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Author Topic: Broken knee Patella and getting cured without surgery  (Read 1690 times)

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Offline Manish

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Broken knee Patella and getting cured without surgery
« on: September 09, 2005, 06:33:55 PM »
Hi ,

I really got amazed to see such a site where you can get answer to all your questions.

I broke my knee Patella on Aug 6, 05, approx 5 weeks back, I went to couple of OS and 2 suggested me for surgery but next 2 finally asked me not to go for surgery, but the time waiting to get appointment for OS was horrible.

Yesterday ( Sep 9) I had my X Ray done again and didnt find much improvement in the broken area, means i could still see the gap in the bones, How much time it generally takes to heal that and doesnt't it need a permanent cast??

And one question which always bothers me is !! When knee cap is broken how can you bend it ? OS and PT have asked to start doing bending exercises.

Thanks in advance,
Manish
« Last Edit: September 09, 2005, 06:41:29 PM by Manish »

Offline three_screws

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Re: Broken knee Patella and getting cured without surgery
« Reply #1 on: September 10, 2005, 05:02:11 AM »
Hey Manish,

                No good about breaking your patella, it's a painful exercise! I am not sure about your situation about whether to have surgery or not it's especially difficult for you as you have two surgeons suggesting each way. I had a hip operation in January in which my pelvis was broken and reshaped. This left gaps in between my bones which have to grow and reunite. It's been 8 months, i haven't been in pain for quite a few months now but the bones so far have not fully unioned. I have talked to my OS about it alot as i have had to have series of x-rays to monitor the progress. The bones are growing but i guess it's just a long process! So the fact that you only broke your patella about a month ago may be promising, you still have plenty of time for the bones to reunite.

If you are stressed about the situation go and see yet another surgeon. Perhaps research their credentials to see what areas they specialise in. You may find a surgeon that has a special interest in breaks of the patella who can help you.
Goodluck with everything, sorry i cannot be of more help.

Pip :)
Bilateral Hip Dysplasia
Closed reduction on hip '85'
Salters Osteotomy on hip '87',
Osgood Schlatters 1996,
Several subluxes- right knee, meninscal cyst 1998,
Full patella dislocation left knee/cracked knee cap,
Arthroscopy on knee *2 '02', '04',
Full Hip Recon (PAO) Jan '05'

Offline bikersmurf

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Re: Broken knee Patella and getting cured without surgery
« Reply #2 on: September 10, 2005, 05:33:36 AM »
:-*
Hello!
I too found this site. I love it. I was not aware alot of people have so many problems with there knees. I was inan accident and had no choice but for suurgery. I had a open patella fracture, and know it's been 15 days I can bend my knee and stand up.I have had 2 pt sessions already. The musle stretching feels good. I have wires to keep mine in. I am not happy about the scar, but happy alot of the pain has gone away. I had a spinal epidrol in stead of general anisastia. I liked it much better cause they give you something to sleep and not all the other that goes along with operations. If doctors are are giving you different choices, ask yourself which way you think is best. Ask them which option will cause less arthrightis and will save you more proceccedures in the long run. I find its easy to bend it, but to pick my leg straight up right know  is very hard.It's wise to explore all choices then decide what you want, don't let dos bully you onto any thing. I have a knee stablizer no cast. you can take it off at times when sitting with leg out. I hope I gave you some ideas..
Motorcycle accident(open patella shattered)
8-05 reconstruction surgery wires pins, crown and figure eight , FEb 06, had bad fall and damaged knee and hardware. May 5 06 op to remove hardware and repair tissue, quad and nerve damage. Recovering!!

Offline amy1

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Re: Broken knee Patella and getting cured without surgery
« Reply #3 on: September 10, 2005, 06:18:43 AM »
It depends on the type and location of the break. About seven years ago, I tripped onto a cement floor.  I was carrying things and couldn't get my hands out in time to break the fall so I landed right on my knee cap very hard.  I knew that I had really done some damage. I couldn't walk on the leg and used some crutches we had lying around the house until I saw the ortho the next day. I had a spiral fracture.  It looks kind of like when you slam a hard boild egg on the counter.  There are lots and lots of spiral fractures in the area and the entire area kind of indents in a bit.  In my case, the doctor saw no loose fragments so he put me in an imobilizer to be used whenever I walked. If I was just sitting, or laying on the couch, he told me not to use the imobizlier to the joint doesn't stiffen up and the quads donlt atrophy. Repeat films two weeks later showed that there were still no loose fragments.  After about four or five weeks, when enough healing had taken place, I graduated to a hinged knee brace and then finally to a knee brace without hinges.  After about 8 weeks, I was able to walk without any brace at all.  I felt fine and did not require physical therapy.  Of course last year, I needed a partial lateral meniscus removal and microfracture which were separate from the fracture.
6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week

Offline Manish

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Re: Broken knee Patella and getting cured without surgery
« Reply #4 on: September 11, 2005, 07:11:48 AM »
Thanks a lot for your responses.

My doc had decided not to have surgery and he's a Knee specialist at Institue of Sports Medicine, here in MN.

I guess i didn't move my leg for quite some time (almost a month), so thats why my knee has become stiff... I am doing some exercises suggested by my PT since yesterday. I am doing them myself at home, my insurance doesn't cover PT.

I have also started walking (using crutches and with immobiliser on). I feel scared that I'll hurt myself without the immobiliesr.. I feel my leg doesn't have enough strenghth left..

Any suggestions for a fast recovery?? Am tired of sitting at home all day :((

Did any of you guys take calcium tablets or any special diet for faster building of bones ??

Thanks,
Manish.

Offline bikersmurf

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Re: Broken knee Patella and getting cured without surgery
« Reply #5 on: September 14, 2005, 04:07:52 AM »
 :-*
Hey!
Glad no surgery, you can take baths in hotest water you can stand and it will losen up muscles. I do my knee pressing in there, (knee press is leg straight out and push knee into bottom of tub.) Also with brace on lay leg out on bed, couch and move foot forward and back, this will help with quads also. lying flat out and doing half sit ups will pull on leg muscles. There are alot of things you can do. I know the fear when they took my brace off only 8 days after surgery and to my surprize my knee felt better after being able to be move it from being straight. Your fears are valid, but you have the power to do it. B.S.
Motorcycle accident(open patella shattered)
8-05 reconstruction surgery wires pins, crown and figure eight , FEb 06, had bad fall and damaged knee and hardware. May 5 06 op to remove hardware and repair tissue, quad and nerve damage. Recovering!!

Offline Heather M.

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Re: Broken knee Patella and getting cured without surgery
« Reply #6 on: September 14, 2005, 09:50:53 AM »
I would appeal the decision of your insurance company to refuse to cover PT.  Ask them if they want to cover future operative procedures to remove a bunch of scar tissue that formed because you didn't get proper mobilization and PT after your injury!!  Seriously, it is very common to have a stiff knee and to have trouble bending it after such a serious fracture.  Some people get past it with gentle and persistent PT...and lots of patients.  Others require surgical intervention to remove all the scar tissue that can gather in the joint.  The best you can do is get clear instructions from your doctor on what exercises you can do and do them religiously.  And ask him/her to write a letter to your insurance and strongly recommend PT.  You have to make an economic argument in some cases.  In other cases, it's as simple as calling the insurance company and appealing the decision--my company in particular has this policy of declining charges and refusing coverage for the first and even second request.  Then it mysteriously approves things the third time they are submitted.  It's infuriating, and it wastes my time, but there you have it.  It's worthwhile to persevere and NOT TAKE NO FOR AN ANSWER.  Remember, your goal is to get better.  The insurance company's goal is to make money, and they do this by taking your money and then paying as little as possible in the way of benefits.  You can't take this lying down, so to speak  ;)  Make a pest of yourself.  Read the benefits coverage, then read up on the appeals process.  Never speak to the first person who answers the 800 number at the insurance company's customer service line--always ask to speak to a manager or caseworker who has decision making abilities with respect to your coverage--otherwise you are wasting your time.  Follow up phone conversations with an email or fax sent to the person you've talked to--kind of like a 'memo of understanding' reiterating what you spoke about on the phone and what the conclusions were--especially when you are waiting for something from them.

You may also want to bite the bullet and arrange for one or two PT sessions on your own--pay out of pocket.  Be sure to call around to a few clinics and see if any offer a 'cash discount' for uninsured patients (which essentially is what you are if they company won't pay for your PT sessions).  Some places do offer discounts when you pay with cash or credit card on the day of your session.  You can get an evaluation and a series of specific exercise with guidelines and detailed instructions for how to carry on in your own home.  Then, you can go back a few weeks or a month later and check your progress--then get more exercises.  This is well worth it.  Be sure to cut the services to the bone when you go to these sessions--some PT places charge you in 15 minute increments for the therapist's time--make sure that you are the ONLY patient the PT handles in this time!  At least half the clinics I went to did this as a courtesy to cash patients.  Also, ditch the warm-up on the bike, heating pads, e-stim, and ice while you are there (you can do some of this at home prior to your session) as these clinics will charge you for this stuff!!  Seriously, it took me three sessions to figure out they were charging $45 for 15 minutes of 'cryo-therapy' which is putting an ice pack on the knee.  Same for hot packs to warm up the muscles--you can just as easily do some gentle range of motion stuff in the waiting room or even use a heating pad on the knee immediately prior to going to PT (of course heat isn't appropriate for all injuries, I'm just giving an example).  Many  insurance companies will buy a TENS or e-stim unit outright if the doctor prescribes its use for more than a month, because it's cheaper to buy the unit than to keep paying a PT clinic to slap electrodes on you, or to rent you one of their units for home use.

Anyway, these are a few examples of ways to get into PT for minimal out of pocket costs.  You could even do this while appealing your insurance company's policy.  Your doctor or his/her PA can be very helpful in the process of arguing against certain short-sighted insurance policies, so talk to him/her about helping.  And talk to others with this problem.  There is a bulletin board section for 'bone breaks around the knee' on the main bb page, so be sure to check it out.  Another web site that others have highly recommended is http://www.mybrokenleg.com  You might want to check it out and talk to others that had non-surgical treatment for their patella fractures.  And use the 'search' feature on this web page to look up posts from others with an injury like yours.  The search box is near the top left corner of each page on the bulletin board.  Just type 'patella fracture' in the box and click search, or consider doing a more refined search using the 'advanced' feature.  I'm sure there are FAQ's explaining how to best do an advanced search--it's not that hard, once you figure out how to limit the sections where you want to search for the keywords you're interested in.

Good luck and keep us posted.  I think the key with your type of injury is patients and gentle, non-weight-bearing mobilization of the joint.  Regaining as much range of motion as possible with as little trauma (swelling and pain) as possible.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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