Tibial condyle fracture

[s.oliver]

Hi,

Client of mine (female)

Started training with me Oct 2022
Age: 59
SQ 155x3, DL 205x3, Press 70x3, Bench 93x3
Height: 5ft7
Weight: 73kg

Injury occured Sat 1st June.

MRI report from yesterday:

Lateral: Evidence of bone oedema noted involving the lateral tibial condyle with a non-displaced fracture of the lateral tibial condyle. Non convincing evidence of joint incongruity seen.
Minimal high signal noted the cartilage of the lateral femoral and tibial condyles in keeping with grade 1 chondral changes. No lateral meniscal tear seen.

Medial compartment: normal cartilage in the medial compartment. No medial meniscal tear seen.

Patellofemoral compartment: full-thickness chondral loss involving the patellar facets and then the anterior articulating surface of the lateral femoral condyle with underlying bony changes in keeping with grade 1 chondral changes. Patella tendon and quad tendon appear normal.

Other findings: There is a suprapatellar joint effusion. The ACL, the PCL and the collateral ligaments are intact.

Conclusion: There is a non-displaced fracture of the lateral tibial condyle with underlying bony oedema. Early chondral changes in the lateral compartment. Advance chondral changes in the patellofemoral compartment.


She went from non-weightbearing (crutches) to light weight-bearing (gentle walking/stair stepping) since the injury occured and has started doing body weight quarter squats.


Any recommendations and things I shall pay attention to for when I re-start training her?

Is the box squat a sensible option to begin with?

Many thanks,

Oliver

[Martin Shenfield]

Leg press into full squats as soon as possible for me only using a box very briefly to get depth correct. I had a tibial plateau fracture.

If she doesn't have access to a leg press I guess you'll have to do progressively lower box or banded squats.

Don't let her break her leg, and make sure she doesn't favour the good one.

[Mark Rippetoe]

How did the injury occur?

[s.oliver]

Leg press into full squats as soon as possible for me only using a box very briefly to get depth correct. I had a tibial plateau fracture.

If she doesn't have access to a leg press I guess you'll have to do progressively lower box or banded squats.

Don't let her break her leg, and make sure she doesn't favour the good one.

Thank you Martin

[s.oliver]

How did the injury occur?

Slipped on the terrace

[Will Morris]

How good is your insurance and release of liability? If that is iron clad, maybe you could be a bit more aggressive, but if it is not iron clad, you are playing with fire by loading her knee this early. She is two weeks post tibial plateau fracture with at least some slight indication of joint incongruence, though it isn’t convincing. It takes 6 weeks for a fracture line to heal. She still has an acute fracture, and lots of bone marrow edema within the joint. Her knee is going to hurt, and should she have a fall, stumble, etc under load, and she opens that fracture back up and displaces it, she will have to have surgery and you will be sued for everything you have. An interval radiograph showing displacement of the fracture will 100% be blamed on you, and you will be responsible for the resulting surgery to realign the joint margin.

[s.oliver]

How good is your insurance and release of liability? If that is iron clad, maybe you could be a bit more aggressive, but if it is not iron clad, you are playing with fire by loading her knee this early. She is two weeks post tibial plateau fracture with at least some slight indication of joint incongruence, though it isn’t convincing. It takes 6 weeks for a fracture line to heal. She still has an acute fracture, and lots of bone marrow edema within the joint. Her knee is going to hurt, and should she have a fall, stumble, etc under load, and she opens that fracture back up and displaces it, she will have to have surgery and you will be sued for everything you have. An interval radiograph showing displacement of the fracture will 100% be blamed on you, and you will be responsible for the resulting surgery to realign the joint margin.

She hasn't been back at my gym yet, so I haven't trained her since the accident. She was given the "mini squat" exercise (and seated knee flexion/extension movements) by her physio.

I would like to know at what point it is appropriate to load her knee again. Am I right in assuming to wait for six weeks post fracture?

[Martin Shenfield]

I should definitely add that I didn't mean start doing leg press as soon as possible... Do that when it's appropriate. It took twelve weeks for me to not be on crutches. I was definitely non weight bearing for the first part of that. I'm amazed she can climb stairs two weeks on.