"so glad I found this site," new kneegeek

[xj]

To Rhonda and to you experienced knee fracture folks:

I woke up from knee pain this mornings (and most mornings) and after some googling, I found this great site. I have previously done an extensive Medline search on patellar fractures and do have a collection of about 20 scientific articles on the subject, but as expected, most are somewhat vague with respect to real symptoms and advice. I was in a pretty serious auto accident and fractured my left patella (displaced and comminuted; I think 6 pieces, 4 were removed and the largest 2 pieces were used to create my new kneecap with 2 screws and a figure 8 wiring) and am now 2 and a half months post-op. I see my OS this Thursday and hopefully I can get off my crutches and loose the brace too (it is a range of motion brace that has been open for the last 1 and a half months). Because I also hurt my neck, he does not want me to use one crutch because of lack of symmetry with my shoulders/neck.

Here is my brief timeline:

1/19/03 - auto accident  Ithaca, NY
2/4/03 -surgery (ORIF, partial patellectomy) LA, CA
2/4-2/7/03 - in hosptial with drug reaction problems
2/18/03 - started PT (20 degrees of flexion)
2/24/03- quad contraction (my brain is sending signals to my knee again ) (ROM 70 degrees)
2/26/03 - SLR, yeah, I can lift my leg
3/3/03 - ROM 90 degrees
spent most of March at 100 degrees,  
3/17/03 - back to Ithaca, NY (ugh, it's cold here and its hard to find new PT and OS that I like
4/7/03 - started aquatic therapy, which helped get me over this long plateau
4/25/03 - 120 degrees ROM and I think I can see my VMO, but still on crutches with ROM brace

?/03 - I can't wait to walk again!

My OS said that you cannot rebreak the knee with ROM exercises you do on your own (by the way, for the first two months, I did my exercises, as he recommended, about 5-6 times/day), because it is held together so tightly with all the metal. If you use a CPM machine, however, you can put more stress on the hardware and you risk disrupting the integrity of the fixation it so I did not use one.

I read many of your posts and have a ton of new information as a result ; thanks. It is amazing how much I have in common with some of your fractures:

(1) A sudden reconnection of my brain with my quad muscle so I could first contract it (3 weeks post-op) and then do a straight leg raise (3 and a half weeks post-op). It was simply amazing: I went from not being able to lift it to being able to lift in a couple seconds one morning. That was probably the largest hurdle so far.

(2) I  also had a 100 degree plateau. I spent three weeks hovering at 100 degrees and at some point they stopped measuring weekly because I was so frustrated. Oh, the plateaus are so difficult. I started aquatic therapy two weeks ago and that has helped me get to the 120 degree mark.

(3) A trauma surgeon in LA (amazing surgeon and great man too!) operated on me, but thinks that I can sit normally if I can get 90 degrees of flexion (despite the fact that it is tremendously painful).

(4) Before the fracture, I was also very athletic and active (ran, biked, and even missed a ski trip to Aspen). It is very hard to be in a brace and crutches, but maybe I can a triathlon in spring 2004.

Anyway, I was hoping you could answer some questions:

(1) It is still very puzzling to me why it hurts so much after nearly 3 months. It still wakes me up and I usually ice and elevate it and try to go back to bed. Sometimes it feels hot and is swollen and sometimes it even hurts when it is straight (usually at the end of the day).  Was that the case for you?

(2) My bad knee also clicks (not really a loud popping sound, which is what my good knee has started doing, but a dull clicking sound near the top of the patella) with some mild associated pain when I push beyond 120 degrees. Do you think that is from the hardware or something else? Do you still have clicking a year after surgery?

(3) My job requires that I stand 8 to 10 hours/day, when do you think that will be possible? Gosh, right now I can stand for about an hour before it starts throbbing.

o.k. one more...

(4) Is running painful for you?

Best wishes to Rhonda for your hardware removal surgery,

[Rhonda]

Hey XJ,

I replied to you on the other thread, but am cutting and the reply here pasting, since it makes more sense in this thread..

*************

Once the inital shock of the surgery wore off (a couple of weeks,) pain while sleeping wasnt' a huge issue with me.  I think my back hurt wrose than my knee sleepign becuase I had to sleep on my back- which I dont' think I've ever done on a regualr basis..  But of course, I'd have phases where I'd get strange pains in my knee.   Nad at this point, if I overdo it for some reason, I will get some achy feeligns with my knee.   And  the swelling still happens on occassion.  I have those gel ice packs, and I just slap it on over my sweatpants/pajamas, then wrap an ace bandage to keep it on my knee, and I go to sleep like that..

The clicking when you extend your leg and it click as it gets close to the "straight" point.  This is basically arthritis.  My docs say that most normal knees even do that, to a much less noticeable degree.  If I put my hand on my good knee, I can feel it there too, slightly- alhtough I can't feel or hear it otherwise...     Because of the injury, any kind of arthritis is more pronounced since the kneecap is less smooth.   They weren't too concerned about it though..  probably because there isnt' much you can do...

Yes,  if you heal like me, you'll be fine for a "standing" job.  It'll get easier and easier as time goes on..    Try walking or light elliptical traininer workouts between PT seesions.  This will helps gets those stabilizers muscles back working a little more.

Running painful?  Not usually, if I am going at a light pace. But if I try to go faster, I limp, cant' go all that fast, and sometimes it does hurt.  Sometimes I feel a sharp pain where the metal is, when I try to run on the faster side..  But I'm getting the metal out in a month, so hopefully, I'll get better...

[Pat_A.E.]

XJ, I know how you feel about finding this site.  It is very helpful and there really isn't much out there about patella fracture.  Sounds like you are making good progress.  I truly believe that being active and in good physical shape helps with recovery.  Hard to imagine that the leg raises are called "exercise"  and they could be that difficult to do! In addition to the eliptical trainer I found a stationary bike to be good especially for ROM.

Regarding standing.  This is one thing that does bother me.  Standing in one place for more then a few minutes causes my knee to stiffen and ache.  It's much better if I can keep moving.  My guess is the muscles are still not back 100%.  I'm told it takes a year, so I'm not too concerned yet.

Running.  Never have done much running but I did do step aerobics and distance walking.  The  high impact aerobics and running in place cause much discomfort so I'm cutting back for the time being.  This may  be a function of age in addition to injury.  I hope not because I didn't have problems before the injury and really want to get back to a full workout.

Keep asking questions because someone on this board has been exactly where you are and will have some advice.

[lizl]

 I'll follow Rhonda's lead and copy and paste my response from the other thread, so your responses will all be in one place.


XJ,  

I'm only 10 days behind you, and it sounds to me like you are doing great. I have been in physical therapy for three weeks, and I'm at 55 degrees flexion right now. The PT is waiting on the doctor's go-ahead to be more aggressive on the flexion, because the Dr. has said "no forced flexion" so far. I don't have any popping sounds, but I'm nowhere near as bendable as you are!

I'm having the most severe pain in the morning when I first get out of bed. In fact, I have to really push myself to get going. Straightening my leg hurts, even before I put any weight on it.

LizL

PS: Besides our troubled knees, we all have another thing in common--and that's the reaction when we first found this site! Though I'd known people with an assortment of broken bones, I had never met anyone with a broken patella. To be able to "virtually" meet other people who had the same thing was a huge gift.

And, yes, people think 5 or 6 weeks is plenty of time for us to heal, and then we should be right back to our old selves! I nearly fainted when the doctor told me "at least 8 weeks" before I could expect to return to work for a modified schedule. I'm still on a limited basis at just under 12 weeks.

[xj]

I promise to be less wordy this time....

To Rhonda,
About the swelling, my OS says that the reason why knees stay swollen for so long after surgery is still a mystery to him. In fact, he jokingly suggested that I write my dissertation on the subject.

Ugh, so the clicking is arthritis...already? I didn't realize I would get it so soon. Anyway, I'll just focus on the good things....I was measured today and I am at 130, yeah!  As far as running is concerned, I will be patient with all of that. Just need to get my leg stronger now.

By the way, did you ditch your crutches first or your brace? I am getting mixed answers from my PT and Ithaca OS - the PT says the cruthces and the OS says the brace (because he insists that it is not productive to walk with a limp, which does make sense).

Hello Liz,  
I guess the end of January was a pretty unlucky month for both of us.

I noticed in your signature that you had some sort of reaction to the drugs...what kind? The interesting thing is that I had a stomach sensitivity (in other words, I could not hold anything down) after the gave me any IV narcotics. They first used morphine and even the second narcotic they tried, delaudid, did not work for me. After the forth day of this mess, I took 1/2 a vicadin and some regular tylenol and went home. My OS said that since this is a rare reaction, they don't warn the patients ahead of time about it...I guess that makes sense, but maybe it is not that rare.

Today someone at work asked me, laughingly, when are you ever going to get off those crutches and continued laughing. I wish I could laugh about this now, but I can't...not yet. I tried to explain that this is a serious injury and that it might be a while, but it is still frustrating dealing with these types of people. I will, however, persevere.

Pat,
Thank you very much for you your thoughts...it is really good to know that standing will get easier. Seems like such a trivial thing, that is, to stand for an hour, pain-free.

Wow, you are already doing step aerobics at 7 months after your injury...I can't wait. Sounds like you are going very well.

I saw (in another thread) that you had your hardware out (gosh, that expression sounds strange) 2 months ago...Do you have less pain and difficulties with exercising now than you did before it was removed?

Best wishes to us all for a good recovery. At least Spring is on its way,
XJ

[lizl]

XJ,

Actually, we're closer in the time frame than I thought since your surgery was Feb. 4. My surgery was Jan. 29. Why did they wait over two weeks for your surgery? That must have been terrible!

About my drug reaction: They do not know to what I reacted, but the doctor said it could have been one of about six different drugs, with the most likely suspects being the antibiotics or pain medicine, rather than the anesthesia.  It started as a rash on my back and my rear end. I was in so much pain that I didn't really notice it, but a friend who helped me go to the restroom did notice it the day after surgery. Since my friend said it was quite bad on my buttocks, we summonsed the nurse who got some ointment for topical application. By the next day (going home day), I was breaking out on my arms, the trunk of my body and even on my face. I showed the rash on my arms to the doctor that morning, and he prescribed Benedryl--but he was pretty disinterested.

The rash was progressing to hives before I left the hospital late that afternoon, and the nurse was concerned enough to phone the doctor. Since it was Friday, I'm sure he was probably home for the weekend. He ordered an increase in the dose of Benedryl, but the nurse cautioned me to be sure to have the home health nurse keep track of the rash. I was worse the next day, Saturday. The home health nurse phoned the doctor when she came by in the afternoon (got the on-call doc, rather than my surgeon), who said I should go to the ER.

Actually, I had already decided to that; but I waited for the home health nurse, so she would not arrive at an empty house. Between the pain and the hives, I was at my limit of tolerance, and the hives were torture underneath the brace. The ER doctor found some of the lesions in my mouth, as well as on my face; so he put in a call to the surgeon for more aggressive treatment.  The Benedryl had probably kept me from having a more dramatic reaction. Though surgeons don't like to prescribe steroids so soon after surgery, it was decided that I needed them as well as stronger antihistimines. I was not having trouble breathing, so I opted for oral medicine rather than going back on IV. After a few hours in ER, I was released to go home with orders to return if my symptoms worsened. Since they did not know which medicine was the culprit, the doctors took me off of all the meds I had previously been taking, including Benedryl and Vicodin.

Rather than risk another reaction, the doctor refused to prescribe anything in the narcotic range. He switched me to Ibuprofen for pain and put me on an ulcer drug to protect my stomach from the heavy dose. Let me tell you, Ibuprofen alone does not work as well as Vicodin or codeine. Oh well, I'm through the extreme pain phase now! Truthfully, I think it was one of the antibiodics, but nobody knows for sure. It does leave me with an unsettled feeling, though, for the future. I'm sure you feel the same way!

When you mentioned the IV morphine making you sick to the stomach, it reminded me of what happened to my Mother following a surgery. She was given a PCA pump and told to use it to "keep ahead of the pain." Mom is a skinny little thing and her weight is a major concern any time she gets sick. As she had been instructed, she hit the PCA each time they brought a food tray so she could sit up and eat. Strangely, though, by the time we got the food uncovered and in front of her, she began to feel dry heaves coming on.  It wasn't until after she had missed several meals and her weight was dropping that we made the connection between the PCA and the nausea. They changed the PCA medicine from morphine to something else, and she got better immediately. I wish it had been that simple for you! :-/

LizL

[Rhonda]

I was on one crutch only after 2 weeks.  After 3 weeks, I didnt' use any crutches at all around the house or the office (although, outside I would cart one around- mostly so people woudln't bang into me, etc).

I wore the brace for 3 months.  The first two months, it was locked straight, the last month I coudl unlock it.  I may have been abel to ditch that soone, but my OS had a family emergency in England (where he's from ) and was there for a month.  The fellow (step above a resident) was too nervous to give me the go ahead to ditch it without the attnding's say so.. so I had to wait for him to get back from the UK.  (The day of my surgery, he had said I'd in it at least 8 weeks...)

hey, my little sister is having knee surgery today!  She has a maltracking patella and and is having a patella tendon realignment..  Wish her luck!

[Pat_A.E.]

I stopped wearing the immobilizer totally but remained on crutches for about another month.  Then  I used   two crutches for about two weeks before going down to one crutch for another two weeks.  Like Rhonda I still carried it in the car or while shopping - just in case for another few weeks.

After the hardware removal I was able to regain full ROM and no longer have the sharp pain where the wiring crossed the patella.  It is no longer painful to do deep knee bends but I still can't kneel.  I am very happy to have those pins & wires gone.  I think ususally the removal isn't done until about 1 year but one of the pins had dislodged from the bone and was poking out of the side of my knee.  

I'm not so sure the your reaction to narcotics is so unusual.  I have exactly the same problem and due to the nausea  & dehydration & a hypothyroid,  following the first surgery I experienced a situtation were my body temp dropped to 82, my heart rate & pulse were racing and none of the 4 specialist called in knew what was going on.  My husband is an anethethist and did some research and found the cause.  Anyway, for the hardware removal they didn't use any narcotics and I did great.  Thankfully, I seem to have a pretty high pain tolerence and get by with minimum pain relief.

The clicking and popping may not be arthritis.  I have had that in my knees for many years without any other problems.  Funny how it came back in the injured knee as soon as I started using it normally again.  I have accepted that this knee will never be the same but it doesn't keep me from doing what I want to do and for now that is good enough!

[xj]

Hello to my buddies with broken (and fixed) patellas,

Pat, thanks for the encouragement. I am back to give a progress report from my last OS visit.

I saw my OS last Thursday and he seemed happy with my stronger leg and range, but since I cannot walk without a limp, he wanted me to continue to use crutches until I can walk productively (limp-free). My PT agrees with him and I have a lot of people saying that walking with a limp is NOT productive. So here I am, 11 weeks after surgery and I still have my crutches. He said I could ditch the brace, which is nice, but I do feel naked with out it. In church over the weekend, I thought a three year old was going to go tearing into me, but his father yelled at him...anyway, I am getting used to being bracefree now. Anyway, I am going to do many more leg raises and quad sets to help quad/vmo get stronger.

I don't know if any of you are taking  glucosamine and chondritine, but I also asked my OS about them and he suggested it MAY help rebuild the cartilage. I did have damage at the fracture site as many of you also probably have. He did say that you have to take them regularly (3x/day) for a couple of years to see any affect. Sounds sort of expensive for something that might not even work.

I also asked the OS about the clicking and he said it might be the hardware. I am getting used to all the new sounds (knee music?) and the discomfort it is not that bad when it clicks.

It is interesting that the narcotic reaction is not that rare: Both Liz's mother had similar problems with morphine and Pat also did. When I remove the hardware, I will definitely go narcotic free...hopefully, I can be as strong as Pat. I guess that is like having a baby without an epideral, but I don't know how that pain would compare.

Liz, what did your OS say about the "forced flexion?" Are you able to work on your range more aggresively or does he still want you to be cautious?  Also, to answer your curiousity as to why they waited two weeks to have the surgery....it was because of the car accident, I had lots of other bruising/injuries that they/I wanted to heal a bit before I had knee surgery. Also, I wanted to fly to LA for the surgery (I did not want to have the surgery in a town of 30,000) and I was in too much pain to fly immediately.

Rhonda, how did your little sister's surgery go?
Do you have your hardware removal surgery scheduled?

O.K., I do have a positive thought...I love aquatic therapy. I am able to walk in the pool and cycle in deep water without anything or anyone helping me (yes, freedom!).  It is also helps with the swelling...after only 3 weeks in the pool, my bad knee is starting to look like a real knee (just in time for spring).

Best Wishes,
XJ

[lizl]

XJ,

How are your other injuries doing? You have certainly been through the grinder, haven't you? It is wonderful that you are doing so well. Hopefully, reading this web site has ressured you that you are doing well.

My doctor still says no forced flexion. I told him that the therapist wanted permission to be more aggressive, but the doctor said he would rather let it come back on its own--even if that means slowly.

When the doctor came in to see me for the pre-op consultation the day of my injury, he told me that he would "try" to save the kneecap. It was his opinion at that time that my kneecap was quite damaged from the concussion/pressure that broke it. Rather than a clean break, it broke jagged in a sort of frayed fashion with the pieces completely displaced (by a couple of inches, in fact). One of the pieces also had a large crack in it. I think all of that is part of the reason he is being so cautious, though he said that the x-rays now show good alignment.

I have been at 62 degrees for a few days now, but I can tell that I am gaining strength. I can even see the beginning of a calf, so I'm going to just take it one day at a time and not be too fixed on the numbers. There is a new knee patient (severed tendon, I think) at PT, and he is doing much better than I am, in terms of flexion. It's tough not to kind of compete with him and with you, XJ! Then again, maybe that's good for me. . .

About that morphine thing, remember my Mom did fine on another narcotic--and you might, as well. No need going "natural" if you don't have to. Maybe your doc can do some sort of allergy/tolerance testing on you ahead of time? When I am spending less time at PT and OS appointments, I plan to bug my general practioner to test me to try to pin down what caused my drug reaction. I actually did natural childbirth for my second delivery; but I took a whiff of nitrous oxide (laughing gas) at the very last minute, when it turned out we needed forceps for an assist. It was a very short-lived medication, and it worked. Maybe laughing gas is an option for you?

My PT also really frowns on limping. He says "slow down and use the crutches to help with a normal follow-through" on  each step. I cannot walk limp-free using only the brace, even though I'd love to leave the crutches behind. I've been practicing with one crutch. Are you using both crutches, as well as your brace?

LizL

[Rhonda]

XJ,

Hey, my sister's surgery went fine, but sometimes she's had some pain med issues...  BUt otherwise she's OK so far..  I have to call her again today...  It's only 8:00 her time right now, though..  I know better than to call now...

My surgery is scheduled for May 28..  I get an excuse to sit on my butt and eat bon bons all day, for a few days!  But then its back to the gym!  I just hope I can run normally again by  the end of the summer.   THis staggering type of running I do is getting pretty old... I'm taking the summer off from floor hockey, obviously.   We won our last game of the spring season last night (for my Tuesday league - still have one more Wednesday leauge game left)...

[Pat_A.E.]

XJ, Let me clear this up, I DID NOT go natural for the hardware removal.  I had an epidural and valium so I was totally out.  I took torodal for the first day and nothing the next because my spouse and I were hosting a cocktaill party at our house and I wanted to be able to have a wine!
I have been taking glucosomine chron. on and off for the past couple of years.  Since my injury I have been taking it regularly.  Most of the OS at the ortho institute I go to recommend it.  I understand that not all brands are created equal and the best are Bio-Flex, Walgreen's store brand and Wal-Mart's store brand.  I think the Bio-Flex is the most expensive.
Walking with a limp is bad because you end up with problems someplace else.  Currently, I am having pain in my right hip, same side as the knee, and I think it's because my gait is off.  I'm going to go back to my therapist in a few weeks to see if he can figure out what I'm doing wrong and get it corrected.  Last Nov. when I asked my OS when I would be walking again he asked "With or without a limp?"  At the time I said I would take the limp!  Now I know that isn't a good option.
Keep doing those leg raises, etc. and keep smiling.  You will get beyond this.

[xj]

Hello Liz, Rhonda, Pat, and any others who want to join in,

Congrats to Liz and me - we are now three months post-op and the worst is behind us now!

Tonight is the second night in a row that my knee feels like it is burning and is more swollen then normal. I  over did it on Saturday (no, I didn't go walking in Disneyland, but I did way too much standing and walking) and now I am paying for it. I am trying to remind myself that the OS says that the swelling takes a long time (6-8 months...sometimes more) to subside. Is this what you guys are finding? The ice pack over the PJs is probably the only thing that has saved me the last two nights.

It continues to amaze me how random people who see me on crutches (particularly at work) compare my fracture to their ACL tear or meniscus tears. I simply don't have a good way to respond to these people other than saying that a knee fracture is a bit more serious. Any suggestions? I feel like I am justifying my injury to them and feel like such a girl to be complaining so much, but I know that ya'al (no, I am not from Texas) would understand.

All of last week, I went brace free (yeah!) and now feel confident without it, but I still use both crutches as I cannot walk without a limp without them. O.K., no walking with a limp....this is the general consensus and I will stop fighting it! Although this is getting somewhat old, I have patience (one thing I did not have much of before the accident...so I guess there is always a silver lining).  

Liz, Thanks for asking about my other injuries...the only one that is still bothering is my neck and upper back. Thank goodness I did not break anything there, but they were sprained/strained and I am told it will take a while for the soft tissue to heal.

Wow, it sounds like your fracture was terrible...a displacement of inches is tremendous. The more I read on this site, the more I realize that the rehab tends to progress slower with the more difficult fractures. The first day I visited the PT (two weeks post-op) she measured me up at 20 degrees and told me it would be 2-3 months before I would be at 90 degrees.....so my initial progress was, as she describes it, miraculous. Based on the other patellar fractures she has seen, she was expecting a 5-10 degree flexion gain/week. She had seen 3 other patellar fractures so I trust her judgment. I also made the mistake of comparing myself
to other patients at PT and for this reason, but my PT yells at me when I do. In fact, she only measures me twice/month because she doesn't want me to be that focused on those numbers.

Great news on being able to "see" your calf. Gaining strength is rewarding as the results are visible.

Rhonda,
Wow, I didn't realize that you are playing floor hockey (in two different leagues!!!). Does it feel great to do? That definitely gives me something to look forward to. I think I am going to start setting a goal for myself every two weeks, which may help me get through this lack of real activity period.

Pat,
You are right; going natural during the surgery would be crazy. My mistake; I meant going drug(narcotic)-free post-op. When I get to the hardware removal point, I will have to ask about torodal since I had an allergy to both narcotics they tried. Wow, having a party day two post-op must have been a great way to emotionally recover?

Thanks for the suggestions on glucosamine/chon...I will just take it everyday and try not to worry about the cost. Since I don't spent money on cosmetics, maybe I can look at it like makeup for my joints...Oh, probably not, but it was just a thought.

As always, thanks for ALL of your encouragement!

My tulips are finally blooming and spring is here to stay,
XJ

[Kathy G]

Hi, XJ - glad to hear of your progress. WATER THERAPY RULES!! I was able to break a 90 deg. plateau when I started working in the pool and hot tub, as well as using a stationary bike. I am just past 100 deg. in flexion and 0 extension, so I am making real progress.

I like the others believe it is important to walk with a crutch or cane to rid ourselves of the limp. I can walk without either, but I do still limp badly. However, I can tell now that my calfs and quads are getting stronger, I can withstand more weight on my legs for longer periods. My OS says that for my injury (tib plateau break near the right knee) it would take about a year to year-and-a-half to recover, and he was quite correct in his assessment!!

At any rate, great to hear of your progress. Also glad to hear you've decided to go the supplement route (a lot of mbl'ers at MyBrokenLeg.com swear by 'em so I started taking them, too. Think it's helped with pain management. Also glad to hear I'm taking the "right" brands, as I alternate betw. Walmart and Walgreens brands, depending on what's on sale.  

Keep us posted on your progress, XJ. And thanks for the reports!

[lizl]

XJ,

I'm really beginning to envy those of you who are in water therapy. On the other hand, I don't have to make time for the "shower before you get into the pool" routine or worry about how my out of shape body looks in a swimsuit.

I don't know how a broken-wired-together patella compares to a torn ACL, in terms of severity. I just know that my recovery is going to take as long as it takes. Again yesterday at church someone asked, "How long are you going to be on those things, anyway?" I'm not sure if she meant the brace, the crutches, or the combination--but I just responded, "Broken knees take a long time to heal."

LizL