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Q. Are there alternatives to physiotherapy for treating tibial plateau fracture and equinus contracture?

Answered by
Dr. Renjit George Marcus
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 08, 2022 and last reviewed on: Nov 23, 2022

Hello doctor,

I had a tibial plateau fracture, which was fixed three months back. After 20 days, I was diagnosed with chronic compartment syndrome. A series of wound debridement and grafting was done. I had a foot drop from the time of the fracture. Now it has become an equinus contracture, so rigid that the ankle cannot move. I am currently under physiotherapy. I wanted to know the different treatment options for this condition. I have attached a recent X-ray. Kindly inspect and revert.

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#

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As per the X-ray (attachments removed to protect the patient's identity), there are no arthritic changes in the joint. So I suppose an Achilles tendon lengthening surgery should be enough. But the nerves in your leg should be in good condition. Hence, I suggest a nerve conduction test to assess whether the nerve can be preserved. If the nerve is damaged, you would need neurolysis or a tendon transfer, but in most cases, the nerve will be intact. So Achilles tendon lengthening should be enough.

I hope this helps.

Thank you and take care.

Hello doctor,

Thank you for the reply.

I have attached the report of the nerve conduction test taken three months back.

Kindly inspect and revert.

#

Hello,

Welcome back to icliniq.com.

The nerves are damaged, so even if we lengthen the Achilles tendon, no movement would be as possible as before.

So I suggest the following options.

Wait for nerve regeneration for one year with EMG (electromyography) every three months. Since you are young and the nerve has not been cut, there is a good possibility of nerve regeneration. If regeneration is occurring, do an Achilles tendon lengthening. The drawback is that arthritis can occur during the waiting period, so lengthening will not be an option once it has happened. If no regeneration occurs, ankle arthrodesis will be the only option. It will give you a stable, pain-free joint, but you will not be able to move your ankle.

Do a tendon Achilles lengthening now and wait for regeneration which could occur. Walk with a brace till then. The advantage is that deformity will be corrected now, reducing the possibility of arthritis. If there is no improvement in nerve function, do arthrodesis or continue with a brace.

Please consult a specialist, consult with them, start taking the tests, and undergo procedures with their consent.

I hope this helps.

Thank you and take care.

Hello doctor,

Thank you for the reply.

Can you explain why the contracture occurred?

#

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

The contracture might have occurred due to necrosis and fibrosis of muscle following compartment syndrome.

I hope this helps.

Thank you and take care.

Hello doctor,

Thank you for the reply.

#

Hello,

Welcome back to icliniq.com.

You are welcome.

Take care.


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