healing of the patella itself

[jm121205]

What is the time line that folks have been told it takes the bone to heal?  I have been told 4-6 weeks in the past but suddenly my OS is getting all freaking and saying he wants me in the brace for 12 weeks.  I have around 110 degrees ROM and I have ample muscle stregnth to support myself.  I can stand on the bad leg without the brace on that foot only and I am in no danger of falling over. 

I know this is the second ORIF he has done in less than 6 months on this stupid thing, but I am beginning to feel that this is punitive.  any advice?  Judith

[Nettan]

Sometimes breaks can take longer time to heal because of different issues..can be how the break was, age, condition of yourself and complications.
If you not feel confident with this ask your OS why and be sure get a good answer.
You can also get a second opinion.
Hope you can get ride of the brace soon.

HUGS NETTAN 

[mtsarpilot]

Judith,

  Many people report being out of the brace by 6 or 8 weeks.  Like you, my OS kept me in it for 11 weeks saying things were not healing so fast.  He was basing it on X-rays taken every 2 to 3 weeks.  It was frustrating at the time and I felt he was being extremely conservative.  Then we went another month after getting out of the brace before I was allowed to start any strengthening work.   Even more frustrating.  To help get through it I kept reminding myself that although this was frustrating because I was a month longer than everyone else, I have to look at thiis for the long term.  In 2 years, that extra month will be long gone and not an issue, but the quality of the healing will be.  If you start into things to early and the healing is not good, it is damage for the rest of your life.  The month seems horrible now, but it is nothing in the long run and you have to think about the rest of your life.  Don't push it.  If the OS wants you in the brace, stay in it.  Do it right now, it will pay off.

  110 ROM is awesome.  Keep working on the ROM.  In reality, ROM is your limiter, not the brace.  If you got out of the brace, you could start some basic strengthening, but ROM is what is going to keep you from really getting the bulk of you muscles strength back anyway.  So while the extra time in the brace seems like a limiter, it really isn't much of one, it's just a frustrating pain in the butt.  You can keep working the ROM even though you are in the brace (my PT took it off to work on ROM, just make sure it is not by using your muscles and pulling across that patella).  You'll keep progressing and ultimately are not losing any calendar time in your recovery as you will still be focusing mostly on ROM right now anyway.  Another 10 to 15 degrees and you will be past the point of everyday functioning, that's a huge milestone.

  Hang in there.  You are not far away from major progress soon, don't mess it up now.

Joel

[kimmyxs]

Judith, I am 5 weeks past my dislocation and fracture and 3 weeks past my surgery - yes surgey was 11 days after my fracture.  My muscles were so tight when the staples were removed that my OS decided not to open the brace at all.  He was concerned that it would rebreak the patella.  I was disappointed and asked him I could do anything on my own.  He said remove the brace in the evening while in bed, lift the knee and see if it was fall to the bed without pulling across the knee.  I got to 30 to 40 degrees on Thursday - a week after my last appointment. He said I could open the brace to 30 degrees, and a bit each time I could get more movement without the pain.  He will rexray Friday.  He hopes I am fully healed enough to begin PT.  His concen and mine is that amount of time I have been with no movement.  I can do straight leg lifts and can move the kneecap when my quads are contracted. 

I admit to being frustrated.  Even though I am 47, I am fairly active and even miss going to the gym.  I would like to be ready to begin bowling by at least October.  I originally hoped to begin by mid-September, but no such luck.  That 190 average will suffer.  At least it isn't my sliding knee.  My 6o mile walk for cancer and the MS150 went out the window as well.  Mabye next year.  I have a felling the MS 150 will end up being easier than the 60 mile walk!

Joel, how long before you had much ROM?  How long before you were PWB?

[mtsarpilot]

I went from NWB to FWB on the 11th day after surgery.  FWB and walking are tough when the brace is limiting motion though.

My brace was set to 0 - 30 after surgery, so I started with 30 degrees ROM.  It stayed in that position for 5 weeks.  At 5 weeks they opened up the brace to 60 degrees.  It took me 3 weeks to gain that new freedom and reach 60 degrees ROM.  At that point they opened it up to 90.  It took me another 3 weeks to gain that new freedeom and reach 90 degrees ROM.   It took 3 more weeks to reach about 120 which enabled turning over a bicycle pedal.  I think the next 15 degrees took over a month, 120 to 135 went much slower.  I was limited at 135 by the wire, after the wire was removed in May I now can get the same active ROM as the good leg.  Passive is still about 10 degrees less than the good leg.

Everyone regains their ROM at different rates.  So much is dependant on the injury, the scar tissue buildup, adhesion buildup, the exercises your PT uses, etc..  Most people seem to report ROM gains going much faster than mine.  That was frustrating at the time because I was working it very hard, many hours per day, yet others were doing so much better in ROM.  But it still got there, just took longer.

Joel

[kimmyxs]

Joel, thank you for the information.  Since this seems to be a fairly rare break, the information is rather sparse.  I wish I had that 30 degrees so early.  My OS actually seemed rather pleased that I called and asked the question.  I understand the use of the brace for stability, but I would like to get back at least some freedom. 

When you went to FWB, did you did the crutches?  They seem to be more limiting to me than anything else! 

[mtsarpilot]

At the visit that they took out the staples the OS told me to ditch the crutches and start walking.  He said it would take a couples days to get comfortable walking so take it slowly.  He was right.  30 degrees of motion in the brace was critical to walking without the crutches.  If you are still locked straight, I can imagine walking without crutches would be much harder and would really tweak your back because of how much you'd have to swing your leg on each step.  Even at 30 it was a contortion that seemed to stress my back to walk.   I remember it being at about 50 degrees that I finally felt like I could bend my leg behind me enough in each step to begin getting a reasonable stride.

Hang in there, it will come in time.

Joel

[jm121205]

Joel, I really don't trust my surgeon right now.  Long story not particularly interesting either.  But it is hard not for me to compare my two surgeries, they were less than six months apart.  And last time at this pont I was released from the brace with half the ROM and stregnth that I have now. 

At least per your history, I see that my second surgery was done like yours so the time line seems to have precedent.

[mtsarpilot]

Judith,

  It seems that each OS has a different belief on how long in the brace, how quickly on to allow ROM gains, when to start strengthening, etc..  They probably have a basic recipe that has worked for them, and want to stick with it.  I'm amazed at how much variety there is in all the folks on this forum.  While my OS seemed to be at the far end of the conservative scale like yours, another OS here in town (in the same practice) actually puts patients in a CPM right after patella ORIF.  That is the opposite end of the scale, but boy would it help in reducing the ROM issues. 

  The hard part would be if you don't trust the OS.  I'm sure you have thought about it, but if there is any way to get a 2nd opinion from another OS, that could really help your confidence or change the course of treatment.  Even if not an OS, talk with other medical professionals that have experience in patella fractures.  Maybe a PT or an OT for example.  Even if you have to pay for a PT visit out of your own pocket, the peace of mind may be worth it.  See if you can get a referal from the family doctor to someone he/she knows and trusts with this kind of experience.

  But, if nothing else, let the time pass.  As frustrating as it is, the time will go by and you will get to the next stages in the process.  Keep thinking about the long term value of a good solid patella that healed well.  If it takes a little extra time, it is worth it.

Joel

[jm121205]

Thank you for your attempt at encouragement.  I have been treated badly and I really don't ever want to step foot in that clinic again.  There is no option for a second opinion since no one will even look at me with a failed surgery.  Yes, I have tried.  But I need the wires out so I put up with him and his awful staff. 

And looking at it as a long haul is NO COMFORT WHATSOEVER!!!! This has been a long haul already at nine months with another 9 months unless I get this miserable hardware out earlier.  My best hope is to try to get to the point where I can just show up and let them perform their machinations and leave.  There is no way this can be anything but awful.  But as the wise woman said, that which can not be avoided, can only be endured.    Judith

[Min]

Judith - I have no advice to offer other than having had knee replacement surgery followed by a patella fracture 3 years after that - (7 weeks ago now). I was reading your story, thinking of you and wondering how you are getting on. Do you want to fill us in?

Min

[jm121205]

Hey Min,  thanks for your concern.  My fracture has healed.  I had an xray about a week ago and if my surgeon wasn't so familiar with exactly with where the fracture was, he would not be able to see it. So that is good news.  I  came to the conclusion that I needed a new PT.  My original PT works for the clinic where the surgeon is, therefore she has a very vested interest his happiness over mine.  So a new PT has been more concerned about me and I think I will be done with that soon. 

I have reached a detente with the surgeon-- I appreciate his skill and knowlege but I still question his decision making.  Nonetheless, I have decided to confront him on the basis of why I don't trust him.  If he is unwilling to listen then I will take a formal complaint to the department chair and the dean of the school of medicine.

My OS does not want to take out any of the hardware and I want it all out.  I can feel the wires and screw ends just below the skin.  Yes, I think it is gross too.  My second surgery was a nightmare due to anesthesia issues, so between that and recently losing an acquaintance on the table, I am afraid of another surgery, so I am willing to give his way a try and see if I can tolerate the tinker toys. 

I realized recently that I spent 7 of the last 10 months in a brace, my energy levels and stamina are low.  I am slow to gain stregnth and I am learning to be patient and nice to myself even though it is not my nature.  It has been an emotional year for me and but I am really not looking forward to seening it end.  As hard as it was and for as much as it sucked, what I have learned as been remarkable and I want the good stuff to contine....  And yes, by limiting my time at the clinic, I have been able to see things with a better attitude.  Thanks.  Judith