Diary of Scott's right patella fracture recovery

[sabasc3]

Hi everyone, I figured I'd join the diary writing club, so I can provide more detail than my signature allows.

09.09.09
Fell and broke kneecap on sidewalk - lateral displaced fracture of the right patella into two pieces.
My daughter's friend's mother recognized me as she was driving by and with the help of a kindly passerby and a shop clerk, carefully loaded me into her minivan.
At Urgent Care clinic, received morphine shot and had x-rays.  Attending OS reviewed x-rays and confirmed diagnosis of triage MD.  Fitted with immobilizer and discharged.

09.11.09
Appointment with attending OS,  He was really great at answering my questions.  He arranged to perform my surgery on 09.18.09.

09.18.09
Admitted to hospital for surgery: 2 pins 2 wires, small fix to (right?) retinaculum

09.19.09
Hospital stay -- OS visited and said repair went very well, and that my patella cartilage felt smooth and continuous when he palpated it.
Great bedside manner

09.20.09
OS visited again and gave my discharge instructions.  He also helped me change the dressing on my incision as it seemed a bit tight and I couldn't feel my right foot. 
Hospital discharge

09.21.09
Feeling in right foot is restoring.

09.28.09
Feeling in foot is almost completely restored.
First post-op OS visit:
- staples out
- fitted for brace, w/ROM set to 40
- Rx for PT 12 weeks, 2 times a week.

09.29.09
Scheduled my 12 weeks PT.
First PT appointment w/ice&TENS target ROM 30
My primary physical therapist is very gentle and careful. 
I will visit her and another PT who will fill in when my primary PT is unavailable.

10.05.09
Feeling in foot is back to normal. 
Observed redness at the last inch or so at the thigh-end of the incision; I suspected minor infection & made appointment to see OS later the same day.
Tried to go to work.  Not too painful at first but very achy and fatigued at end of the day.  Got green light from manager to apply for short term disability.
Second post-op OS visit:
Redness was due to rubbing of the brace, not infection -- whew
OS observed my ROM and updated target ROM to 50

10.06.09
Got my own portable battery powered TENS unit (also does EMS).  Name of the unit is "Twin Stim".

10.07.09
PT appointment - the other PT got 63 ROM, with no pain, just tighness!

10.16.09 - 4 weeks after surgery.  Knee is much stronger.  I can contract my quads with no pain at all.  Looking forward to strength training at the PT clinic on the bike etc.  In the meantime I'm lying on my side and gently using my leg muscles to slowly extend and bend my leg ( pain free ), contracting my quads, doing heel slides, and RICE (rest, ice, compression, elevation).  Walking with a rollator almost everyday too.

Stay tuned

[sabasc3]

10.19.2009 - just used up the battery that came with my TENS unit.  On to rechargeable NiMH batteries.  Hopefully they'll last at least as long between charges.
10.21.2009 - PT apppointment in the AM.  Expecting PT to try for 60 ROM but I think I already have that ROM now :-).  Next week I should be able to start strength training at PT. 

[sabasc3]

Today's PT session confirmed 60 ROM flexion. 

Rode the bus to and from PT appt. and spent a few hours at playground with daughter.  This walking etc. was good for strength but wore me out.  I was very fatigued around 5 PM.  I put shoes on (running shoes with laces) for the first time since the accident.  That made a big difference in stability and comfort.  I was wearing sandals (simple plastic foam with strap over the metatarsals) at first because they were easy to get on and off.

Sleep: Lunesta worked well for me, I noticed only one minor side effect: slightly altered sense of taste.

Started strength training of hip area and hamstrings at PT office.  Waiting for clearance from OS next week prior to quadriceps strength training. 

[sabasc3]

I just got a great result on X-ray today.  My fracture is barely visible!
OS gave me the green light to start light quad strengthening and to walk in my brace set at 40 degrees flexion. 
That made a BIG difference in my ability to walk smoothly. 
My flexion estimated today by OS is around 80-90 degrees.
My next OS appointment is Nov 23 and he thinks I may be able to come out of the brace then. 

[sabasc3]

Started strength training at PT office Wednesday.
Pain was significant but quite tolerable.  I couldn't lift my straight leg off the table yet, but pretty close.
I got to do some rocking motion on the bike (actually went over the top but then PT advised me to wait until next visit to do more full circle pedaling)

Today I tried lifting my leg at the knee-end of the femur (with my hands) and was able to hold it straight. 
It was kind of painful but I could hold it, so I hope that between more PT visits and my home excercises that soon I'll be lifting without my hands helping. 

x-rays:
09-09-09 - Broken!
09-10-29 - 5 weeks after surgery (pic 1)
09-10-29 - 5 weeks after surgery (pic 2)

[sabasc3]

Woo-hoo!
I finally did a straight leg raise (10 of them actually)!!!
I first tried it with my brace on while standing and made it to 45 degrees or so.
Then I took the brace off and tried it in bed.  It feels a little sore but very doable. 
Previous attempts (at the beginning of the week) would result in a quivering quad and moderate pain. 
I'm so happy to reach this milestone!
Scott

[sabasc3]

Where in the world is Scott?

Hey folks, pardon my extended absence. 
I was laid off at the end of Dec and my family decided to finally act on a plan we've had in mind for quite some time.  Relocate back to New England.  We are now in central Massachusetts, and I have pretty much recovered from my patella fracture except for residual atrophy of the right quad.  I have a surgery date to pull out the hardware (new OS - Dr Paul Pongor in Marlborough) on April 2. 
The hardware makes my right knee warmer to the touch (after a full day's activities) than my left, and there's a persistent pain around the periphery of my patella.  I'm looking forward to getting the pins and wires out. 

My latest two x-rays visits show that I broke the wire where it passes through my quadriceps tendon (imagine a break like this / \ at the midpoint of the uppermost part of the wire in the image below - I don't have a file with the broken wire x-ray). 
09-10-29 - 5 weeks after surgery (pic 2 - front)

Speaking of unemployment - if anyone has any leads on software QA positions in central MA (or toward Boston metro area) please let me know via personal message.

Thanks,

Scott

[jackiek]

Hi Scott,
Glad to hear you've moved to my old stomping ground. Lived in Brookline Ma between 1993-7. Lovely state. Hope you find work there. Plenty of computer businesses so you should be ok.

As regards the injury, I have been off Knee Geeks for some weeks now. Trying to wean myself off obsessing over my knee and getting on with my life. But your email to me sparked my curiousity. Yes my knee is always hot when I have done excess exercise. I have just returned from a trip to Sri Lanka to get over the last six months of pain and no sleep. After a yoga session, it got very hot and the long flight also got it going as well. It still hurts to climb high stairs (think the quad is still too weak and I have got very lazy with exercising) and sometimes the patella gets off-track so there is pain...explained by the VSO ? muscle on the side (can't remember its name). Also sometimes the knee gets quite stiff. But I did an 11 kilometre walk with my walking group a month ago so I am quite proud of myself for that.

I see a OS in about two weeks (last appt three months ago). Here, they don't take out the hardware unless its causing problems. But I guess in your case, its necessary. Anyway best of luck for the next op. Keep us updated.
Jackie

[sabasc3]

Hi folks,
I am going in for ORIF hardware removal tomorrow morning.
I'm searching the 'geeks postings here for clues as to how long people were out of commission after removal of pins and wire from patella.
If you care to reply here, thank you.  I will post excerpts of, or links to, posts I find regarding the subject.
Thanks!
Scott

[sabasc3]

I had a really easy time with my hardware removal so far.
Yesterday, my OS (in Massachusetts) took out the hardware (put in by OS in California).

I had the best experience I've ever had under general anesthesia. 
I received a scopalomine patch http://en.wikipedia.org/wiki/Scopolamine and an oral anti nausea medicine sometimes given to cancer patients, prior to surgery.  I didn't feel the least bit nauseous during recovery at the hospital or after.

I also had a femoral nerve block which helped me stay pain-free until around 24 hours later.
My hardware removal incision is shorter (along the original scar) and covered with a waterproof clear dressing.  I'm delighted to be able to bear weight, do a straight leg raise and move it (albeit with limited ROM while the incision is fresh) and shower with it.

The only unfortunate thing about the femoral nerve block is that it also prevented me from being able to contract my quads until the block wore off.  I absent-mindedly forgot this just long enough to have it buckle under me.  Fortunately I had something to grab onto to break my fall. 

Quads are working fine now. 

I'm hoping my ROM and strength will return fully to pre-op levels and beyond very soon.
 

[sabasc3]

I'm off the pain meds!  Just ICE (Ice Compression Elevation) periodically.  Slept ok last night.
Pain is really mild now, more of a tightness.  I did a slow walk up a flight of stairs with no pain, but not a fully normal gait since I'm still trying to avoid bending beyond about 70-90 degrees while the incision continues to heal.   

[sabasc3]

I forgot to mention that I have stitches instead of staples this time around.  They are the kind that dissolve, so my follow up appointment with OS should just involve checking my incision health, ROM, (lack of) pain etc. 

[grandmalinda]

Have been reading your diary  Scott, and am particularly interested in your hardware removal. I , too, fractured my patella in Sept of 2009.  It was my left one, but that's really beside the point. My OS told me in December, that he absolutely would not remove any hardware until it had been at least a year, so don't even ask. He also told me that if I felt that I needed to have the hardware taken out, to schedule a visit a couple months in advance. To make a long story short,,that time is almost here,,I have some swelling and lumps on my knee, and of course, the constant dull ache, so I am very anxious to try getting the hardware removed. Thank you for posting your experience with this part of the recovery. Wish me luck in trying to convince my OS to do  my surgery a little early.

[Greta]

grandmalinda
If you are experiencing problems with your hardware - persuade them to remove it!
Read my other posts and you will see what I have been through, and how - as LostPirate put it - having it removed is like the difference between night and day.
We are all different, and all OSs are different, but I was making no progress in my ROM, and it had to go. It was scheduled to be removed in February (6 months after it was put in) and even though I am 70, they must have considered the healing had been sufficient. In fact, due to a persistent (UT) infection it wasn't removed until May - 9 months after.
But I've not looked back since - so I hope you can persuade him to remove it
Keep us informed and good luck
Greta

[sabasc3]

...interested in your hardware removal ... trying to convince my OS to do  my surgery a little early.

Hi GrandmaLinda,
Sorry for the delay posting a reply.  I am sooo glad I got the hardware out. 

I healed and continued to increase ROM without any further PT appointments, and now I'm back to my full range of activities, including walking, hustling to keep up with my 6 year old daughter, biking, and swimming.  Climbing stairs, biking and other full flexion activities don't bother my knee anymore.  The swelling's gone too.  As some have observed in their own knees (and my original OS mentioned), my repaired patella is larger than before but not drastically so.   

One interesting artifact: when I press and gently rub my R patella I can feel the tracks where the figure 8 wire was, so I assume bone grew around the hardware (kind of like how a tree grows around a foreign object like a fence -- see below).   

Another artifact I noticed is that the stapled section of my incision has a different scar than the sutured part.  The second OS (hardware removal) closed with dissolving sutures after retracing a part of the original incision closed by staples.  The sutured part left kind of a wide scar, whereas the stapled section left a very narrow scar. 

My OS here in MA was fine with taking the hardware out as long as I didn't do any intense sports (no basketball for example) after he removed the hardware.  Sometimes my post-surgery knee actually feels better than my other knee :-).

Right/Left ROM difference is negligible, with only a bit of tightness in full flexion of R knee.

All in all I am so grateful to have had access to modern medicine to fix this fracture, as I expect I'd be partially crippled without the fix.

Like Greta said, I hope you can get approved for hardware removal! 
Let us know how things go for you, GrandmaLinda!
Scott