Transverse Patella Fracture

[Linwight]

Tuesday morning I fell and fractured my patella. I didn't get to A&E until Wednesday morning when I was totally unable to perform a leg lift. An x-ray confirmed a transverse fracture. I have a groin to ankle plaster for the next 6 weeks, and been told not to weight bear and to rest for at least two weeks. Another xray is due in one week and have been told that if the fracture is wider, they will operate to pin the cap together.

The plaster has already become loose and my foot swells whenever my leg is not elevated, so I'm intending to return to A&E tomorrow.

Can anyone reassure me that I'm getting the right treatment??? I'm 58 but fairly fit and very active and would like to return to full fitness as soon as possible.

[wanttorun]

Yes I think this sounds about what you should expect.  I am a little surprised they put you in a cast rather than a brace.  I am guessing your fracture was non displaced and not requiring surgery.  By the sounds of it, though it is close to being displaced which is why your surgeon is asking you to rest for 2 weeks.  As difficult as it is, you should do everything you can to rest this knee so that you don't need the surgery.  Some swelling is normal.  The nice thing about having a brace is that you can ice.  Just keep it elevated as best you can.

I've been through this twice now...in a brace from my second surgery now.  It will get better.  Pam

[Linwight]

Yes I think this sounds about what you should expect.  I am a little surprised they put you in a cast rather than a brace.  I am guessing your fracture was non displaced and not requiring surgery.  By the sounds of it, though it is close to being displaced which is why your surgeon is asking you to rest for 2 weeks.  As difficult as it is, you should do everything you can to rest this knee so that you don't need the surgery.  Some swelling is normal.  The nice thing about having a brace is that you can ice.  Just keep it elevated as best you can.

I've been through this twice now...in a brace from my second surgery now.  It will get better.  Pam

Pam = thanks. I know nothing about knees, braces or casts. I'd really appreciate knowing as much as possible as I want to return to normal asap and will do as much as poss to facilitate that.

[Suejs14]

Pam is right on - if you can avoid surgery, you'll be much happier & recover/rehab quicker.  Smart to return to doc when the cast is too tight.  I was also in a full-leg brace (immobilizer) with a displaced fracture (with surgery).  The brace is great since you can open it to scratch itchy spots and it's possible to ice your knee.  Definitely stay off the leg so the fracture 'gap' stays manageable w/o surgery.  It's only a few weeks and you can fully heal.

Good luck and keep us posted.

Sue JS

[Linwight]

Had a follow up appointment today (7 days) seems it's not a transverse fracture but convoluted??? Can anyone explain please? Also the knee cap has moved. The doctor asked how old I was (58...going on 30) before consulting with a colleague then deciding it hadn't moved enough to warrant an operation.
Advice for the next week is more rest and another xray in 7 days!  Can't help wondering if NHS budgets reduce for the over 40's !

In hindsight perhaps I should have suggest yet another cast, as this one is also a bit loose.

Comments welcome.

[Suejs14]

Convoluted?  Perhaps comminuted?  A comminuted fracture is in several pieces, typically with space between the pieces.  A displaced fracture means the pieces are far apart.  If the gaps are particularly narrow, it's possible to get away without surgery because they'll knit.  If the pieces float away from each other (if you use your quads or other muscles much it can cause this to happen - so avoid weight bearing) you may need an ORIF (open reduction, internal fixation . . . surgery to bring the pieces together by screws and wire holding the pieces together).

I'm in the US so haven't a clue about your NHS other than hearing many groans and complaints and the occasional cheer for their coming through for someone.

Good luck, stay sedentary and sane.

Sue JS

[wanttorun]

Is there any way for you to get another opinion on this?  Your doctor should be explaining to you the difference between the different types of fractures.  If I were you, I would do everything I could to avoid the surgery.  BUT, it would be very difficult to go through this period of "rest" and no movement only to discover that you do indeed need the ORIF which would then would require another period of healing and immobilization.  It sounds like you have more than one piece of bone broken but they are close enough together that the hope is they will "move together" on their own.  If you can, see if you can have another OS look at your films.  good luck to you.

[Linwight]

Thanks for your reply - I've only just seen it. My doctor consulted with another person - presumably another consultant, before deciding that surgery isn't necessary at the moment - just hope they're right! So yes, I'm resting, not weight bearing and getting thorough bored. I do get myself around the house - needs must - and now I have a wheelchair on loan, I've been taken out a couple of times in that. It has a leg extension, so the only effort is transferring from resting position, to crutches, to wheelchair.

On a related matter - my sleep is being interrupted every night by the foot on my injured leg twitching. This isn't a little spasm, but quite a substantial movement. Also my hips are giving some pain. I'm lying horizontally and decided a couple of nights ago my leg is more comfortable horizontal and not elevated. Is this foot twitching and hip pain normal?

Really appreciating the knowledge on this forum

[Suejs14]

I found twitching to be normal . . . I think it's because a muscle that is used to "working" and now "resting" gets antsy and has to move.  If you're in an immobilizer, you might want to try toe circles, drawing the letters of the alphabet with your toe and toe pumps (point and flex toe) . . . I found this helped with twitchy feet and with swelling of the foot/ankle.

My hips also hurt from being in the wheelchair all day.  The two things that helped were 1) a large pillow on the seat of the chair (and another under my leg to raise it as well) and 2) reclining in bed with both legs outstretched to read, work on my laptop, etc for a couple of hours in the am.  That way, I wasn't in the chair for so many protracted hours.

Good luck -- keep positive and keep healing.

Sue JS

[Linwight]

Thanks Suejs - appreciate your help - would be good to know I am healing and not just waiting for the doctor to finally decide it needs an operation!

[Linwight]

Had my followup appointment and xray and was told the patella hadn't moved, so come back in 4 weeks for the plaster to come off - fantastic! BUT I was also shown the xray and could see a crack under the patella - the doctor pointed out that when I can bend the knee, this will grate on the bones underneath. I was given no further details but am beginning to really worry about the long term problems which seem likely to arise from this. Any ideas???