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Author Topic: Injury today 3/31 (Easter - Yay!) Comminuted Patella Fracture Serious swelling?  (Read 2952 times)

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Offline rwt0277

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So glad to find this forum/group exists (and then again I'm not :)  )  Today while coaching 8 & under ice hockey I went in for a hockey stop (low speed actually) when my blade stepped on a puck instead of the ice surface. Went knee first into a 90 deg. lip on the boards that meets the ice. Before the swelling I could clearly see a diagonal indentation of my kneecap. That was at 9am.

Wife drove me to urgent care and we got there about 10am. Swelling was pretty bad now and the pain (as you're aware I'm sure) was excruciating. Wonderful for my 4.5 yr. old girl and 2 month old baby to experience. The entire time I was there they never elevated my leg or iced it. They took xrays and determined it's a comminuted patella fracture but said all of the OS's were on vacation the entire week. There is an on-call Dr. but they instead said if I could stand with my leg immobilized & on crutches and manage the pain they'd send me home to wait for a call from the OS in the morning to schedule surgery on Thursday (4 DAYS away). They gave me a script for vicodin and something for nausea. I took a picture of my knee before leaving the hospital at 15:30 and then again at 17:30. The swelling has appeared to double in size!

I called our advise nurse for our healthcare plan and was told the reason they probably sent me home was that a lot of OS's like to wait for the swelling to go down before operating. She advised I call the OS's office to find out about whether or not the swelling is of more concern. Calling them only resulted in being told "we cannot legally advise you - however if you feel it's a serious concern you should go to the ER."

Attached are pictures of the swelling at 15:30 and again at 17:30. For fun I've also attached the xrays. Should I be concerned about staying at home until the morning? I live in the US and they LOVE to bill you anytime you even breathe in their doorway - if I'm going to just wind up going to the ER and SITTING there until the morning anyway I'd rather wait it out at home.

Thoughts?

Offline EdD

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Sorry this happened to you. I don't know very much about patella fractures but I know a lot about ACL's and swelling. My advice would be stay off your knee. Elevate it and make sure it is above you heart. Keep it straight. Ice ice ice. You can do 20 minutes on and  1 hour off  6 times or more a day. See if you can get a cyrocuff. Easier to ice and gives you some compression. I would not have surgery with a knee in this condition. I would want to get all the swelling down and regain my range of motion ("ROM") first. I'm in San Diego. I hope this helps.
1/23/2006 tore the ACL, MCL, meniscus, femoral nerve while  skiing
1/30/2006 ACL reconstruction hamstring graft, meniscus repair at Vail
4/2007 femoral nerve damage diagnosed
8/1/2007 LOA/MUA at Vail "severe arthrofibrosis"

Offline EdD

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 With regard to timing of surgery, I saw one study that said "Surgery was performed on the day of admission in 17 patients, 1 day after admission in 24, and from 2 to 6 days after admission in 22. In 4 patients, surgery was performed 7 days after admission due to medical reasons. Forty-four fractures were treated with modified tension band wiring (Figure 1)"
http://www.healio.com/orthopedics/journals/ortho/%7B1cded17c-0273-4f4a-b472-21baa2a7358f%7D/implant-removal-following-surgical-stabilization-of-patella-fracture
1/23/2006 tore the ACL, MCL, meniscus, femoral nerve while  skiing
1/30/2006 ACL reconstruction hamstring graft, meniscus repair at Vail
4/2007 femoral nerve damage diagnosed
8/1/2007 LOA/MUA at Vail "severe arthrofibrosis"

Offline kimb

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Definitely ice and elevation. Ouch :( I'm not sure I'd try with a compression device like a cryocuff. They are wonderful for a lot of things but I'm not sure compression would be the best idea on a broken bone, plus I imagine it would hurt like the dickens. I am also not so sure that the same "rules" that apply to torn ACLs with regards to surgery would apply to a broken kneecap. I don't think a person can be well expected to be able to regain a normal range of motion when something is actually broken in such a manner. Moving limbs that have broken bones is generally recommended against so that further cracking or breaking does not happen.  Make sure to ask a lot of questions when you get to see someone. What horrible planning to have all all of the surgeons on vacation the same week! That seems pretty unreasonable. Could you go to another provider to see if you can be dealt with sooner, or another branch of the same provider? 
I hope you can rest somewhat comfortably until you have to see the doctor.

Offline EdD

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Right. I agree with Kimb. You should ask a lot of questions especially about the timing of surgery and the condition of your knee.  I also agree that the same "rules" that apply to torn ACLs with regards to surgery may not apply to a broken kneecap. I was not suggesting that you do anything on your own to regain ROM now other than getting the swelling down. I did read that one of the complications of this type of fracture is knee stiffness--arthrofibrosis--which is what I have. It can be caused by blood in the joint and immobilization after surgery. There are a lot of studies concerning the development of arthrofibrosis after knee surgery--especially after ACL surgery. The studies focus on the timing of surgery, swelling, ROM and the condition of the knee. Since knee stiffness is a complication of patella surgery, I would want to know about the pros and cons of immediate surgery. Do you need surgery right away or can you wait until the swelling goes down?  I don't know. Ask the doctor. You may also have blood in the joint from the fracture. Ask about the pros and cons of getting your knee drained. There are studies that say that blood in the joint may lead to stiffness. Since stiffness is a side effect, you should ask about the possibility of moving the joint ASAP after surgery.
I'm not sure if compression or a cryro cuff would cause you pain. Mine had a "hole" around the patella. Gameready also makes one with a hole for the patella as well. Ask your doctor.
1/23/2006 tore the ACL, MCL, meniscus, femoral nerve while  skiing
1/30/2006 ACL reconstruction hamstring graft, meniscus repair at Vail
4/2007 femoral nerve damage diagnosed
8/1/2007 LOA/MUA at Vail "severe arthrofibrosis"

Offline rwt0277

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Saw an OS yesterday who I really like. Seems to have great bedside manner and very knowledgeable about his work. He is going to do hollow screws (at least 4) and use an 18 gauge wire to do the figure 8. He's also going to use a fiber wire to wrap around the patella exterior to kind of secure the entire thing in place I guess.

Surgery is scheduled for Friday at 14:00 PST. He gave me better pain killers in the mean time. He said I would probably be back on the ice in 3-4 months. Is that realistic? Anyway I'd just be happy to be able to stand again without pain.

Thanks for the support guys!

Offline rwt0277

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Surgery went well on Friday. There are only 2 screws that were needed and an 18 gauge wire. No fiber wire was needed either.

I've never been under general anesthetic either. I remember the Dr. saying to me he was simply prepping the operation, then the next thing I know I'm waking in terrible pain (knee) and they're all done. Very very trippy experience.

Attached is a photo of after they sewed me up. My new problem though is my leg spasms every couple hours when I'm trying to sleep. Know how sometimes you startle yourself awake? Kind of like that, except I wake up with my knee muscle hurting. Also, sweat burns the incision like someone poured lighter fluid on me and lit it.


Offline rwt0277

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So it's been nearly a week and I go tomorrow morning to have my stitches removed from my knee cap (I hope, because they sure are a PITA with all their poking/pulling).

Lately I have noticed I cannot get good sleep though because of a serious muscle spasm that's happening. You know how all your muscles twitch when you first begin falling asleep? Well the one that controls the muscle around/above/under my kneecap suddenly twitches OFTEN and immediately wakes me with gut wrenching, fire burning, pain and wake damn near everyone in our apartment building with my sudden and extremely loud yelp.

Anyone know of a way to get this to stop? I tried tightening the straps on my brace just above and below my kneecap hoping it would help isolate it, but that hasn't seemed to do much of anything.

Anyhow, I'll ask the Dr. tomorrow as well but thought I'd ask here too. Sure hope I get good news. It really sucks suddenly not being able to drive, feed myself (cook), do laundry, run with my 4 yr. old, help my wife with the 2 month old baby, etc. It's disheartening.















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