Shattered Left Patella 6-4-11

[jeffykneecap]

Wow! I'm glad to have found this website and see all of the other posts. It has been a great encouragement today to read about your progress.

My story:  53 year old male, fairly active, golfer, commercial real estate agent. Saturday June 4, I had a trip and fall in the garage. As luck would have it, I landed awkwardly on my left patella. At first, I thought maybe it would be a bad bruise, but I couldn't move my knee at first. I'm not sure how I hobbled into the house- my wife said I was white as a ghost. I iced it for a couple of hours while I fell asleep on the couch. Within four hours, we headed to emergency. I was fortunate that the OS was on duty and did the surgery the next morning. It sounds like the two screws and the figure 8 wire is a very standard fix. The OS told me that he wasn't sure he could save the kneecap - worst case. Seeing the posts, it sounds like many others have had similar breaks. I was told he was able to piece together 5 major pieces and remove some of the smaller shards.

I've been in a Bledsoe device since the operation, but was told not to put weight on it for 6 weeks.

While in the hospital, I was on hydrocodone and they gave me a scrip for it with my release. I never had it filled and haven't needed any pain meds since the release, not even Tylenol. Wondering if Advil would help with the swelling?

I like the ice packs too. Seems like it still gets hot at random times.

I'm looking forward to checking out more posts and reading about other's successes and experiences. This is a tough club to be in, but there are some great stories and even better people here. Thanks, Jeff

[jeffykneecap]

Today is 3 weeks post surgery.
Using the backwards up the stairs method of getting upstairs to the bedroom for a better night sleep. We're in a small house with the sunken living room (not easy to get to the couch or to the kitchen from there), and the BR's are upstairs. 2 and 1/2 weeks on the couch downstairs until I felt confident enough to try the stairs.
Has anyone tried Boericke and Tafel's Sports Gel? I was reading about it on the Vitacost website. I've seen comments on this site for Arnica Gel, but hadn't seen this. Please let me know what you have experienced. Thanks, Jeff

[floridanightingale]

Who are you? Superman? No pain meds!?!? I was howling like a hyena in the hospital WITH a morphine drip in my arm!  For 3 days!  You sound like you are in very good fitness, so as you probably picked up on the boards, you will likely have an easier healing process than most.  I am 32, had a terrible comminuted fx with same day ORIF (the two main pieces broke several inches apart), but I feel like youth and a decent level of fitness have been on my side with the healing.  I was out of the brace at a couple weeks and have almost full flexion now (full weight bearing, walking with a cane and the slightest of limps).  Still have SERIOUS quad wastage, so my biggest word of advice to you (as you likely have seen on the boards) is to keep your quads as active as you possibly can (my O/S and physician's assistant warned me repeatedly from literally day one to "fire my quads" by flexing/pulsing the muscle throughout the day).  I did not.  For the first 6 weeks, I was lazier than I should have been and I regret bigtime it now.  To answer your question, I have not tried Boericke and Tafel's Sports Gel, just Arnica.  Maybe amazon has some reviews?? I haven't seen it on this site at all.  Maybe if it works for you, you can suggest it to the rest of those unfortunate souls suffering from displaced patellar fractures!  I wish you all the best with your recovery--it sounds like you are doing well! 

[jeffykneecap]

Thanks FN,
No, not superman, just another person who's grateful for the blessings that I do have. I had lots of pain in the hospital and was really worried about the pain when I got out. For whatever reason, by the time I was released, no issues with pain. I hadn't had a pill since the morning and was released at 6 PM, so I figured I'd try to make it without the pills and somehow it worked. I was on morphine for the first 224 hours, then onto hydrocodone. (Denial?)
I've been advised by the OS not to fire up the quad in case I pull the kneecap apart. I have been doing some light massage on the quad because I couldn't stand the atrophy. I was worried about the lack of blood flow to the knee too - real or imagined, I don't know. It seems to be working, but I get worried about having to start over, so I am really trying to be careful. I screwed  up yesterday and accidently put weight on my leg - big dummy - just forgot. It hurt at the time and it feels a little numb today in the little toes. Hoping it won't be anything serious.
I'll let you know on the gel. I read about it on the Vitacost site. I get some of my herbals and vitamins from them, so I ordered a tube today.
I'm not sure what the "comminuted fx with same day ORIF" means, I'm still new to the site and learning the terminology. It took me a while to figure out what OS meant, LOL.
You sound like you've been able to bounce back quickly, and I appreciate your comments. Thanks so much for sharing. I'll continue to look for your progress on the board as well.
One last thing, I've been told it's ok to shower, but we only have the small shower stalls with the 8" rise in this house. I'm afraid to jump over it with a hop and slip in the shower, so I continue the sponge baths. Trying to climb into thewhirlpool tub was scary too. Wish we had a handicap shower now. The no rinse soap from the hospital has been a big plus.
Again, thanks for the reply. I feel very fortunate to have found this great community to discuss a topic that the regular bipeds just don't appreciate.

[Suejs14]

Nope, FN (aka "Birdie") is right - no pain meds = Superman.  Unless you were in pain and not taking them - then no pain meds = Stupidman <gr>.

I, too, had a comminuted fracture (more than two pieces) and an Open Reduction Internal Fixation (ORIF).  That just means they cut you open to reduce the fracture (pull pieces together), and fixed the pieces together internally - with the screws and wire.

I know what you mean by all the spaghetti initials for words - the first several times I'd seen my kids' stuff I thought TMI had to do with 3-mile Island (nuclear near- meltdown in PA).

Re working your quads - check with your surgeon.  Mine still doesn't want me to work them 'cause of the possibility of pulling the pieces of my knee apart.  I was able to press the back of my knee down onto my bed, however, and this does work the quad a bit.  That, toe pumps and circles and glute squeezes were it for exercise until the 6-week mark.  I was in a full leg immobilizer (hip to ankle) for 6 weeks and now grateful to be in a mid-calf to mid-thigh Bledsoe crossover brace.  Towards the 4-5 week mark I began putting a bit more weight on my leg - very gradually - and it was fine.  I think that helped me to drop the second crutch so quickly.

My shower was like yours - and it was too scary to go hopping over it - especially on the way out when it was wet.  There are some rubber and plastic protective sleeves that go over immobilizers and braces, so you can keep it on to shower, if you find the courage.   Finally- I've used traumeel gel - like arnica - and like it.

Best of luck, and condolences for joining this elite club.

Sue JS

[jeffykneecap]

Hi Sue,
Too funny. For whatever reason, I just haven't had the pain. Maybe LuckyMan is more appropriate (Emerson Lake & Palmer?).
Thanks for the encouragement on the shower. I thought maybe I was just being a baby. I'm going to hold off until I can stand on it and keep doing the daily sponge baths. I use the kitchen sink for the shampoo. At least I can balance with elbows on the counter.
I started following you and Birdie when I first found this site, since you appear have gotten an early start on me. I appreciate hearing from both of you. It makes the recovery much less depressing. Thanks so much for explaining the acronyms.
My doctor told me no weight on it until 6 weeks because he did not want to risk the knee breaking apart again. I had 5 major pieces he told me about putting back together, and dozens of little pieces, some of which he just removed. He said it was kind of like a jigsaw puzzle. He took the two pieces still attached to the tendons and three of the other larger pieces kind of fit together in between like jigsaw pieces. Then he did the screws and the figure 8 wire. At the 2 week mark, I could still see the gap on the x-ray. I've been in the Bledsoe since the operation, and he gave me a 40 degree flex to do twice/three times/day. He also said to massage the knee and gently move the kneecap.
I'm heading out for a trip to my office today, so I can catch up on almost 4 weeks of paperwork, pay bills, etc. Then home for a nap this afternoon. Last night was pretty miserable - up at 2:30 AM and could not get back to sleep. Small twinges in the knee and I just couldn't get comfortable enough to get back to sleep.
I gotta say that i'm excited to hear you are starting your golf exercises after a couple of months. I was scheduled to play the week after this happened and hadn't played for months before, so I am just itching to get back. Watching Rory win the US Open was fun, but there is nothing like being on the course.
Thanks again for your words of encouragement. I wish you continued progress with your recovery as well! Jeff

[Suejs14]

Hey Jeff,
Ask your OS re: partial weight bearing with your brace locked at 20.  I understand the patella is not affected by a weight bearing load until the flex is at 30 degrees or more.  I am envious that you are beginning ROM so early - and doing patellar massage.  That might have saved me from laying down so much scar tissue.

3-weeks post I officiated at a Junior golf tournament - in a cart all day.  You can't imagine how exhausted I was at the end of the day.  It takes a while to re-build your stamina after surgery.  Don't wear yourself out at eork today or tomorrow will be a bust.

Re:shower- I put a bathroom rug over the top of a dining chair and brought it to the shower so when done I could turn around, grab the chair and sit - didn't have to crutch out, only crutched to get in.  Worked pretty well, but I still did sponge baths most of the time.

My golf "exercise" is just weight bearing - shifting from center, right, left and return to center (with posture as if holding a driver-bent knees).  Not doing any turning.  It's not much, pretty easy, but a baby step.  Loved watching Rory!  I have friends in Holywood N Ireland (golfers, of course) who know him.  They're "over the moon" as they say.  I was scheduled to fly to AZ for a national better ball tournament the morning after I fell.  I was calling my partner and tournament director from the ambulance.  My PT thinks I might be putting and hitting soft 50 yard shots come August - I think you're about 6 weeks behind me, so maybe you'll be holding a club this season.  Don't know if you'll play full out before the snow flies, though.  This patella stuff gets in the way of life and becomes your life.  Keep positive and stay in touch.

Sue JS

[jeffykneecap]

4 weeks post surgery today (Sunday). I worked Tuesday and Friday this week (just phones, computer and some light filing). It is amazing how exhausting it is to start working back the strength - overall - not just this pathetic looking leg (atrophy of the quad). The OS told me not to put any weight on the leg - including no driving - before the next appointment (15th of July). He's worried that the flexing of the quad could pull the pieces of the kneecap apart. I'm trying the Boernicke & Tafel Sports Gel. It's supposed to be even better than the Arnica Gel, so I'll let you know if I get different results. (One of the active ingredients in the B&T Gel is Poison Ivy. So far, it's not itching or turning red - LOL.) The knee is still pretty swollen and red. I've used the gel for four days and haven't noticed a difference yet. I'm still liking the occasional ice packs.
I got brave enough to try a shower yesterday after a month of sponge baths. We have one of those 3'x3' (or smaller) shower stalls with a water pik showerhead, so it was a little challenging to get inside. Once I made it to the floor, and scooted backward into the shower, I had to bend the knee to fit inside on the floor of the shower. It felt SO GOOD to finally get cleaned up! Because of the amount of work involved, I was sweating after, so I'm not sure it was a terribly effective use of time - haha. Had to lay down and rest after the shower.
Good healing to all! Keep the faith - there are a lot of people with more life threatening issues.
I keep reading the entries on this site, and appreciate seeing the progress and encouragement from other members. Thanks to all of you for your contributions.

[jeffykneecap]

I'm trying to go to the office and make some phone calls and stay on the computer this week. The kneecap seems to be more swollen again today, although it doesn't hurt. Sitting at a desk with the leg on another chair seems to put a strain on my already tight hamstrings and lower back. I've had to stretch out on the floor a couple of times today already. Fortunately, it's a small office and no one thinks it's weird for me to lay on the carpet and take a short nap. LOL. I haven't been consistent with the sports gel, so I can't tell if it's working yet. Supposed to use it up to 4 times a day. When I was less mobile I was better at applying regularly. Eagerly waiting for 7-15 when I see the OS, get another set of X-Rays and see if I'm healed enough to start on the PT. I am so out of shape that taking a shower seems to make me sweat - a lot of good that does! Seems so easy to get exhausted these days. The worst part is that everyone else thinks I should be healed and back on my feet already, wondering why I can't fend for myself yet. The knee is an amazingly important part of the body, and it took this happening to really appreciate how blessed we are to have two functioning legs. Like the monkey said when he got his tail caught in the lawnmower - it won't be long now. I can only hope............

[Suejs14]

Poor monkey . . .

Just tell people it's a 2 year recovery.  That's not far off, really . . . and it gets their attention really quickly!  I follow-up by telling my friends that it's two years before my knee will approximate what it was the moment before I landed on it.  No one's rushing me and lots are complimenting how well I'm doing  . . feels so much better that way.

No need to rush your healing -- it won't hurry up because of the impatience.  I can totally relate, though!  I found that a pillow under my knee/calf and the "other" chair being slightly lower was the best way to sit and do things.  It kept the leg straight and the weight off the knee.  It was uncomfortable to have just the foot propped up -- it made my knee hurt for some reason.  Good luck . . . only a bit more than a week before the surgeon gives you some kind of go ahead.  Keep positive, keep smiling

Sue JS

[jeffykneecap]

Dear Diary, I had a scary experience on Saturday....I went out for a meeting in the morning, then took my wife to a movie. When we got home around 4 PM, I noticed my left foot was about 50% larger (swollen) than the right foot. By Sunday AM, it was back to normal. I think it was because I left the leg down for a good portion of the day. I notice that the foot turns very red when I'm up on my walker moving around. I still elevate the leg consistently, and occasionally ice the knee when it gets warm. I see my OS on Friday for the next set of x-rays and the new directions for therapy. Praying for good news!
For those of you reading these posts, please read floridanightingale and suejs posts. Sue and Birdie are further along with the same injury and have done a wonderful job documenting their progress. Wishing speedy recoveries to all! Jeff

[Suejs14]

Jeff,
Re:foot and leg swelling - not to worry, it's normal for now.  Mine swelled up lots for the first 2-3 weeks after I was out of the full immobilizer and into the Bledsoe - and weight bearing.  You need to have a more "normal" walking gait for the muscles in your calf and leg to push the fluids back up.  I actually exaggerated my heel, toe, push off moves so I could remember how to walk.  Plus you need a certain degree of flex to have a good gait.  I think I was @60 when I began walking better and the swelling decreased markedly afterwards.  So, for now - pace your upright time and get the leg elevated whenever you're sitting.  The fluid moves out while you're prone (sleeping), so should always be better in the am.  Oh, I also got a thigh-high TEDS stocking for when I flew and used it on days when I'd be upright more than usual - shocking how well it works!

Keep posting your progress - and stay happy.

Sue JS

[jeffykneecap]

HOORAY! Yesterday was the 6 week post-op with the OS. I received permission to walk! AND DRIVE! Friday afternoon I drove to the MVD to get my handicap placard, then to the orthotics shop to get fit for a Bledsoe 20.50 knee brace. So many of the braces are neoprene, and they'll be hot here in Phoenix in the summer, so I'm hoping this will fit. The knee just feels so unsteady right now, and I worry about bumping it with something.
Saturday I drove to Walmart, got a backpack so I can carry stuff, filled my car with gas at Costco, did some banking, and GOT MY HAIR CUT! Oh yeah, I actually STOOD UP in my shower today! Goodness, it's so good to start doing regular stuff again!
The first steps with the walker yesterday were pretty wobbly. I've been hopping around for six weeks and it was really hard to forget how to hop. LOL. The knee hurt a little, and my ROM was about 50 degrees, so it was tricky. With some concentration and a little help from the walker, I got moving at a slow pace, and quite a limp. I met some really nice people yesterday and today who made a quick dash to the door to hold it and help me out.
The knee is swollen tonight, so I'm icing it and taking my Aleve.
Monday, I start the PT process. I'm not sure what to expect, but reading other entries, I'm expecting there to be some pain. (No pain, no gain?) . I asked my OS what his expectations for the next visit (4 weeks). He told me 110 degrees. (My jaw dropped, he smiled and said he'd be ok if it's 85 - which still seems like a lot when he told me I was at 50 right now). I'm not exactly sure how to measure the range. I'll probably learn that from the PT Monday morning.
I'm going to take my dog for a walk tonight when it cools off a little. I might even try the community pool tonight for a little exercise. I can't wait to get back into golf shape, but I'm not going to push it.
I noticed that my left ankle is pretty weak, and pretty sore tonight as well. I feel like I need a good massage on the instep area, but I can't quite bend the leg enough to get to it.
This post has gotten longer than I expected when i started, so I'll write more after PT on Monday or Tuesday.
Cheers to all, and keep the faith. It can get better, and it's better when the attitude is right.  Someone once told me that "attitude determines your altitude." I expect to fly again. Or at least play golf.

[floridanightingale]

WOOHOOO!!!!!!! Great post!!! Some awesome milestones. Keep it up, Jeff. This is a crappy injury, but over time, it DOES improve. 

[jeffykneecap]

Thanks Birdie! You and Sue have been such a GREAT encouragement for me during some of the darkest days in recent memory! Thank you, Thank you, Thank you!
A quick update. I could not raise my leg off the table for my OS on Friday, but by Saturday night, I was raising it (at will) on the couch. I did a few sets of 10 reps yesterday. I'm guessing my ROM is around 75 degrees right now. Boy, does the knee feel tight when I try to bend it, like the skin on top is going to burst. It's a weird feeling for sure. I slept without the knee brace last night. The scar area is still very tender, and it kept me up a good portion of the night. NAPTIME on Sunday!
I WALKED the two blocks to the community pool last night (with the walker - although I was able to carry the walker part of the way). I sat in the hot tub for a few minutes, then into the warm water pool for about 20 minutes of walking back and forth. Then walking back home. What a treat! This is only the third time I've been to the pool since we moved to this house last November.
My quad is still really pathetic looking, but I have faith it will come back pretty quick. I hope I can do the plywood and 2x2 like Sue in a couple of weeks. How big is the plywood? 1/2" or 3/4' thick?
It's so exciting to start geting back to being self-sufficient. I'm sure there will be a set-back at some point from what I've read in the posts, but I am highly encouraged for now. LIFE IS GOOD!!!!!
Happy healing to all. May you experience continued progress in your rehab!