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Author Topic: Early Hardware Removal  (Read 16700 times)

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Offline mtb1

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Re: Early Hardware Removal
« Reply #45 on: September 21, 2014, 10:25:10 PM »
Here is a visual 'where I'm at'. Enjoy.

https://www.youtube.com/watch?v=PXK45TbJkdY
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 mjeffrey

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Re: Early Hardware Removal
« Reply #46 on: December 10, 2014, 07:34:02 PM »
Thought Iíd post my progress since Itís been so long since an update, It was great to see that Aaron is back on the bike and riding the trails again (check out the video in his last post). I think I could get out again as well but Iím still a bit cautious of riding on the road. Iíll probably wait until the new season now (itís wet, cold and muddy here atm).

After seeing my OS 2 months ago he said that I wouldnít need to see him again unless there are issues and that I could stop PT and replace it with the gym. PT was becoming pretty boring and I felt it wasnít helping so I stopped it.

Iíve been going to the gym 3 times a week since May and in the last  2 months Iíve been doing ďspinnngĒ classes on the indoor bikes. They last about 50 minutes and are pretty intense. After this I do some weights so itís a pretty long session. For the legs I do leg press, leg curl and leg extensions. The leg extensions show the difference in strength between the legs, uninjured leg 45kg and injured leg 30kg, so about 2 thirds as strong. The machine only goes up to 80Kg so with both legs Iím already at 75 which isnít too bad. I was starting to get a bit of pain with the extensions so Iíve stopped them for a couple of weeks now and may start again gradually or not at all - I donít feel they are essential and they do put a bit of pressure on the knee cap. I also do proprioception (standing on a bosu ball or one one-leg with the eyes closed) and stretching exercises while resting between sets. 

I started walking one-way to work once a week 6 weeks ago (4km). First day was great, no issues but the second time it hurt from the start. Not sure what made the difference. This week there was a metro strike so I walked both ways. It was uncomfortable about 1k from home on the way back but not painful. If I concentrate on relaxing my leg while walking and try not to overstride it is less uncomfortable (I tend to try to walk too fast). The walk to work takes 40 mins which is about the same as I did it before the accident.

I now walk up and down stairs and escalators in the metro and am trying to do the ďquick stepĒ while going down stairs. Not there yet since the injured leg doesnít react quickly enough but itís gradually improving.

Knee is still stiff and I feel it when walking. There is a painful spot on the outer lower side just below the patella. Before the hardware came out I thought it was a k-wire now Iím not sure what it is.

A patch of skin about 2 cm in diameter has lost sensation which feels a bit weird it may be permanent but it feels like it is improving or maybe Iím just getting used to it. 

I have patella-baja (patella too low), I guess from the arthrofibrosis of the patella tendon but it is not super bad. My kneecap seems to be bigger than before and the OS said it was due to fibrosis.

Flexion remains about the same, after warming up it is about the same as the other one but it needs more effort to get there. Pretty happy with that given the problems I had but then again flexion isnít everything.

Knee continues to be hot at times but not really swollen anymore (or maybe just slightly).

I suppose it is only 10 months since the accident and for a patella fracture it was pretty bad but I had hoped for better. I get the feeling that the stiffness will remain (it is not improving) unless I do something more radical about it. Iím considering seeing another OS about I but will wait for the new year.

Anyway, a (too) long post again and I can understand the TL;DR response but I wanted to write it anyway :).

I still read all the posts on the board and am following everyoneís stories. I wish you all speedy recoveries.

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 morgana

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Re: Early Hardware Removal
« Reply #47 on: December 11, 2014, 03:06:00 PM »
Great video mtb1  That was pretty cool footage, and even cooler that you were out doing it!

mjeffrey  Nice post.  Sorry you aren't where you want to be yet on certain things.  I know with the tpf that many things took me years to get to "normal".  It didn't mean that things were terrible or even just bad, but certain moves weren't as comfortable or as second nature as prebreak.  For me, the child's squat was a move I did daily for years.  I could get to that same height, but the bad leg was at a 90 degree angle instead of the butt touching heel position.  I am finally at butt touching heel, but my body weight is still slightly shifted forward to keep from falling on my butt.  Getting closer to balanced over time.  Which is to say, things can still change and improve.  I am 6 years past fwb and it's still improving, small amounts now, but...

That said, seriously reach out and ask your pt and os about leg extensions.  Again, I'm tpf, not patella - but, both told me repeatedly that I should NEVER (not just during healing, but NEVER) do leg extensions with more than 5#(2.2 kilos) because that angle would stress the knee and the tibia causing damage and a knee replacement much earlier.  Their indication was steps and other natural movements would stregthened the muscles without the overload stress that extensions put on the area.  I realize that our injuries aren't the same, and that OS/PT's the world over have different philosophies on the same injury.

Okay, off my soap box and back to you - Congrats on your gymrat status!  Some of the spinning classes in town offer videos to watch so you get the sensation visually that you are riding thru some cool territory.    Does yours?  (I get so caught up in the video that I stop pedalling, so I don't do well in those - lol)   Love the bosu ball.  And yoga helps to really focus on one side so you can feel what the body needs to do.   Again still seeing changes coming with that.  And I've been back to standing to pull on a wetsuit for years now, that was a great feeling.

Keep posting.  And I'll keep watching for Your Follow Ups too.

Hoping the healing continues and you do see and feel the improvements you are hoping for!
5-26-08 Severely comminuted bicondylar fracture-right tib plat - locking plate & 6 screws† Bicycle Accident
nwb for 12 weeks
6-12 started pt
7-21 added swimming
8-25 pwat with walker
9-02 four prong cane
10-07†cane
10-15†cane as needed,slight limp
10-27 OS:next visit 10-2009

Offline fabifrancisco

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Re: Early Hardware Removal
« Reply #48 on: December 19, 2014, 12:52:40 AM »
I am hopefully getting my hardware removed Jan 2015... keeping my fingers crossed.  I have to have a clean CT scan on my six month anniversary which is 12/26.  Please keep us informed on your progress!
6/27 fractured patella; ORIF surgery same day
7/18 removed staples
7/24 30 ROM
7/31 40 ROM
8/4 45 ROM (was supposed to be 70)
8/14 57 ROM (was supposed to be at 90)
9/14 90 ROM
10/14 120 ROM
11/14 Setback  110 ROM - hardware problems
12/22 Set back :(
06/23 Hardware removal?

Offline Margorita03

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Re: Early Hardware Removal
« Reply #49 on: December 29, 2014, 08:07:51 PM »
 Hi All,
I am new to this message board but thought i would ask a question.  I broke my patella over labor day weekend into 5 pieces. I had surgery back on Sept 10 wasn't able to start physical therapy till the beginning of November.  At this point i am able to bend it to 102 degrees still limping.My question is this my pt told me that I would be better off having my hardware removed just wondering if it seems to hlep the situation or actually make it worse?  This has been one of the most harrowing experiences of my life and i dont want to put myself any farther behind in progress any opnions appreciated  ???

Offline mjeffrey

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Re: Early Hardware Removal
« Reply #50 on: January 01, 2015, 11:02:16 AM »
Hi Margorita

No one can predict the outcome of any surgical procedure. You always need to weigh up the risks versus the potential benefits. You have all of the risks of surgery, possibility of infection, anaesthesia complications etc plus extra rehab time. My surgeon said it would take me 8 weeks to get back to where I was. I would say he was about right, it was 6-8 weeks.

On the other hand the surgery is nothing like the original: much less post op pain, easier rehab etc. Most people who have had it done here on knee guru recommend it, there are several older threads about it as well.

There is also this study
http://www.healio.com/orthopedics/journals/ortho/2010-5-33-5/%7B1cded17c-0273-4f4a-b472-21baa2a7358f%7D/implant-removal-following-surgical-stabilization-of-patella-fracture
Quote
Nineteen of the 22 patients with implant removal had improvement in symptoms that varied from complete pain relief in 3 to moderate relief in 16. Three had no relief of symptoms following implant removal.

So if you're having issues with the hardware discuss it with your OS. He will first check that the break has healed fully (I had a CT scan) but it seems a bit soon, most OS's are reluctant to do it before 6 months and some insist on a year.

good luck,
Mark
« Last Edit: January 01, 2015, 11:53:28 AM by mjeffrey »
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 #51 on: January 16, 2015, 04:05:59 PM »
Hi Everybody,

I am 51 weeks post-injury and 23 weeks hardware-free. Almost a year already, time seems to have accelerated.

Mark, it sounds like you're doing excellent. You are on a much different path than I, but we are having similar results overall.
 
I have not seen my OS or a PT since having my hardware out. I get enough exercise from work & from having fun on the weekend, and I have had no real issues. Flexion is still not where I want it to be but is continuing to improve ever so slowly. Strength is coming back, but is also below my expectation. There is little pain, only when I push it. Kneeling/crawling around is not easy, but I can. Up & down stairs is no problem, but we always have to be careful now don't we? I pack large heavy objects around at work and have do stairs one at a time in those cases. I can jog for short spurts. I can stand up and pedal reasonably smoothly up short hills. I have been snowshoeing & got back on the xc skis for the first time last week. We picked up a puppy in early December, so I am walking LOTS! Everything is done with a much increased level of caution than before, which is ok most of the time  :) Generally, I feel pretty good about where my recovery is, but that is only because I have read of so many other not-so-good experiences & horrific injuries on this forum.

Margorita, keep in mind that I am not qualified in any way to give medical advise. But I can say that hardware removal was total relief for me. I think I had k-wires rubbing on my patellar tendon, and once they were removed, the pain disappeared and I was able to make true progress on recovery & enjoy movement again. Mark's comment is pretty spot-on as far as the surgery is concerned. I was back at work welding in 3 weeks, and probably back to where I was pre-removal in 5.
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