New patella break patient

[Swally]

Hi
On March 1st I  broke my left patella in two places and shattered some bone into pieces and also fractured both wrists.I fell onto a metal sign support that workmen had discarded on the pavement. as I tried to get passed it I tripped and fell onto it. Ouch!
 In hospital I was put into a full leg plaster and 2 arm casts. The surgery for my knee took place 2 days later, with standard wiring and figure 8 band/mesh. I was discharged on elbow crutches 2 days later and told I was FWB. I was given no other guidance or information.
 At 6 weeks I was re xrayed and told the bone was healingand  put into a full hinged leg brace set at 30 degrees. The consultant said not to wear it at home but in the car and when out. I started PT at 8 weeks, given SLRs and passive quad strengthening. By now my wrists were almost fine. At 10 weeks the brace was moved to 60 degrees.Why I thought? Nobody told me what to do to get there and my leg was just so stiff. My RoM under torture was 45 degrees. My leg brace is a nightmare and slides down. My leg is too small for the brace and makes me stiff legged so I have stopped wearing it which is easier.Since I only get fortnightly sessions with the NHS,i go to a weekly private PT who massages my leg, gives me moral support and is trying to improve my gait. My NhS physio said on Friday that she will refer me to hydrotherapy.
Next week I have my 12 week appt with my consultant. I have no idea what to expect since I feel my progress is so slow and it is so depressing spending a lot of time in isolation. My ROM is about 75 degrees this week but I have been told this is ok at this stage? I have a holiday booked in August and dont feel that I will make it. Can anyone give me any ideas of my likely progress? My holiday was to be walking in Andalusia. I know walking will be out but will I be fit to do some sightseeing and swimming?
Does anyone have any advice for me? I cant believe this has happened. I took early retirement at Xmas to enjoy my free time!  This has been mainly pain and la sense of isolation. Friends and family seem to think I should be Ok by now and seem surprised that I  still need lifts etc.I sense they think I wont get any better and get looks of sympathy.It is driving me mad!!
Louise

[lostpirate]

Swally....

A broken knee cap is no fun to recover from. It's a long and slow road to travel for sure. You seem to be about where you should be in your recovery. With this injury, if all goes well and you have no set backs you can expect to be pretty close to 100% again in about a years time from when you had your surgery. Unfortunately, many people have set backs and then recovery can take longer. I was one of those people. It took me about 2 years to get back to a point where I could pretty much do most things I could before my accident. I am currently 3 years out and just within the past couple of months my knee has started to feel normal again. Meaning the tightness in it and occasional pains and aches are pretty much all gone now.

As for people seeming to think you should be ok by now. That's something we all have gone through. Unless someone has suffered through this type of injury they have absolutely no clue what's going on. This is not a typical fracture where it heals in a few months and you are good to go again. Sure with this fracture, the bone will heal in 3 months, but then you are looking at many months of rehab. People don't understand what happens to a leg when it is immobilized for a month. They don't understand how you lose your ROM and your muscles atrophy to the point that they can barely support your body weight when you get out of your immobilizer or cast. The certainly don't understand how long it takes to get that ROM back and to get those muscles back to normal strength. They don't understand that we basically have to learn to walk again! They also don't understand how frustrating it is for us to be going through it. It's not like we want to be in the situation we are in and are enjoying trying to get back to normal! I got so sick and tired of people making comments about my knee and how long it was taking me to recover that I actually got short and down right rude to many of them when the kept making those comments. Most of them got the point and stopped making those comments. Sometimes you just got to tell them you don't want to talk about it anymore, to stop asking you about it and to stop making comments about it. If you have to be rude or mean to drive that point home then so be it. That's usually about the time they start to figure out just how frustrating things may be for you.

Good luck in your recover, and remember, recovering from this injury is a marathon and not a sprint. It's going to take time. You're going to have good days and you're going to have bad days. When you have a bad day you have to try and not let it get you down. You have to realize that this is normal for recovering from this injury, take it with a grain of salt and realize that tomorrow will probably be a better day.....

[acg]

lostpirate could not tell you better: this is a serious injury, not for the fracture itself, but for the time you need to recover strength and ROM.

my experience: been for 7 months with the pins and wires in both patellas (I shattered both knees and broke my right femur). Until the hardware was removed, could neither walk easily nor recover some strength on my legs, even though I was on PT and swimming every day.

hope this does not discourage you, but be realistic and never give up, it gets better!

[Swally]

Thank you so much both respondents. It is so supportive to have feedback like this to help me realise that I am going through a fairly normal period of recovery. Difficult that it is . I hope that I have positive feedback from my OS tomorrow and can start more physio. I must stay positive!

[fsugirl]

I love this place!  It really stinks to be going through this, but it's so nice to know you're not alone. My injury was on 3/18 with surgery 3/22... I'm currently struggling to get 60 degrees ROM. I thought I would be so much further along now... And I, too, am starting to get annoyed by others' reactions to how long recovery is taking - I'm experiencing the exact same things you two have described!!  Thanks to all here!  We've gotta just keep hanging in there!

[Suejs14]

Hi -- I haven't been a regular poster lately (am 13 months post ORIF and doing well) . . . Lost Pirate is totally on point.  This injury isn't simply a broken bone . . . I told everyone it was a 2-year rehab so they wouldn't think I should be "normal" again for quite a while.  I'm still working on quad strengthening and trying to get more flexibility in the tendon/ligaments surrounding my knee.  I was verrrrryyyyy slow in ROM.  If you can find some of my earlier posts (in diary section) you can see how slow I was.  I found using a warm water pool at the fitness center was extraordinarily helpful -- the pool was at 94 degrees F.  Then, using a leg press machine at the fitness center . . . place your feet on the pad with low weight resistance . . . and put the "sled" close to your feet.  Then, straighten your legs (easy) . . . and continue to return to "start" where your knees are bent.  I found it a clever way to increase ROM.  I finally am pretty close to my other leg -- not exactly sure what it is, but I can sit in bed with my knees bent fully and read the paper in the mornings.  I'd noticed this the other day and was pleasantly surprised that I only noticed it because I was doing it without any tension/pressure or discomfort in the knee . . . it actually felt normal. 

Dedicating yourself to rehab now will let you return to fully normal . . . it is a slow process, but daily and continued working on it will give you your knee back.

Best of luck.

Sue JS

[Swally]

I achieved 90 ROM this week, 14 weeks after surgery, and am more mobile at last. I can drive and walk without a limp. Coming down stairs is still a challenge tho'! However, I am in more pain now, not in the knee, but in the whole leg. It stops me sleeping. I am reluctant to keep taking ibuprofem and paracetamol because of the well documented side effects but i just cant manage without them. Also, my legs are restless and I have problems keeping still.
I  am not due to see my OS until September so does anyone have any tips/ ideas ? I feel that I overcome one hurdle and another one looms. But driving again is wonderful because I am independent again.
Lou

[pinkstripes]

I'm glad you are doing better. I just got cleared for driving last week and it's a whole new world again.
I think the pain you are feeling may be your weakened muscles doing work again. Are you spending much time on the exercise bike? That really helps range of motion.
Two weeks ago I started up group cycling (spin) classes at the gym again (before the break I took classes 5-6 days a week). I'm not 100% in them, but I can tell I'm getting stronger with every class. My knee doesn't give me problems during them, it's my quad.

[Swally]

Hi,
Thanks for your reply. I have tried the exercise bike but can't get the pedals to rotate even with the seat high.  I have been on the cross trainer yesterday and today though. I can't do it for more than 15 minutes since my legs get so tired. I used to do spin classes before my accident and lots of aerobics so I should cope. I'm perplexed by my inability to exercise for long, my quads and calf muscles seize up. I think driving my car and using the clutch is tiring my leg. It's a new car and the clutch is stiff so it's quite a challenge to drive it for an hour in traffic.
Still it's a lot better than sitting in as I've done for 3 months.
Lou

[acg]

my PT says that usually cycling requires to comfortably bend your knee by yourself to 105-110º, so that might be a guide for you.
what helped me (I had the 2 patellas broken) was to sit on the horizontal static bike as far as my legs allowed and move the pedals as much as I could in both directions for 15 minutes a day, no resistance. after few weeks of that and many other exercises, I made it to cycle easily and after few weeks I could switch to the regular static bike. once you get there, the goal is to low down the seat as much as you can, so your knee(s) get used to work while bent.
hope this help

[lexielou]

Hi Lou,

I've not posted for a while but you can see my journey in old posts.  We all know how traumatic a broken knee is.  It is a long process and 10 months down the line i am nowhere near the woman i was.  However life is good...i appreciate things more and probably exercise more than i ever did as the injury gave me something to aim for (recovery) and taught me to respect my body.

All I will say if you are driving an english car with a clutch at 3 months post injury (is that right?) you are doing well.  It was 5 months before i could do that.

stay strong.

Lexie
 

[Rollerblader]

Hi Everyone!  Good to see some old friends here!  I'm almost 11 months along.  We've all had our ups and downs, but we are getting there! 

Swally, I had an awful jittery leg when I was about 90 degrees.  I went back to my post and couldn't figure out how long it lasted.  I couldn't sleep at all.  I went back to taking my prescription drugs to help me sleep until it passed.  I called it my caffiene leg.  I had shooting pains in my knee and my thigh.  Once I started taking my  pain meds, I was able to sleep and was able to relax.  I also used a heating pad and took hot baths with lavendar and salt.  I used a mix from Carol's Daughter, but I think Epsom salt would do the same.

It's good to hear from Lexie Lou, Sue, acg and of course Lost Pirate.  You all really encouraged me along the way.  I wish I had held off a little on my hardware removal.  It sort of set me back some.  I had mine out right at 6 months and I had to sit around for 3 weeks and I just got out of the habit of exercising.  I'm still not running or jogging.  I have been walking 1-2 miles per day lately at the park while my two kids train for cross country. My knee makes all kinds of popping, crunching and grinding sounds.  I had hoped it would go away with the hardware removal, but it's about the same.  At least I won't have a hardware issue in the future.  Plus, I had to get the hardware out of my elbow anyway.  It's much better now.

Everyone, hang in there!!!  I can do everything I need to.  Maybe not everything I want to do.  The walking at the park will really help.  There are alot of hills and I feel so much better when I go.  After a long day, I will go down the stairs at our house toddler style which is frustrating, but I've climbed straight up wall ladders at work to get on the roof of buildings.

Take Care everyone.

RB

[lostpirate]

Swally...

I am not surprised that you have pain in other areas of your leg. That's actually pretty common and for a number of reasons. The 1st being that when your leg was immobilized all the muscles in your leg atrophied and weakened. They all need to be strengthened. And that can be easier said then done. All those muscles need to be targeted in therapy. Its very common for some muscle groups to strengthen slower then other. The VMO and hip are notorious for that. That's why it's so important to have a good therapist. They can recognize when muscle groups are coming along slower and adjust your exercises to target and strengthen them. When one muscle group is behind it puts more stress the other muscles and that can cause pain.

That kinda leads me to the next reason why you are probably having pain in other areas of your leg. Even though you are walking without a limp you probably aren't walking in the proper motion. We are notorious for unconsciously compensating (or babying) our bad leg. We want to protect it. We tend to short step and bear more weight on our good leg. We also don't walk properly. We tend to flat foot our steps, throw our leg from our hip, and lock out our landing when we walk. The proper way to walk is too roll your step of your toes, extend it from the knee (not throw it from the hip) and land on your heel without locking out your leg (that means your leg should be a little bent at the knee when you land your step and not totally straight) Watch what you good leg does when you walk and compare your bad leg to it. I bet you'll notice a difference. All this compensating we tend to do causes pain in other areas of our leg because not only are we making the muscles work in an unnatural manner we are also making them bear more of the load because we are babying that bad leg.

I had pain at various times in my calf, my hamstring, behind my knee, my hip and lower back. It was all because I was not walking right. Even though I wasn't limping I was still compensating. I was short stepping, flat footing, throwing from my hip and locking out my landing. I didn't even realize I was doing this. My therapist always caught it. This is why I say after this injury we really need to learn how to walk again. I seriously had to think about every step I took and to do it right. If I didn't I'd fall back into my bad habits. When ever I had a bobble or muscle pain I'd watch my walk and sure enough I was doing something wrong! As soon as I corrected it the pain would go away fairly quickly. This is very common with our injuries. Almost everyone has to deal with this problem in their recovery. It's only been within the last few months that I have been able to walk properly again without thinking about it.

[Swally]

Well, in the last few weeks I have made progress. I can cycle a static bike but it hurts so much to start!! I can go down some stairs normally too. However, my leg is still stiff . My physio thinks I only need a couple more sessions and I am panicking. I suppose I have mobility but I want to get back to my pre accident state? How long, if ever,does it take to be free of the stiffness and discomfort? When will I be confident to kneel?
Any tips gratefully received. This board has been fantastic help so far.

Lou

[webster1661]

Hi Lou! I am a "repeat patella fx". My 2nd time was Feb 18, ORIF surgery Feb. 23, so I'm only 9 days or so earlier than you. I am still having trouble coming down stairs (up is getting better). As for kneeling.... !!??? I've tried a couple times, even just on the bed and it is really uncomfortable, in large part because 1/2 my knee still has no feeling so I can't feel the contact with anything. Do you have full feeling returned?
Stiffness and discomfort... stretching out the leg and doing exercises helps reduce the stiffness I find. also massage is good too.  Some of your stiffness could still be coming from the hardware. Has your OS said anything about removal? You can check on this site for lots of info / experiences about hardware removal (I am in favour... had my first hw out at 6 months post-op after my first fx. and it felt SO GOOD to have it out... then I fell again and my patella just split again in exactly the same 2 pieces! 
Good luck! keep up with the exercises even if physio discharges you.
Webster