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Author Topic: Early Hardware Removal  (Read 16799 times)

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Offline mjeffrey

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Re: Early Hardware Removal
« Reply #30 on: August 20, 2014, 03:54:28 PM »
Hi Jacob

Sounds like you are doing OK, hope you feel better soon. I'm surprised they didn't give you any pain meds. 10 minutes after I woke it hurt like hell and they gave me some immediately. I needed something (Ibuprofen, nothing too strong) for more than a week.

Did you end up staying overnight? They planned to keep me as well to leave in a drain but in the end there was no drain and so I went home ;-).

Can you pedal comfortably with a 120-degree ROM?

Hi Daihard. 120 is plenty, 110 should be OK, but if not just put the seat a bit higher!!!
Personally I didn't like the recumbent bike but if you get a chance, no harm comparing. Do you have an exercise bike at home? I rented one initially but then needed it for so long I bought a turbo trainer http://www.evanscycles.com/products/minoura/b60-remote-trainer-ec024622 and a (necessary) special tyre for the mountain bike. Works pretty well and I prefer it to the exercise bike.
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mtb1

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Re: Early Hardware Removal
« Reply #31 on: August 20, 2014, 06:18:20 PM »
I would say 110 was minimum for me to pedal. I raised the seat as high as possible and scooted my foot forward on the pedal.
I have a Minoura trainer as well. I used it a fair bit during recovery round #1, but that was just to avoid ice & snow outside. For round #2, I was probably on it a total of 20 minutes before I decided to venture out. It will be hauled back to the basement today and stored away until next time ( ;) NEVER!).
fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline jacobj

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Re: Early Hardware Removal
« Reply #32 on: August 21, 2014, 07:43:27 AM »
A bit over 24 hours update:

The pain from surgery has remained pretty much the same. Stinging from the incision coupled with general pain inside the knee that wasn't there before. I haven't taken any pain meds for it as the pain is bearable. Ended up staying overnight as I managed to score myself a private room. I probably would have pushed to be discharged same day if I didn't have my own room. No crutches or walking aides. I drove myself home from the hospital this morning. So far it's a walk in the park compared to the initial break.

As a side note, I was in the anaesthetic bay waiting for surgery and the surgeon came in to say hello, and basically told me "no time is a good time for hardware removal, i had a patient that had it removed 2 years after the fracture and 4 weeks later he stumbled and broke the patella again". All that has done for me is to make me a bit paranoid about breaking it again. When you're prepped for surgery it's probably to late to warn me about the dangers of hardware removal lol.

Cheers

Jacob

Offline fsugirl

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Re: Early Hardware Removal
« Reply #33 on: August 21, 2014, 01:40:09 PM »
Glad to hear it's going so well for you, so far, Jacob. 
I didn't stay overnight & I did take pain meds for 24 hours & use my crutch a little, but those last two things were more out of precaution, I think.  I pretty much felt good quickly and was back to normal activities... though I did wait at least a week to start back with regular exercise.  I think I looked worse than I felt - was all bandaged up, using my crutch for extra support (or maybe it was sympathy? ;)).

Interesting last comment.  As I was trying to decide about having the hardware removed (2 years out from injury), my husband said, "whatever you think will make you less paranoid about re-injuring is what I think you should do."  Both of us wanting me to get back to living life more like I used to - without so much caution! - we discussed this very thing.  It held the most weight on the 'don't do it' side of the decision-making process... but I did it anyway.  So, thanks for the reminder! ;)  Though I know re-injury is very possible - for some reason - I DO feel like I have more confidence now... so I'm still glad I went through with it.  Here's to hoping I don't fall now!! :)
3/17/12 patella fracture
3/22 ORIF - 3 screws, wire, immobilizer
4/2 - sutures removed, crutches, nwb
4/30 new brace-locked, referral for pt ~20/25ROM, pwb
5/9 started pt 30ROM
5/18 45ROM
5/25 50ROM-brace to 30
6/1 60ROM-brace to 50
7-MUA
More PT
Dynasplint fullROM
10/30-PT release
4/30/14-HW remova

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #34 on: August 21, 2014, 08:20:50 PM »
Hi Jacob,

Hi Jacob thanks for the update.

As a side note, I was in the anaesthetic bay waiting for surgery and the surgeon came in to say hello, and basically told me "no time is a good time for hardware removal, i had a patient that had it removed 2 years after the fracture and 4 weeks later he stumbled and broke the patella again". All that has done for me is to make me a bit paranoid about breaking it again. When you're prepped for surgery it's probably to late to warn me about the dangers of hardware removal lol.

I was interested to read what your surgeon said. I'm sure there is more risk of another fracture given the bones will be more fragile after the HW removal and for a while you're less sure on your feet and more prone to falls. On the other hand see this:
Quote
Tension-band wires ultimately will break.
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048243/.

So maybe if you have a wire tension band (I have 2!), the choice will be made for you.

It happened recently to someone on keegeeks:
I've never posted on here so apologies if this is in the wrong place!

In 2012 I fractured my patella in 2 pieces in a car accident and had surgery to have the figure of 8 wire tension band. My surgeon had told me its the best thing to happen for patella fractures and it would be fine to leave in unless it cause problems in the future. fast forward 2 years and here we are. I started exercising recently (jogging, running etc) and felt a sharp pain in my knee. I was unable to walk or even move it in the slightest without agonising pain. It swelled up to twice the size and I had an emergency xray where I was told by my doctor part of  the wire had broken off due to exercise and slipped into my joint - she would send the Xray to my surgeon and he would take it from there. Yesterday I got a call from the hospital informing me I will undergo surgery tomorrow morning to remove all hardware including the separate piece inside the joint.

I am 20 years old and completely confused. I cannot find online anywhere anyone having to urgently get the wire removed/ it snapping and going into joint. Does anyone know what I am to expect tomorrow? I just feel a little annoyed as I haven't been told anything about the surgery or recovery time. To top it all off I was given a lecture for jogging as I am apparently never supposed to do this after the original operation which I was also never told!


Personally I have a lot hardware and the 2 other OS I saw took it for granted that I'd need it removed.
Also if you look at how they place the tension bands (through the tendons) then it is no wonder there is pain. For me that pain at the quadriceps tendon on extension has now gone. Any ongoing knee pain/problems will tend to inhibit the quadriceps muscles so I saw no future in keeping the wires and decided to get them out as early as possible so I could start to recover properly.
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #35 on: August 22, 2014, 04:50:30 PM »
Day 14 post HW removal.

Well quite a bit has happened since I last gave an update but I'll start with a warning: Don't overdo it!!!.  I did and am now having some consequences which I'll explain below.
I returned to work on Tuesday, Day 11 and it was OK, needed some pain meds during the day but nothing too dramatic. I decided I'd try to push my flexion a bit and got to within about 10 degrees of the good leg (using a 3kg ankle weight and gravity). Nothing too dramatic and it is by no means unassisted but I was reassured that I would get back the flexion - after the MUA I am more than a little paranoid about more adhesions. I also did 30 minutes on the bike.

The next day I paid for it with more pain and on changing the dressing the wound looked a bit red and inflamed. No fever but a bit of bleeding so I made an appointment to see the doctor for Friday (today). I thought he could also take out the stitches rather than wait till next week.

Thursday a bit better and Friday I was walking pretty well up hill to the hospital. The wound has closed ok but not fully healed below the knee and apparently I had been doing too much, so much for the "no restriction on flexion" line I got after the operation >:(

Anyway they cleaned it up, removed the stitches and the scabs and told me to come back in a week. The new dressing is gauze pads soaked in alcohol and closed with a compression bandage, I need to change it and clean it daily.
No PT, no flexion exercises, limited walking and no biking.
So an extra week of recovery, yuk.

I'm going to edit my previous posts and put a warning about the mistake I made.

see you
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline fsugirl

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Re: Early Hardware Removal
« Reply #36 on: August 22, 2014, 07:04:10 PM »
Hi Mark,

Thanks for the update... & sorry you had to learn a lesson the hard way.  As we're constantly reminded (and - I know - I say it ALL the time) - every situation really IS different.

So strange to me that I - who took FOREVER to recover & was on pain meds for MONTHS after the initial procedure(s) - recovered quickly (& had no flexion issues - though, of course, I doubted the instructions too!) and had virtually no pain post HW removal.  I'm sure there's a scientific explanation... & it involves a difference in procedures, but... on a very simplistic level, it's weird to me. 

Hope it's all down hill from here!

Anne
3/17/12 patella fracture
3/22 ORIF - 3 screws, wire, immobilizer
4/2 - sutures removed, crutches, nwb
4/30 new brace-locked, referral for pt ~20/25ROM, pwb
5/9 started pt 30ROM
5/18 45ROM
5/25 50ROM-brace to 30
6/1 60ROM-brace to 50
7-MUA
More PT
Dynasplint fullROM
10/30-PT release
4/30/14-HW remova

Offline mtb1

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Re: Early Hardware Removal
« Reply #37 on: August 23, 2014, 02:42:35 PM »
Well that sucks Mark, but hey, what's one more week eh?

It's the dawn of day 17 for me & I'm still doing good. Went for a 1km trail walk with the dog, then a 50 minute spin around town on the bike yesterday. Strength & ROM are still not back to pre-removal but I notice small improvements every day. Like Jacob, I seem to have pain inside the joint where there was none before. Extensions are still difficult, and I cant fully straighten the leg unassisted without significant pain. I have been dressing-free since I pulled my staples on day 7. I never had more than a dry non-stick gauze pad and elastic bandage. The incision is 95% healed, just a couple of small scabbed spots left.

I think that sometimes doctors will say 'no restrictions' knowing full well that the pain will naturally restrict most people. After round #1 I had no restrictions on flex, ended up overdoing it, and was told to back off & take it easy. I haven't been any more patient with myself this time, but at least this time there is no fracture to pull apart.  :)
fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline Twinkeelfool

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Re: Early Hardware Removal
« Reply #38 on: August 26, 2014, 03:08:22 AM »
Sounds like some mixed results, although overwhelmingly positive guys.

About the bone rebreaking, I've heard some people claim a bone can be even stronger after being broken. I find it a little bit odd, like counter intuitive.

I've got til next May/June to wait ( surgeon wants to wait at least 12 months ). I'm back at work ( physical job, lots of stairs ) and it's pretty good for that stuff but surfing or intense activity ( besides excercise bikes ) is pretty much out at this stage. On one hand I'm very happy but it's like I'm in a holding pattern til the wires come out, just squatting like a mofo a few times a week haha

Good to hear all the post hardware removal experiences.
No, a snapped knee cap is not the same as a TKR for the 3rd time!!!!

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #39 on: August 27, 2014, 08:11:38 PM »
19 days post removal.

Today I stopped wearing a bandage and just used some gauze and tape so I could walk fairly normally. The incision is looking a lot better and it feels like it is back on track. Although I was meant to wait until the end of the week when I see the (backup) OS again, I went to the gym today and did some light weights. Flexion unassisted is about 110 and assisted I easily get to 120. I'm fairly confident that it will get back to full flexion soon, it just seems like it is not really blocked.
Still a bit inflamed but it already moves a lot better than before. The big thing is that the sharp pain around the quadriceps tendon on leg extension has gone and if I tried I could easily do more weight than before. Also no more pain where one of the diagonal k-wires came out.

I felt I could run on it if I wanted but didn't try and will wait a couple of weeks.
During patella mobilisations it moves more than before and almost as well as the good leg.
Muscles are still a bit stiff, weak and prone to cramping but I'm sure that will improve gradually.
Not perfect by any means, still some odd clicking at times but much better than before the removal.

cu
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline jacobj

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Re: Early Hardware Removal
« Reply #40 on: August 28, 2014, 03:41:27 AM »
Day 8 Update

Hi Guys,

It's now day 8 since surgery. Finally back at work today. I could have been back days ago, but the doctor gave me a letter saying I'm unfit for work till the 5th of September, so I thought I might as well take a few days off.

I've taken all the bandaging off including the steri-strips. The wound looks pretty good. My knee is quite swollen at the incision sites and I think the tendons must be quite inflamed because there are hard areas at the top and bottom of my knees. I'm relatively pain free, just a bit of soreness around the incision. Full extension is possible without too much pain. I can get flexion to about 120 degrees before it feels like it's putting too much pressure on the stitches.

Walking up and downstairs i a lot less painful now then before surgery! I just need to get some more strength back into the quad to make it comfortable. That will come in time. I haven't tried kneeling yet because of the incision, but I expect that the will too be pain free after the inflamation settles.

Overall, I'm pretty happy with my progress so far.

I have an appointment next Wednesday (3rd Sep) at the hospital for a checkup.

Cheers

Jacob

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #41 on: August 30, 2014, 03:37:51 PM »
Hi Jacob

Sounds like your recovery is much better than mine at that stage and great that even now you have less pain with stairs than before the op. Seems like a really positive sign to me.

For me it is now 3 weeks post op. I saw an OS yesterday (mine returns from holiday on Monday) and he was happy with the incision, he removed the scabs and redressed it. I am now "allowed" to do PT, gentle indoor biking and swimming, no lower body weights.
Since he removed the scabs, I didn't do any more flexion exercises until it closes again but I am confident there won't be a problem.

I commented that even now the knee moved more freely than before and he OS replied: "of course now the hardware has gone, that's normal!" Interesting.

He said I don't need to come back unless there is a problem. All a bit anti-climactic really :). I would have liked to say goodbye and thanks to the OS who I had the impression gave me some special treatment (maybe because I was interested and worked hard). I guess I'll send him an email once the recovery is complete, I bet they seldom find out what really happens to their patients.

Knee is still moderately swollen and hot in the afternoon and as for mobility, while improving daily, I am not yet at the point I was at before the operation. 

cu
mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #42 on: September 08, 2014, 06:31:59 PM »
4 weeks post removal and so just a quick update.

Started doing more serious gym work this week and was able to do leg extensions on the injured leg with 15kg on weight stack and no pain (before removal 0kg and pain). I am also able to do a martial arts style front kick with full extension and no pain, previously about 10 degrees deficit with pain.
I can go down stairs without problems e.g. carrying 10 kg of shopping in each hand - this would have been impossible before removal.
I did some intervals on the trainer during the week and it felt good, I was able to get out of the saddle without problems (impossible before).

Starting to see a bit more definition in the quads but the VMO is lagging despite a lot of work with the NMES machine and trying to work them on the leg extensions.

Flexion is back to where it was before the operation (or slightly better) and my heel is maybe 4cm further away from the glutes than the good leg.

However the knee is still hot and swells up, particularly in the evening and worst, the annoying clunk when walking is still there. I'm seeing the doctor tomorrow about that, just preparing my list of questions now :).

How are the rest of you guys going. Still positive?
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mtb1

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Re: Early Hardware Removal
« Reply #43 on: September 18, 2014, 03:08:17 PM »
Breakthrough!

I am 8 months out from my injury, and 6 weeks hardware (& hardware related pain) free. In the past week I have worked, gone for a couple of trail rides totaling over 30km, and cut hauled split & stacked 2 loads of firewood. On my ride last night, I stood up and pedaled a couple of times. I can do about 6 revolutions - not smooth ones, kinda herky-jerky, but standing revolutions no less. Perma-grin!

ROM is not where I want it to be, but I continue to work on it and I think I'm still making progress. There is discomfort in general at times, but nothing that has kept me awake at night, and I have taken very little medication. I have a click on extension, but I sort of expected that, and it is not painful at this time. There is still a little swelling, particularly at the end of the day. It appears that my pair of patellas will not match ever again - the injured one pulled apart a little in the first 10 days and is snow slightly larger than the good one. Muscle tone is good, strength is coming back, but there is still a vast difference in the size of my legs. I'm going up & down stairs fairly normally, with some effort. Same with vertical ladders onto scaffolding at work.

I'm happy overall with the recovery so far. I think I'm lucky in that I am an active person, so I don't have to really concentrate on exercises - they're just a part of normal life for me.

Aaron.



fractured r patella into 3 pieces 2014/01/23
surgery - k-wires, tension band, screw 2014/01/24
sent home, no cast/brace/immobilizer same day
follow-up with OS 2014/02/04
2nd follow-up 2014/03/11, ROM 90
3rd follow-up 2014/04/08, ROM 130
HW removed-2014/08/06

Offline fsugirl

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Re: Early Hardware Removal
« Reply #44 on: September 19, 2014, 04:20:46 PM »
More of an update later, but a quick announcement...

I RAN TWO DAYS AGO!!! :D  It was only two intervals of about a fifth of a mile, within my regular walk, but... I RAN - with NO major pain.  There was some pain, but nothing more than what I expected - just from the heavy impact.  Yippee! :)
3/17/12 patella fracture
3/22 ORIF - 3 screws, wire, immobilizer
4/2 - sutures removed, crutches, nwb
4/30 new brace-locked, referral for pt ~20/25ROM, pwb
5/9 started pt 30ROM
5/18 45ROM
5/25 50ROM-brace to 30
6/1 60ROM-brace to 50
7-MUA
More PT
Dynasplint fullROM
10/30-PT release
4/30/14-HW remova