Banner - Hide this banner

Author Topic: Fractured Patella - long time forum lurker  (Read 1605 times)

0 Members and 1 Guest are viewing this topic.

Offline KGMjor

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 1
Fractured Patella - long time forum lurker
« on: January 16, 2015, 09:09:28 PM »
Hello, I have read this forum through out my recovery. It has been very helpful/motivating/informative. I wanted to write most of this down because I haven't and I can feel myself repressing/forgetting most of it.

I am a 27 y/o Male. I was competing in a mountain bike race and I crashed during a steep descent at around 30 mph on May 31st, 2014. It ended up being the left side of my face and right knee that caught the fall. I had 75% fracture to my orbital bones/area, to include my nose, and my right patella was broken into 9 salvageable pieces. Luckily: No concussion or soft tissue damage to my knee. The on-call orthopedic surgeon was very hesitant about doing my surgery and offered what I thought was a premature prognosis. I was given advice by one of my teammates, passed along through my wife that day, to have surgery done at OHSU. My wife piled me into her petite Yaris the day after my wreck and we made the three hour drive to Portland as the doctor had one opening in his schedule for the next three weeks. I had my surgery 4-5 days later, just two weeks before college graduation/military commissioning. My professors were fairly lenient and I was given two extra weeks to complete my finals, though, most of what I wrote in that time I can barely remember. I imagine most of the grades I received that term were given with a dollop of sympathy.

My recovery was a lot like many of the other recoveries on this forum. I had a four-strap brace with a ROM hinge, lots of painkillers (also, the nerve blocker for three days), and not much of an appetite. Also, a warning to anyone who has not yet had surgery: No amount of fruit or natural bowel-assisting food will mitigate the need for stool softeners. I learned this the fourth day post surgery: I had ran out of my pain killers and had to wait for the prescription to be mailed from Portland to Bend (because it is a narcotic). I experienced what felt like the combination of the flu and hangover. I had no idea I could experience withdrawals after just four days; but my ignorance was probably a combination of arrogance/selective hearing. Luckily, the surprise of withdrawal and the pain of impacted stools made the decision to cancel my prescription pretty easy. Quick note: That was easily the most painful day since my accident, or really, my entire life. I don't mean to embellish or abuse hyperbole, but that is the horrifying truth.

My surgeon was happy with the surgery, but preferred that I remained fairly conservative with pursuit of ROM. Essentially, I was allowed 20 degrees every two weeks (starting at 30), until 90. I began this regiment fairly ambitious: I wanted to defy whatever rule-of-thumb dictated that I bend so slowly. I was successful in this way up to 50 degrees, but when I reached fifty, I felt sensations that I had not felt before. They were sharp, shooting, and painful, and that was alarming to me. I kept at 50 until I reached the two week period I as "scheduled" to push to 70 degrees. The two week period getting to 70 was very humbling and very heart breaking. I could not get beyond 55-58 degrees. The OS had instructed that I not force and only use my hamstrings, but I felt I had become stagnant. Each day I would unlock my brace and with fair ease, push to 30, but every time I pushed to 50 with the intent of working up to 70, it felt like it was the first time. It felt raw and unchallenged, as if my efforts were not true enough to award me the sensation of progress. This continued through the two week period to 70. Unlock, bend, squeeze, gently (unadvised) use my hands to pull my leg in, but my knee would not bend beyond 55-58.

The following two weeks, when I was sitting at 55-58 and supposed to be working to 90, I decided I needed to try something different. Instead of locking my brace out at the target ROM, I locked it out about 15 degrees beyond. Locking the brace out beyond my target ROM was probably one of the best decisions I had made. Within 5 days I had gone from 55ish to 75 and by the end of my two weeks I was at 95. I had two more weeks before my post op appointment and I was spending about 30-40 solid minutes warming my knee up with 30-50-70 and then pushing to 110 (8 wks post op). I went to my post-op appointment pretty rejuvenated and optimistic I would be able to ditch my brace (I had stopped using my crutches and been walking with straight leg around week 3-4). I had X-rays taken. My knee had progressed fairly quickly. The bone had "taken" or fused and the patella sat/flexed in anatomic alignment. I wasn't able to hyperextend my knee on flex, but I was able to straighten it to zero. While I had to continue wearing the brace, I was given clearance to do whatever I was capable of within tolerance, with the brace limited at 120 degrees. From that point on, I felt really good about my recovery. I began walking long distances: at first they were accompanied by new pains and aches, then those would slowly diminish. I would walk 6-8 miles a day or walk to work (about 9 miles round trip), I feel like this made my push to full ROM much easier (I was at 140ROM at around 12 weeks). I was able to go to the gym again and lift, though if I was standing, the weights I used were very light.

Today I am at about 26 weeks post accident. Of the hardware that was in my knee, all but two screws have been taken out (wire and rods removed). It is very easy for me to run up hills (something I did religiously prior to the accident), but I have only just began running comfortably on flat surfaces and only very small distances (800m continuous, 1 mile in 200m sprints). Going down stairs still feels a little staggered and I cannot run comfortably downhill. I have been able to do full squats for a while, but I really have to focus on using and distributing weight equally between legs. I still walk to and from work regardless of what particular exercise I might do that day. I feel very good, but I have a long way to go. I was participating in 26.2-40 mile foot races prior to my accident and I competed for the Oregon National Guard Biathlon team. Those events and the training for them are much closer to me now than they used to be.

Offline randoknee

  • Forum Faithful
  • ****
  • Posts: 176
  • Liked: 10
Re: Fractured Patella - long time forum lurker
« Reply #1 on: January 17, 2015, 05:08:11 AM »
Good on you!  It's great to read about such a positive outcome.  I expect things will continue to get even better over time.  Of course we all want to know, How's your bike?   

About the same time you were crashing, my son crashed while Mtn biking,  landing on the top of his head resulting in a fx of  T1, T2 & C2-4.  Non displaced and he's recovered fully w no paralysis.   His full face helmet and the armor he was wearing probably saved his life.  Moral to the story is wear your safety gear.  Now get out there and have more fun!

All the best!   Dan
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment