repeat fracture of patella

[webster1661]

This is my first post here but I've been reading lots since I first fractured my left patella June 6, 2011. I had surgery and pins and wires were put in to hold it together (it was in 2 pieces, horizontal fracture). Had hardware removed in Dec. 2011.  Then on Feb. 18, 2012 I fell again and refractured it in the same place. Had to have surgery again and this time Dr. put in screws and wire; screws are likely to stay in but wire may be removed later.

My question is: how many others have had a repeat fracture?     How common is this?
I'd be happy to answer other people's questions about what to expect, etc now that I'm going through it all for a second time!

Cathy

[CariUK]

Cathy, so sorry to hear that you've refractured your patella! I fractured mine in November and its been 16 weeks of rehab hell, the thought of a refracture terrifies me! I can't imagine what you must be feeling right now. Best wishes for your recovery, keep us updated about how you're getting on. Cari.

[webster1661]

Thanks Cari!

It was most definitely NOT fun the first time round.... as soon as I fell the second time, I heard a "CRACK", couldn't walk, told my husband "I know we have to go get xrays again"!  Needless to say I was very depressed and cried when the xray confirmed my worst fears: broken again, same place. The good news: I knew what to expect;  the bad news:  I knew what to expect!! and how LONG it would take, again!  I was 8 months post-op from first fracture and doing well.

It is certainly a long road to recovery. It sounds like you are doing pretty well at pt and rom is returning. I remember each time my pt measured my rom I was so excited... typically I gained an average of 5 degrees each week. Then I reached the limit of what my hardware would permit around 120. I had my hw removed exactly 6 months after 1st surgery and my knee felt so much better almost right away! It felt more "natural", like it belonged to me again and after a brief set-back while waiting for the incision to heal again, my rom stared increasing again. I think 145 (?) was the last measurement I remember, before falling again and undoing everything.

I like your blog and am reading my way through it. You had a more complicated break of your patella than I did.... several pieces (mine just split in 2). Ihope yours joins back together and fills in nicely. Mine was slow to heal the first time (maybe due to my age?...almost 49; low bone density?....I'm at risk of  osteoporosis;.... who knows). This time round the dr. (same os) is allowing me to put 50% wb on it (first time he said 8 wks nwb!). Being able to put some weight on it makes a HUGE difference in being able to get around, and CARRY a plate of food or something!! (lol)

I hope you have continued progress at pt and hopefully you will be able to get your hw out soon? As for the MUA, I've read mixed reviews about it, but if they are removing your hw then they can quite easily do the MUA before they open you up again. Either way, your rom will increase more after the hw is out! Patience. And.... don't fall again, best advice I can give right now!

Cathy

[CariUK]

Ah just replied to the other post before I read this - good to know that your knee felt better after the hardware was removed, that's something to look forward to. I think my ROM is progressing ok, I don't mind slowly, as long as there is some improvement each time.

Interesting that you mention low bone density here, we're not far apart in age (I'm 44) and I wonder about this too. Over the years, I've broken my arm(s) 5 times, the last time about 7 years ago, and now it seems I'm starting on my legs! I don't think I fell that hard when I broke my patella, just kind of slumped down onto it, but obviously it wasn't strong enough to withstand even that. I've asked my GP if he will do a density test when all this is over. I too am concerned about osteoporosis, and more bone breaks are too much to contemplate, I really do feel for you so much going through this again, especially so soon.

Are you in the USA? Its interesting how treatments (weight bearing, length of immobilisation etc) differs so much from place to place. I''m in the UK and even here the process seems to differ from one area to another. I was away from home when I had the accident and the surgeon who repaired it wanted me in a hinge brace from week two. Back at home at the follow up, they put me in a splint for another 4 weeks with no movement at all. I wonder if I would still be this stiff if I'd been moving it sooner.

Glad you like my blog, will respond to your comments there later. Good luck again, keep us updated!

[webster1661]

I'm in Canada. Yes, there is quite a range in doctors' orders everywhere.... even from the same dr.!  First time round I was told 6 wks NWB but then hadn't healed as well as expected so told 2 more weeks (that was my most depressing moment the first time).
Hard to say if your knee would be as stiff if you'd been able to start moving it earlier? I think after any serious injury like this it will be stiff. It's the body's way of trying to protect it?

It sounds like you have broken a few bones in your time. I would strongly recommend that you push your GP for the bone density scan. In my province (Ont.) docs normally start doing them after age 50. Because my Mom has severe osteoporosis  I started asking my GP about it when I was 45 and she agreed to start me early. My first one already showed I was at higher risk than average for my age so now I get one every 2 years, am taking calcium supplements. Not sure what else will help... weight-bearing exercises!!! oh wait..... can't do those right now!!

My swelling is starting to go down a bit more and I'm beginning to "feel" the hw in there again. I still have a huge bruise at the bottom of my shin into my calf but it is improving. My whole leg was one giant bruise for almost the first 2 weeks post-op.

Did I read that you are going back to work soon? Any chance you can go back gradually? That's what I did in the fall when I first went back. I was able to use some of my cancelled vacation time to be able to work 3 days and then 4 days a week.

Take care, thanks for responding! Cathy

[webster1661]

I go back to the OS tomorrow (March 27)... will give an update then on my progress.

Eager to hear/ see how much my bone has filled in the gap (even with the screws in now, doc saw a small gap in the 2 pieces of my patella).

And I want to see if 50% WB this time round is making a difference (I was slow to heal first time).

Stay tuned!
Cathy

[CariUK]

Hope you got some good news Cathy, how many weeks post op is it by now?

I'm starting back to work on a "phased return" after Easter, looking forward to it but very nervous too! Going to test the water tomorrow by attending an all day conference with colleagues to bring me up to date. I'm mostly getting around on one crutch now, but might take two with me! Progress is still slow but steady, ROM was at 100 degrees yesterday! Still attending physio but they seem to have lost interest a bit since the MUA was cancelled, not progressing my exercises at all just keeping me working through the same routines I've been doing for weeks. I've asked them for a reassessment next week, to update my program, because at the moment its a bit of a waste of time attending the sessions when I am actually doing more at home using the info gained myself from the internet. After I start the phased return to work, my next goal is to be able to drive my car by the time I am back full time - I can get lifts a couple of days a week but 5 days is a bit much to organise!

Looking forward to your update, good luck!! Cari

[webster1661]

News from my OS was mixed: 2 more weeks of 50%wb then I can go to 100% and start gentle ROM at physio again. (that's the good news).  The less good news is that the 2 pieces of my patella are not looking much closer. I am now 5 weeks post-op and the new bone growth should be showing up on xrays but it's not. Doc wants me to use a "bone growth stimulator" (similar to an ultrasound machine for muscle stimulation) but my work plan insurance won't cover it so the Doc is trying to work out something for me to "borrow" one for a while... still haven't heard yet. By the time I get it I'll probably have grown a lot more hair on my legs.... but not the bone!!

You mention going back to work. That's good you are able to start back gradually. I would suggest taking a small stool or using a second chair to prop your leg up on. Not all day, but you WILL find after sitting for a while (even more than half hr) it will start to throb and you will need to put it up or go stretch it out a bit, move around.

Definitely take the 2 crutches, at least at first. Are you wearing that locking brace I saw on your blog? Remember.... you don't want to copy me and suffer a 2nd fracture!

That's good if you can share some of the driving or get rides with someone for a bit. My husband and I both work in Toronto so most days we are able to drive together and I just drive one direction (depending on schedules of course).

I know what you mean about the pt. Sometimes I think they just want to keep the $ coming in by making you come in as much as possible. There's another woman at my clinic with a similar knee injury and they have her coming in 3x / wk. I told them I can only afford (money and time-wise) to come in once a week and they accept that!   I've also had a couple different therapists tell me different things. One even said the other pt had me doing an exercise wrong! How am I supposed to know?

Driving is a MAJOR milestone in gaining back your independence! Good luck, take it slow.

Also, when you are back at work, try to do shorter days, at least the first couple weeks. YOU WILL BE EXHAUSTED!! mentally and physically! I used some of my vacation time that I had cancelled to offset my "leaving early" days.

I go back to my OS in another 3 weeks: April 17.

He wrote me a note to be off work til May 6 but I'm thinking I may need to start back part-time before that to stretch out my sick days.

Good luck, stay tuned... keep me posted.  Thanks for the "chat"! Cathy

[Akntter]

I intend on being very careful. Thought I heard that holes from hardware fill with scar tissue not bone. Might be wrong. Most frustrating to revert to no movement, pain... Being disabled. I get to see doc in 2 weeks. Hopefully he will let me progress in my activities.

[CariUK]

Sorry to hear your "not so good news" about the bone growth not progressing as well as you'd like. That must have been a bit disheartening to hear. Did the bone heal ok first time round? Wonder if it takes longer to fuse with a second injury, especially so soon after the first one though. Bet you can't wait to start working on the ROM in two weeks, admittedly the worst bit of the rehab, but at least it marks the start of the road back to some kind of normality. Are you still in a splint right now?

I guess we don't realise how lucky we are in the UK getting our treatment paid for by the national health service, I don't have to pay for PT or OS consultations and was allowed up to five months off work on full pay. Obviously getting to the end of that now, hence the eagerness to get back out there, I can't afford to have reduced pay. Went to the conference yesterday, without the brace as it was mostly sitting arouund. But yes, leg was very achey and swollen up by the end of the day, the pins were really digging in after the 4 hour round trip in the car which didnt help.. and the rest of me was pretty exhausted too! My brain needs some rehab to wake it up again too I think! The phased return to work will start on 16th April - 50% hours for 2 weeks, 60% 1 week, 80% 1 week, and then back to 100%. And in between I can work from home if I need to, so it shouldn't be too heavy going (maybe!).

I think you need to eat plenty of chocolate over Easter to get that bone healing ... well, worth a try isn't it? Brilliant excuse to indulge if nothing else

[webster1661]

The bone was slow growing back together first time too but I was thinking that having put 50/ weight on it this time might have made a difference but it doesn't look like it did. Still no word about finding a bone stim machine for me to use.

I'm typing this on my hubby's playbook so please excuse typos etc. It has some auto fills I'm not used to.

That's great that Uk covers all your treatments! And 5 months off work is great. Sounds like your full day meeting gave you a sampling of how you will feel going back. Very good that you can do it gradually. You mention a 4 hr round trip...is this a regular part of commuting for you? I have a 2+ hr round trip to work, but can carpool most days a hubby, when I go back, probably end of Apr or beginning of May.

Yes, I'm still in the brace for the next 2 weeks. I think I will take it off for physio and then put it back on. Until I see the OS again the week after.

Are you still thinking. / planning on getting your hardware out? If so what time frame? I still will have my wire out later but sounds like my screws will stay in

Well, enough for now on this playbook. Touch base later.  Cathy