel something is not right. My surgeon has me do X-rays before every follow up visit from my RTS and TKR even if I’m not having issues. Also if you have a good primary care doc might be able to help out as they can order testing. Also as we age it takes longer for our bones to heal. Have you been checked for osteoporosis? A good physical therapist can in my experience tell if something is not going right as well. I am so sorry you are going through all this.

Wow I'm so sorry I pray for your pain to ease. I'm 9 months out now from the break almost 8 from the surgery. I'm like you, I know my.bkdybsomething ain't right. Im.going to follow up with my surgeon and possibly a 2nd opnion.

I'm 43 and I have skeletal problems througout mu body. I will get checked.