New boy to the club -Any help/pointers appreciated

[toobs]

Hello All,

Pleased to have found somewhere I can find people who will be able to relate my current circumstances at last. (although wouldn't wish it on anybody else either:)

Was rushing through life like you do (on 17/02/03 )taking all normal bodily movements for granted until I came around a blind country lane at 60mph (yes I know very silly) to discover a bus had the same idea.
Result: Shattered patella where it met my dashboard, folded pelvis and collapsed lung. The latter injuries have healed well although there has been considerations with the hip in relation to my busted knee because they're on the same side of my body.
Basically, it's been 8 weeks since they put together what the doctor described as 'mush' where my kneecap was with all the usual tension wires & screws. Have always had prominent 'nobbly' caps so I'm not too surprised to discover that I can see some of this lovely metalwork under the surface.
What is concerning me is how long it will be before I get a considerable ROM? At present it's about 60 degrees although I'm pushing it as much as possible every day.

Any pointers, lines of encouragement or just general snippets of information would be most appreciated. I've experienced the best and worst of the UK's health system so am more inclined to believe the experiences of those who;ve been there instead of the many doctors who have told me I'll be back on my feet in either 2 weeks or 2 years?!!

P.S I'm 25 and never thought I'd buy a Volvo but would never have anything else now; it saved my life. The crash wrote off the whole bus and my car but I still got out and walked away (although I didn't know it at the time - doh!

[Pat_A.E.]

How very fortunate you are to have survived such a terrible collision!  Just curious, but were you wearing a seat belt.  I understand that patella fractures were most commonly caused in the USA from auto accidents before the seat belt law.  Now they are fairly rare.

You may have figured out by now that you are in for a long recovery.  At eight weeks have you started physical therapy (PT)?  Sounds like it since you are working on ROM.  Until you are weight bearing it is difficult to gain much ROM.  I was five months before regaining full ROM and that was after the hardware was removed.  It takes constant and uncomfortable stretching and bending but it does return.  Regaining the strength in the muscles and tendons around the injured knee is more difficult.  I find I need to keep moving because if I stand in place more then a few minutes the right knee (injured one) stiffens and becomes achey.  I think as the strenght improves it will be able to support me better.   Although I work out 5 days per week the right leg is smaller from athropy. ( Not sure I spelled that right, but hopefully you know what I mean.)
At this point I would guess you have been through the worst part of recovery.  Hopefully, being a young person your recovery will progress steadily.  This board can offer a wealth of information and encouragement.  There is nothing like having others who have been there to offer encouragement and share milestones!

[lizl]

Welcome, Toobs!

It sounds to me like you are doing well, if you are at 60 degrees just eight weeks into the process. I'm a little farther along than you, and I measured 55 degrees ROM today at physical therapy. I've been in PT for around three weeks.

Until now, most of the PT emphasis has been on strengthening my atrophied muscles, though.  The therapist told me that the strength has to come before the ROM, and until now my doctor has specifically ordered that there be "NO FORCED flexion." I have a feeling that next week's visit to the doctor, however,  will bring orders to work more on the ROM. I have been doing "heel slides" for a week now, but only to the point of discomfort rather than pain. I have gone from 27 degrees to 55 in the three weeks of physical therapy.

The physical therapist said that I might be able to get as high as 115 in two more months. I think I've heard that some people kind of "hit a wall," with the ROM stubbornly hovering at various points--so I'm trying to be realistic.

I'm still in the hinged brace and using crutches, but I do take tentative steps in the house with no brace or crutches. Of course, I waddle like a duck and hold onto walls! By far, my greatest accomplishments are being able to drive and to get into the bathtub (for showers, still can't sit all the way down in the darned thing) by myself.

Keep signing in and letting us know how you are doing.

LizL

[toobs]

Hi Pat_A.E, many thanks for your reply and encouraging comments
As it happens, I was wearing a seatbelt when I crashed and despite subsequent testing of it's durability (by the police) it was found to be working perfectly so how I went far enough forward at impact to strike the dashboard remains a mystery     Maybe it's something to do with my being 6ft 3 and adopting a laid-back driving position  :-/
I can empathise enormously with your situation, it's almost catch22 trying to regain all the necessary muscle structure in the damaged leg for things to start moving correctly again. Since my 1st post there has been a little more ROM improvement and seeing as it was a whole 5 months for your own ROM to significantly improve, I guess it's just important I remain patient with the process  
This wednesday I have a consultation with a new OS who should hopefully give me further good news about my hip so I can at least start putting some weight through the leg and 'testing' the knee.

What interests me about all these posts on this site is the difference between what treatment  you are likely to receive if you are in the U.S or U.K?!
I started PT about 3 weeks ago and apart from some verbal advice on exercises to do at home there has been very little else from my supposed, alleged 'intense PT'!! nothing like the mention of hands-on input or machine assisted progression that seems to be the case in the States.
Anyway, despite my groans it's all got to come from me in the end.
I hope your own situation continues to improve too  

[toobs]

Hi LizL,

Thanks for your reply. It was interesting to hear about your own situation and I'm pleased that you are persisting with your heel-slides! Isn't it strange how important those little movements are yet you wouldn't entertain the idea of them being anything like exercises if we had full movement! You've made considerable progress since you started PT anyway
Are you planning on keeping the brace for long? I found it was more counter-productive after 2 weeks so removed it rather tentatively (with consent of OS)..it's too easy to become 'secure' in a knee brace fearing you might damage yourself more if it's not there but essentially they can hold you back too. you're obviously doing well to ditch it AND your crutches even if you do feel like a duck when walking!
My own ROM is also showing signs of breakthrough but I'm also awaiting the all-clear on my hip before I can start really getting stuck-in.  
it's amazing how doctors the world over have different methods of treating these conditions. My current OS is all for pushing the joint beyond what it really wants to - complete contrast to your No forced Flexion advice?!
Hitting a wall when it comes to ROM is very apt - i hovered around 50 degress for what seemed like ages but it's gradually creeping into the higher 60's now. Watch this space...
You're very lucky to be able to drive, guess you have an automatic car. I've another vehicle (manual) but it was my automatic I managed to write off  
Keep your spirits up and best of luck with the PT.

Toobs

[jab105]

Hi Toobs,

Welcome to the world of broken knee caps...I'm 26, so you will probably get going as I did...at 8 weeks, I was finally able to get out of the straight leg immobilizer (not bending my knee for 8 weeks is just no no sort of fun!!)...

The very afternoon that I got the OK to bend, I was at physical therapy...get your ice packs ready, do triple the homework they prescribe (leg lifts all over the place at first, then squats...and ROM)...by the 7-8 week of PT, I was able to do a 15 K walk...now, I guess I'm at around 14/15 weeks into PT?  I'm able to ride the bike as long as I want, I can jog for about 1.5 miles, and other than squatting on my knees, I'm pretty much 100%, even my quad is about 95% the size of the other ...at the 8 week point, I thought I'd never be the same again, and now its a distant memory...hope that helps:)

Tonya

[xj]

Hello Toobs,

I am empathizing with you. I too was involved in a (more or less) head-on collision, but I was driving about 30 mph (I think the other car was going 40 mph). I was wearing a seat belt, but I broke my patella. I was surprised because I had so much bruising from the seatbelt meaning that it must have worked. I don't know if your theory about being tall applies because I am only 5'4" and this happened to me. I think the front end of the car collapsing in on us (the engine is huge and heavy...now they sell cars with engine that drops out of the car when a certain impact is exceeded...my new car is one of them) may have been the culprit. Anyway, too many things in life are mysteries and I can't be bothered trying to work all of them out.

It sounds like you recovering well. I am about one month ahead of you and have struggled because I am working so hard and sometimes I don't see any results.
In fact, the PT has stopped measuring my ROM to keep my from getting depressed (I spent  5 weeks at about 100 degrees). I am 29 and before the accident, I was very active and incidentally, very impatient, so this a challenge for me. The one positive result of my accident was I have become a tremendously patient person now. We have to be. Now that the weather has improved here, everyone is out running and biking, which makes me jealous, but in time I will too.

XJ

P.S. Do they say G'Day in England of is that just an Aussie thing?

[kate_frommelbourne]

Hi Toobs,
It's good to read your comments - you seem so positive. How are you going with your excercises? I wonder if doctors really know how long these things take to recover from. They can only talk in averages I think. They can't really say for any individual. Being young with a good sense of humor must speed up recovery. I guess we just have to do those excercises and hope for the best.
Anyway, I'm glad you were in a volvo. Wish I'd been in one instead of on my bicycle.
Cheers,
Kate

[toobs]

Update 7th May 2003

Hello All,  it's now about 13 weeks after the accident & op and things seem to be going well with the healing process...
Being persistent with the exercises, no matter how trivial they may seem is essential to your recovery.
I slipped into that 'comfort-zone'  (of being able to get about the house after so long lying around) for a couple of days and didn't keep up my full range of leg bends and hell slides etc.
Big mistake as it only takes a short time for things to start seizing up again.  :-/

Think that you're all quite a lucky lot in the US because you get more consistent PT assistance too.
Now working on 75 degree movement but it seems to have hit a plateau on that level again


Main progress has been the fact I can now put weight through the hip so can actually start testing the knee in some sort of walking action .
The wiring seems to be so close to the surface of the skin it looks like it could do with smoothing off to me or it will cause problems in the future. Does anyone here have their wiring still in many months/years on? I've heard so many conflicting stories about metal-work removal.

Well I hope you're all doing well and pushing what you might think is possible. As corny or as cliched as it may sound the best thing you can do is keep your head up  

[dwalsh]

Hi Toobs,

Welcome to the board! Finding people with the same injury helped me so much in my recovery. I had (and still do to some extent) a lot of trouble with ROM. My break, like yours, was very severe (fell ice skating if you can believe it) and 6 month post-op i was only at 90 degrees. I was on crutches for at least 2 months but ditched the brace on the advice of my doctor. My PT the first 3 months consisted of lots of wall slides, forced ROM exercises with the PT,  a CPM machine (at PT),  leg lifts and an electric stim machine (which i eventually took home because i was having so much trouble getting the quad to work again).

Can you switch PT's if your not happy with yours? I did in the very beginning because the first woman i went to had never seen a broken patella before and i could tell she had no clue what to do. Also i did do some water therapy in my third month, it helped a lot, especially with the ROM. Now that I'm back in NYC finding a place to swim has gotten a little more difficult. Just keep at it, I remember thinking this is never going to get better, but it does! It just takes a lot longer than you think (or they tell you) but progress will come in spurts and you'll be amazed.  Just think the worst it over. Plus you'll never take your mobility for granted again!

About your wire...I too have really knobby knees and the wire from the very beginning was protruding right under the skin. It caused lots of pain and I  hindered my ROM. Both my PT upstate and here were nervous about pushing the ROM with the wire so close to the knee. I got 3 opinions and all 3 doctors said remove it now not later.  I had it removed 6 weeks ago (really easy procedure compared to the first time around) which would be 6 months from my accident. I was back in the brace until 2 days ago (that was a pain!). My ROM went from 95 degrees to 125 degrees (and maybe more). The knee feels so much better and the strength is coming back fairly quickly. I highly recommend getting it removed when you are able.

Anyway almost 8 months after my accident I  feel i am finally seeing the light at the end of the tunnel. I look forward to getting back into shape and back into sports. (snowboarding anyone?)

Keep us informed on your progress. Just remember, it keeps getting better.

Doreen

[Pat_A.E.]

Toobs, If you have the choice, have the hardware removed.  Mine was removed 1/31/03, about 5 months after the 1st surgery.  It was very easy and the best part is I regained full ROM with 2 weeks after starting back in therapy.  PT was so much more comfortable without the hardware.  In my case one of the pins had come off the bone, turned, and was poking out, though not through the skin.  It caused a huge bursis which was quite painful.  I was only on crutches for three days following the removal and then was walking as well as before the surgery.  
Good luck, keep looking ahead!