Bone breaks around the knee :
Patella Fracture - - Posted by KATRN (KATRN), 11 July 2004
Need some advise from the fellow patella fracture people out there. I fracture my patella in January and three surgeries later and about 45 days of physical therapy I am only bending at 84 degrees. My doctor has referred me to another physician fearing that I have alot of scar tissue and that is what is limiting my range of motion. My therapist has worked hard to try everything to get it to bend with no success. I am afraid another surgery may be in store and to tell you the truth I am not sure if I can handle another one. This will be my fourth one in a six month period. Any words of advise for me?
Thanks for listening.
Kathi
Posted by lizl (lizl), 11 July 2004
I never got beyond 90 to 95 degress until I had my hardware removed around the 11-month mark.
Do you still have hardware?
LizL
Posted by KATRN (KATRN), 12 July 2004
Lizl,
I had my hardware removed on 5/26. I thought that was the reason I was having problems with the bend that is why I had it removed plus I was having alot of pain with it. That is why I can't figure out while I still can't get beyond 84 degrees.
Kathi
Posted by lizl (lizl), 13 July 2004
Kathi,
I returned to physical therapy after my hardware removal, and that's when I began to make progress.
I also had some meniscus damage that was addressed during the second surgery. That damage, however, would not have even been found if I had not had an MRI prior to the surgery.
LizL
Posted by mrmk1111 (mrmk1111), 14 August 2004
I am 7 weeks since patella fracture my range is 75% been to thearpy 2 times as of thursday the swelling is awful . Therapist says the wire will need to come out.what newsl lol!!! the first vist is was 42cm, the 2 day of thearpy it was 45.5 cm of course it was raining my luck .the thing aches too so keep it up and keep ice close by I wish I could be more positive but I too am lost when it comes to knees,
Posted by mrmk1111 (mrmk1111), 25 August 2004
ok guys first the swelling is down to 44 cent.and now with a lot of pain I can bend it to 90 deg. My therapist is really good .. !!! and w/c has made my doc mad he has told them I could not return to work untill jan.21 if all goes well.. Only thing, they found that out and they told me at work ! Wait I thought I was the one who got hurt how did they find this out first
is that normal employer knows more of my health than I do My knee is now woobley 
and it is popping too that hurts okay good luck till next time ,, god bless you mike
Posted by lizl (lizl), 28 August 2004
Mike,
He who pays the bills gets the info?
Seriously, I wonder if your privacy has been invaded. Are you in US? If so, ask your employer if they have heard of HIPA! There are strict limits as to who can have access to your medical information.
LizL
Posted by KNEECAP (KNEECAP), 13 September 2004
i shattered my knee cap two weeks ago, and im healing well. i think.
i had my staples out one week post surgery. my swelling is 85% down. The question i have is why i have no kicking motion, im not bending my knee, but while in the brace i cannot pick my leg strait up, i have the pulling back motion. (im not sure how to explain, hope you understand) but anyway, i have full feeling and movement in my foot.
hope everyone is healing well
Posted by lizl (lizl), 15 September 2004
KNEECAP,
Welcome to the board.
At only two weeks out, it is not surprising that you cannot move your leg forward from a standing position--backwards is easier, and it's probably good that you are giving it a try.
What has happened is that your quads have been disturbed, and they are trying to take a rest. Sit in a chair with the normal leg bent in normal fashion and tense the upper part of the leg. The muscles that move are the quads. Now, if you straighten out the good leg and do the same tensing motion, you will notice that your kneecap moves upward when you tense (the kneecap is also pressed against the joint). That's why your injured leg doesn't want to tense those quads!
When you are trying to raise your straightened leg, the quads tighten and move in much the same fashion. One of the first exercises you will do in physical therapy is called quad sets, where you simply tense the quadriceps. You will also do straight leg raises from a reclining position. I know it's tough to believe, but the straight leg raises (SLRs) are incredibly difficult to do at first. SLRs are harder to do than simply moving your leg forward from a standing position. Being able to move that leg forward is a good first step, but be sure to check with the doctor before trying to do too much. You don't want to do anything that may disturb the kneecap unless the doc gives the go-ahead.
LizL
Posted by Timo (Timo), 19 September 2004
Hi kneecap..
I was worried about the same thing and I am now six weeks since surgery and still can't do an SLR.
From what I have read on here (thanks lizl) I believe it can take time and patience...good luck.
Posted by EMON (EMON), 24 September 2004
Getting your quads back is a bitch! 
Posted by skd (skd), 24 September 2004
I broke my patella in Feb 2003 and during therapy once I could do an 80% bend on my own, my therapist litterally bent my leg far enough to tear the scar tissue three times a week. After nine weeks of therapy, pain and a lot of cursing I am pleased to say she must have known what she was doing. I have 136 degree bend in that leg today. (That's after I did a repeat hairline fracture of the same patella on vacation this past summer.) I have two screws and eight inches of wire in that knee.
Posted by KNEECAP (KNEECAP), 25 September 2004
im glad to hear that a lot of people have such good recoverys, it will be exactly one month since my accident on the 29th of september. my doctor put me on a brace that keeps my leg locked. i was on crutches for the first 2 weeks and now i can hobble around with my leg straight since your knee cap is not in use while strait.
The worst thing about this break is that its on my right leg and i can't drive. well i can drive, because i drove out the road to get the paper this morning, but my doctor said no.
i figure it is a good idea to listen to everything my doctor tells me to do so i can get a good recovery.
my knee is still somewhat swollen and i wasn't sure if it will be swollen until im completely heeled?(spellcheck) my scar is looking really well and some parts you cant even tell it was cut. it may be because im only 17. im glad to hear replys and i wish everyone the best of luck
Posted by KNEECAP (KNEECAP), 25 September 2004
http://pg.photos.yahoo.com/ph/mrbullwinkle/detail?.dir=e1f3&.dnm=cd07.jpg
this is Me, you can see its messed up, they weren't able to count all of the little pieces
Posted by KATRN (KATRN), 25 September 2004
Micro,
Do you have hardware in your knee? What a photo looks painful just looking at it. I broke my patella on 1/25/04. I am still strugging with my recovery but alot of people have done well. I am still quite stiff and am continuing to work on my bend. I am able to bend about 100 degrees with quite a bit of pain.
katrn
Posted by KATRN (KATRN), 25 September 2004
Fellow patella fracture people out there. I am writing to inform everyone what I have been up to since I started this topic.
I did have yet another surgery on 9/30/04 to remove scar tissue. I am almost a month out and continue to struggle with stiffness and am wondering if the surgery was a good idea. I am going to therapy three days a week. I am able to bend the knee to 100 degree with alot of pain. I am so frustrated and there isn't a day that goes by that I wonder if this nightmare will every end for me.
Any words of encouragement or advise would be appreciated. I am just so frustrated.
Katrn
Posted by HHB (MHB), 25 September 2004
Hi KATRN,
Six mos. out from fractured patella ORIF, this knee seems to be doing okay.
You mentioned you had scar tissure removal surgery about a month ago. What rehab regimen was attached to it? From what I read here on the Soft Tissue Healing Problems forum, (search for scar tissue, lysis of adhesions, and some of the most informative posts made by poster Heather M), the ROM outcome after surgery seems to vary with rehab methods used.
Some folks who post on that forum are genetically predisposed to produce massive amounts of scar tissue (arthrofibrosis). Also, posters there emphasize that overproduction of scar tissue can occur after multiple surgeries performed within a short time period.
Anyway, the successful rehab they describe involves taking great care NOT to aggravate the knee into producing more heat/inflammation -- i.e., no strength-building stuff until ROM is accomplished by gentle means -- it sounds like slow going, but it seems to work well for many who have suffered with the situation for even a long time.
Check it out if you haven't already exhausted those resources, and best of luck in your recovery.
MHB
Posted by KATRN (KATRN), 26 September 2004
MHB,
Thanks so much for the advise I will be heading over to that topic next. I just thought that this last surgery would be the answer to my prayers.
I will keep you posted.
KATRN
Posted by KNEECAP (KNEECAP), 26 September 2004
The top half of my knee was broke in about 3 places and my doctor was able to place a screw through all three pieces, the bottom half was a bunch of mush and it is bound together with wire. I asked him if i would ever have the hardware removed and he said it would prolly be best to keep it in, but if it gave me trouble then we would look into that. I have been in no pain for the past 2 weeks.
i go to the doc in 4 days and that will be a little over 4 weeks. id love to hear him say i can start PT. or just let me drive. i read that someone was bending at 5 weeks, so i may be lucky but im doubting it, the doc seems to be extra cautious so its probably best.
im glad i wasn't placed in a hard cast, because this immobilizer i am on is hot enough. i can take it off and fan it down if it gets hot though.
i went to a football game last night and the game was so good that everyone was standing up. so i was forced to stand the whole time. my swelling reduced in like half. welll maybe not half but it was a good portion.
Posted by KNEECAP (KNEECAP), 26 November 2004
im like 983795493 better than i was a month ago
Posted by VLewis (VLewis), 29 December 2004
I am 3 weeks postop from my fracture and just found this discussion group today. I fell on 12/3 and fractured my kneecap. The OS removed the bottom fragments and attached my tendons to the remaining part.
From what I have read, my recovery seems to be going well. I can walk with a cane, drive and have returned to work. My biggest concern is how hard and swollen the repaired knee seems. It is not causing me much pain, but it is just so big compared to my other knee. Is this common?
I also have developed a skin rash, which I think was caused by my pain pills, Lortab. I stopped taking them on 12/24, but the rash continues.
Posted by kgrosskurth (Kathy G), 10 January 2005
Hi VLewis and welcome to KneeGeeks!
Swelling is common with these types of injuries, but it becomes less and less with time and healing (a lot of it is soft tissue damage and edema). It tends to limit mobility at times. Be sure to elevate and ice it frequently to keep the swelling at a minimum.
Again, welcome - I hope you enjoy posting with us!
Posted by peteymouse (peteymouse), 10 January 2005
Hi,
I posted yesterday but I was in the wrong section. A nice person directed me to here. 
I broke my patella 12/13/04 on my icey minnesota steps. I had my hip replaced in 2001 on the same side(left) and that was a 6 mo ordeal. I was wondering how long of a recovery period this is? Its been 4 weeks now and when my brace is off, my leg still feels like a loose noodle. Even with doing the squeezing exercises off and on all day. I go back to Doc on the 19th of Jan. I don't have alot of pain, mostly the incision discomfort. How long out of work have some of you been? I'm a social worker so I do some sitting but some walking, kinda half and half. I would be able to drive since its my left knee, but keeping it straight out, I don't fit in the front seat!! 
So I sit reclined in the back seat while my husband drives me. 
I need to make some plans for more time off if that is what is typical. Any advice or ideas?
Thanks!!
Patty
Posted by VLewis (VLewis), 11 January 2005
Lots of parallels between your situation and mine. I also have a hip replacement on the same leg with the broken kneecap. My first concern when I fell was that I had mess up the hip, but so far it appears to be working fine.
I was out of work for two weeks after my surgery. I can drive with the seat all the way back. I have to back over the console to get my left leg in but once it is I have had no problems driving.
Most of my work is sitting at a desk and I elevate my leg about half the time, but I still get a lot of swelling below the knee . My wife massages the swelling in the evening and that is pure bliss.
When I am out of the house, I wear the full leg brace put on after my surgery. When I am at home and for sleeping, I replace it with a knee immobilizer that I bought at a medical supply store. It is not nearly as confining and infinitely better to wear to bed.
Posted by peteymouse (peteymouse), 11 January 2005
Thanks for the reply! Oh, I had to chuckle when you made the statement of seeing if your hip was ok! I did the same thing. My husband came running up to me and all I said was don't touch me, I need a minute. First thing I did was move my hips around to be sure I was completely attached! Thank God I was. So I tell myself things could be alot worse!! My problem with the car is I have an small SUV and I'm really short so if you put the car seat all the way back to accommodate my leg I can't reach the peddles with my other one! I'm glad to hear that you went back to work so quickly! Are you in therapy? Are they bending your knee at all? Before I left the hospital the therapy dept had me climb stairs and showed me little exercises, but nothing to wild yet. I run out of vac and sick leave on the 30th of Jan, so that is why I'm trying to decide what is the best to do. I know I will need to go to therapy once he lets me get rid of this brace! So I will need to make time for that also. Thanks again for your response.
Posted by VLewis (VLewis), 11 January 2005
My surgeon does not want me to bend my knee at all until he checks it, which will be January 28, 7 weeks post-op. If everything is OK, he will start me in therapy.
I wear my full-leg brace or knee immobilizer all the time, even in bed. To date, that is the worst part of the accident. It will be worth it, however, if my knee works OK after the brace is off.
Posted by peteymouse (peteymouse), 13 January 2005
Yes I agree there. I'm having alot of trouble with my brace. I suppose my leg was so swollen when they put it on, and now its shrunk to half the size. The velcro I've got doubled up and have made it as small as I possibly can. I got an old pair of my husband suspenders and clip it during the day so I'm not fighting it 24/7. Looks goofy, but what the heck, it works! If he says I need to continue wearing it, I'm definitely asking for a smaller one! or one like you bought. Is it the elastic kind that slides on over your knee? ( We live up here in Northern Minnesota in the woods and it would be a trip to the nearest orthopedic store!) The one nice thing about this whole ordeal is I don't miss going outside! Its gonna get 11 below 0 today for a high and only going to get colder as the weekend approaches. Friday night -37 or more. Yuck!!
Posted by VLewis (VLewis), 13 January 2005
My immobilizer is not elastic. It has two metal rods down the back fitted into an adjustable, padded brace about two feet long. one foot above and below a cut out for the knee. There are four straps that fasten with adjustable velcro squares.
If you are not to bend your knee, I would avoid an elastic brace. I don't think such a brace would prevent bending.
Posted by peteymouse (peteymouse), 13 January 2005
Oh I see. The one you described is the kind I have already. My legs are short so it runs from my hip to my ankle. It has the metal rods running down the sides and back. You had mentioned you purchased a different one to wear at home. The immobilizer. Is that just a smaller version of the brace? I guess thats the one I was thinking before. I thought maybe they made an immobilizer that could slip on but still have the metal in the knee area. I walk quite abit at work and the one I have now I wouldn't be able to make it from side of the building to the other without it being down around my ankle! (without my suspenders that is.)
Posted by lizl (lizl), 18 January 2005
Hi, Petey and V!
Both the brace and the immobilizer usually strap on. When you graduate to a brace, you will probably get one that is hinged to allow increasing amounts of ROM. Until you are ready to bend a bit, you will be in the immobilizer.
LizL
Posted by peteymouse (peteymouse), 20 January 2005
Well I'm back with an update. (5 weeks post-opp) I went to the Doc yesterday morning and he said my knee cap is healing great. I will need to remove the wires, but not until it bothers me. He set me up for therapy and told me to throw the brace away all day. Use it only at night to sleep and when I go outside. I've been practicing with the exercises the therapist gave me yesterday. I'm sitting here with my leg bent all the way to the floor. Anything beyond that is unbearable at this point. But I never dreamed it would be all the way down in one day! Yaay! I have along road ahead I'm sure. I still cannot lift my leg up. Its like its not attached to my body. Therapist is going to hook me up to somekind of electric stimulator tomarrow. Just thought I'd let you know. I can't go back to work for 6 weeks. He wants me to do intensive therapy first. I also have to massage the incision with lotion to soften the tissue. This helps in bending. And the quad tightening is major important. I'm to do them all day long on and off. I'm back to walking with the walker for stability as my leg was really wobbley without the brace. Doc said this won't take long to feel in control again.
Posted by HHB (MHB), 21 January 2005
Hooray, Peteymouse -- sounds like you and your knee are doing great! I agree with your doc -- won't be long until you feel steady again, and your muscles and bend are back, all of that. Your exercises and your attitude, along with a little bit of luck, are exactly what it takes.
Congrats and best wishes for a complete and comfortable recovery.
Take care -- MHB
Posted by kgrosskurth (Kathy G), 23 January 2005
Thanks for the update, Peteymouse - with your persistence, you will get through this if you don't give up!!
Updated Mon Oct 6 2008