The SPECIALIST'S OFFICE => Bone breaks around the knee => Topic started by: abberger on March 07, 2013, 12:34:19 AM

Title: So discouraged after transverse patellar fracture...please respond!
Post by: abberger on March 07, 2013, 12:34:19 AM
I fractured my  patella on 1/23/13 and had ORIF on 1/28. I am a very active 33 yr old who was training for my 2nd half marathon when I fell and tripped. My surgeon didn't feel I would  need official PT, just told me exercises to try at home. However, I was unable to do a straight leg raise, so started physical therapy last week. They have  been doing electrical stimulation and I ordered a machine so I can do it at home as well. I am in a knee immobilzer and still using crutches. Is this normal? Once I can do straight leg raises, will I then progress quickly? I am so tired of not being able to drive!! I don't see my doctor again until the 28th. Wouldn't they normally do an x-ray around 6 weeks to see if it has healed. I just don't seem to be getting many answers. I don't want to push myself too hard, but want to do whatever I can do get these muscles stronger. Also, I tried sleeping without the immobilizer for the 1st time last night, but it ached so bad after 3hrs, I put the immobilizer back on. Is this normal? I really appreciate any help!!
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: lostpirate on March 07, 2013, 06:15:06 PM
Hey abberger!

You came to the right place to get answers!

Starting with physical therapy. Yes! You need this! You also need a physical therapist who is experienced with knee injuries. For you, since you are a runner, I'd highly recommend seeing a sports therapist. They work with athletes and will be able to tailor a program to get you back in action as quick as possible. Any OS that tells you that you can do it on your own, at home, without a therapist is straight up full of crap! I'm speaking from personal experience on this one. My 1st OS prescribed PT for me. The therapist I got was inexperienced with knee injuries and really didn't know what she was doing. I think I may have been her 1st broken patella case. After seeing her for a month or so one of my pins slipped. When this happened my OS removed the pin and took me out of PT until all my hardware could be removed. At 6 months the rest of my HW was removed and he told me I didn't need to see my therapist anymore. He said I could do the exercises on my own at home. What a nightmare that was. After over a year of doing things on my own I was no where near to being fully recovered. A friend of mine recommended getting a 2nd opinion and recommended a good OS. I went to him and he immediately put me back in therapy with a sports therapist who was very experienced with knee injuries. A lot of therapists want to get you back to "functional". Functional basically means having 120 degrees of range of motion (ROM), being able to walk at a normal pace and handle steps and slopes normally. Basically it means being able to live a normal life again. Being able to run and participate in sports isn't all that important to them. A sports therapist wants to take you back to functional and then beyond. He wants to get you all the way back to being able to do everything you did before your injury. What a difference that makes! Within 3 months of seeing him, he had me jogging again and within 6 months he had my leg strength back to close to 100% of what it was before my injury.

This injury takes a long time to come back from. If you're lucky and have no set backs then maybe you will be fully recovered in a year. Many people take longer, and some never get back to 100%. With all my set backs it took me about 3 and 1/2 years to get back to "normal".

As for using crutches. That varies from OS to OS. Some will want you to use them for 4-6 weeks. Others will tell you to go weight bearing in your immobilizer as soon as you can tolerate it. That's know as weight bearing as tolerated (WBAT). My OS told me to go WBAT as soon as I could. I used 2 crutches for only a couple of weeks. I used 1 for maybe another week and then I used none and walked in my immobilizer. The patella is a non weight bearing bone. Meaning there is no load on it when it is locked out straight. It bears no weight then. It's only when your leg is bent that it bears weight. As long as you are in your immobilizer walking on it you should be fine.

Being able to do leg raises is the 1st thing they try to get you doing. It's the 1st of many steps in your PT and the beginning to that long road back to normal. As for how quickly you will progress? That's hard to say. That are a lot of variables with that. Severity of the injury, age, how well the knee heals, etc. are come into play here. But perhaps the biggest variable is how hard you are willing to push yourself and how much time and effort you are willing to put into doing the exercises your therapist tells you too on your own at home. A therapist is basically a coach. He gives you exercises to do, has you do them with him in his office, then has you do them at home on your own. He can tell you what to do, but he can't make you do it. People who are willing to work hard at home and who are willing to push through the pain (There is a lot of pain getting your ROM back) recover faster.

At 4-6 weeks they normally do take an X-ray. That X-ray will show if the bone has begun to heal or not. At 4-6 weeks the bone normally has healed to about 80%. At that point they usually get you into therapy. At 6 months to a year your OS will probably want to take your HW out.

As for sleeping. Sleeping in an immobilizer isn't easy! Many of us have had problems with that! I don't think I got much more then 2 hours of sleep a night while I was in mine. It wasn't until my OS gave me the OK to take it off (4 weeks for me) that I was able to get some decent sleep again.

Good luck!
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: 121212 on March 07, 2013, 07:18:34 PM
Dear abberger,

Lost Pirate is spot-on with his overview.  He has helped a lot of us by sharing his experiences.

I had what I think was the same sort of fracture as you this past December and have been amazed how completely hopeless I felt one month and how much progress I had made by the next.  If you have the time (LOL) you may want to go on the "Fractured Patella recovery time" thread on this site and read other people's experiences.  It helped me a lot to see the within-normal-limits boundaries of recovery from this injury.

Did you have an x-ray @ 4-6 weeks?  Did it show bone healing?  I had xrays at least every 2 weeks after the ORIF until 2 months after the break, then once a month, now going back in 2 months.  You need to know about bone healing before you do anything else. 

Like Lost Pirate, I was released from the immobilizer @ 4 weeks.  The first time my OS tried to bend my knee I thought I'd die.  I kept the immobilizer on except when @pt.  But knowing the bone was healing made me feel safer about experimenting with bend on my own.  Between that and pt, things did get better.  (BTW, I quit using crutches way before that.  Within two weeks of surgery I found walking in the immobilizer and holding onto furniture or walls as needed was easier.  I used a walker outside.)  Sleeping is difficult for a long time --even once out of the immobilizer.  I have a lot of muscle pain (I think) and the skin behind my knee and parts of my calf are still discolored from the bone bleed.  (ugh.)

Seems like the 28th is to long to wait for xray.  I would call your surgeon and get some answers.  It does get better!

Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: lostpirate on March 08, 2013, 06:01:24 PM

That "Fractured Patella Recovery Time" thread has been around a long time. Almost 4 years. There is a wealth of information there! I believe it's the thread I made my very 1st post to too. I went back and looked at it again and found that I have made a lot of posts to that thread over the years!

It's was kinda fun and cathartic for me to go back and read the things I wrote back then while I was going through my stages of recovering from this injury. One thing about this injury. It is a long road back, but the further down that road you get the less and less you think about your knee. When you get all the down it and reach that light on the other end of the tunnel you tend not to think much about what you went through to get there. You are just happy, and thankful that you made it there! All you want to do is get back to your normal life and do the things you want to again. That phase of your life where you went through your injury becomes a distant memory. It's kinda like a bad dream. You remember that it happened, but you really don't want to think about it anymore. As time has gone by for me I have had a hard time remembering exactly how long it took for me to reach the various stages of my recovery. Something that I thought now took about 6 weeks or so I found out once I read my old posts took more like 4 weeks. Those time lines get blurred as the years go by. It's also hard for me to remember some of the exercises I did through the various phases and also when started doing them. When exactly did I start with one leg squats, etc? All those things I have a hard time remembering now are all here, buried in these threads somewhere. And a lot of it is in that one! Reading it again certainly jogged my memory and helped me remember some things!

121212 is right. If you have the time go and read that thread it will help answer a lot of questions for you.
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: abberger on March 12, 2013, 06:35:27 PM
Thank you all so much for responding. Today was my 6th day at PT. I still can't do a straight leg raise, so very frustrated. I've been working so hard at home on exercises. I notice a little more strength. My appt w/ OS actually got bumped up to next week, so that makes me feel better. This is just taking more time than the OS or myself anticipated. I will mention seeing a sports therapist instead at my visit. Thanks again for your input!
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: lostpirate on March 12, 2013, 10:34:27 PM
One of the best exercises to do to gain strength to do that SLR (single leg raise) is to sit on your bed with your leg lying flat. Place a pillow or rolled up towel underneath it and push your knee down into the the pillow. This begins to strengthen the VMO muscle. It's a pesky little muscle, but all things in therapy begin and end with it. When you do this exercise you will notice that all the muscles around your knee cap tense. When attempting the SLR 1st do that. When all those muscles around your knee are tense, like in that exercise, then, while keeping those muscles tense, do the SLR. It works a lot easier that way!
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: Sampson19511 on May 17, 2018, 04:14:07 PM
I know these posts are old but you need to be patient, I am 14 months out of ORIF patella fracture with screws and wires.  I am going to get second opinion from a more experienced ortho surgeon.  My muscles have not responded to any PT or my exercising at home (which I have been doing all my life anyway).  I have tried everything.  Granted some of these patella fractures and trauma cause arthritis and other problems so you need to be sure what you are dealing with. There is apparently nerve damage during these types of falls (fractures of knee) and some nerve do not come back, therefore the nerves do not tell the muscles what to do.  I am also see a neurologist to see if I really have nerve damage.  My surgical leg is 1 to 1.5 inches smaller in circumference than my good leg and the muscles are NOT coming back after 13 months of exercising religiously.  So, do not take things for granted, get another opinion.  The surgeons do not tell you any of this and they also don't even know why this happens to some people.  S :(
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: Sampson19511 on May 11, 2019, 12:36:37 AM
SECOND UPDATED 11/2019:  Hi.  This is another follow up.  I am 2.5 years post screw and wire repair of broken knee cap.  I have always worked out, over 46 years now.  Of late I am stronger than last two years as far as broken knee.  As a last resort to get even "better", I decided to hire a trainer who was also once a PT.  I can do most things however, my patella still does not seem to stay aligned and pain goes up into my hip. I was worried about hurting my hip.  This trainer told me my surgical leg is actually stronger than my nonsurgical leg due to "proprioception" (which is the sense of knowing where a body part is in space at any one time).  I actually was not working out correctly or even walking correctly sometimes.  I would suggest to anyone having trouble after orif patella fracture to try a trainer who knows what they are doing.  I had been to three PTs and three surgeons with no good suggestions or outcomes.  This trainer seems to know more than all of them put together.  It takes patience and understanding of your body to recover completely or almost completely from this type of fracture.  Be patient and keep researching and learning.  S 

THIS IS JUST AN UPDATE:  ORIF transverse fracture of patella, wires and screws.  Well it's over two years since surgery.  I wanted to report that I am stronger and doing most activities.  My surgical leg is still smaller in circumference than my good leg.  I think I am left with arthritis and certainly a bit of pain daily.  My knee cracks and pops alot since recovery.  As mentioned in the past, I have worked out religiously for 46 years.  I am healthy and strong at age 67.  I mow with a walk behind on hills.  I have a large yard so I broke down and purchased a rider this past summer.  Surgeon said without an arthroscope examination you really can't tell if there is anything else that can be done to make you better.  He did not think taking out hardware would help, but I may do this.  I am not sure if I have arthritis, protruding meniscus or something else. My knee is still a bit numb and larger than the good leg.  Guess I am about 90% after two years.  Sideways moves are hard or impossible.  I do not do full squats anymore and no lunges.  I can hike up and down a mountain (6 miles yesterday) with only some stiffness and slightly more pain.  I workout carefully (joined a gym again to use machines (was working out only at home for a while).  I make sure I exercise all muscle groups as if I don't I feel that my patella is pulled in wrong direction. I also have a DVD of stretching for healthy knees and it seems to help when I am stiff.  So.... keep up the good work and keep exercising.  Don't baby yourself and certainly give it time, lots of recovery time.  S
Title: Re: So discouraged after transverse patellar fracture...please respond!
Post by: Sampson19511 on February 10, 2020, 02:54:11 PM
Hello everyone with patella fracture surgery recovery issues.  Thought I would do an update (my injury was 4/2/17, almost 3 years ago).  I am post op ORIF transverse patella fracture with wires and screws.  Still have hardware but may have it removed soon.  I am small but strong, still not much muscle size recovery at all.  I have pain almost nightly while sleeping.  Sometimes my entire leg hurts from hip to my shin and I have to get up and move around.  Other times I have pain just from my knee to my shin front and outside. Other times just the knee.  I know I have arthritis and probably meniscal damage.  Meloxicam has helped.  I find rubbing the IT band helps sometimes either with my hands or a roller.  I do stretches just for knee health which help.  I find my patella changes position when it wants to.  I am wondering if I have peripheral neuropathy (although I do not have all the symptoms, ie foot drop or inability to walk).  There is almost nothing on the internet about peripheral neuropathy after ORIF patella fracture. When you do find an article witten by the experts they deem peripheral neuropathy as a rare occurrence! I am not dumb, been in medical field entire life.  Worked with a trainer and  pain seemed to get worse. Thought about having nerve conduction studies, but problem probably can't be fixed anyway.  I guess I should not complain since I have no other health problems.  I am still active, workout at home and at the gym (all my life), do short hilly hikes, snow ski, etc.  Just live with the pain and I guess.  Thanks.