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Author Topic: Patella fracture - some early hardware issues?  (Read 569 times)

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Offline alessio_db

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Patella fracture - some early hardware issues?
« on: July 28, 2018, 06:09:33 AM »
Hi all,
I'm just at 12wks post ORIF on a 3 part patella fracture (think it was diagonally in half with another part broken off the bottom half - surgery was tension band with 2 k wires) I sustained falling down a ramp at the local skatepark. I've got another post going at http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=74071.msg681961#msg681961 but thought I'd start a new one here as my hardware is giving me a bit of grief and I'm not sure whether I should put up with this for another 3 months or try push to get it out sooner when I see the OS in a couple weeks for a scheduled follow up (3 months post op).

In short, the good is that I'm back at full ROM (probably was back at about the 9wk mark), with the bad leg even better than my good one but I guess that may be due to the muscle atrophy, ie get more ROM due to less leg muscles being in the way (calf and hamstrings). I've been off the brace for about 6 weeks now, walking better each day. Going up stairs is good, going down is a bit of a struggle but I can manage without holding the handrail. Rode my bike to work today (~14km) which also felt fine but I was not really able to stand up off the seat.

The bad - at about the 9wk mark I aggravated my skin against the wire twist in the tension band , which then inflamed itself into a lump. Since then I seem to always aggravate it, either in bed through simple rotating my body to sleep or by wearing pants, so there is always an inflamed lump in the middle side of my knee cap. It feels like someone is pinching me there sometimes, especially just walking around which I think is due to my pants shifting the skin around (maybe I should stop wearing skinny leg jeans??). Also, the top of the left pin (was my left patella) is quite prominent through my skin when I put a bit of flex into the knee - it doesn't hurt to the touch but I seem to be getting a lot of pain at the top and bottom of the knee while trying to work on straight leg raises and VMO exercises. My physio thinks the pain is due to the weak VMO and the hardware, but its quite hard to try build the VMO when all the exercises to do so cause it grief :(

So my questions are, is this lump and pain normal, or is it cause for more concern? As I mentioned above, I am seeing the OS again in less than 2 weeks so I will speak to him about it, but I'm really feeling that I will get a lot less pain issues and therefore recovery progress once these foreign objects are gone for good. FYI from my xray pics it looks like the bends in my k wires are point upwards and not downwards as usual, but my OS has not raised any concern on this at any previous visits...

Offline lostpirate

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Re: Patella fracture - some early hardware issues?
« Reply #1 on: July 31, 2018, 02:02:19 AM »
Hey there alessio!...


I know a lot about what you are feeling!


You're hardware is shifting! I went through the same thing! At aout 3 months I could feel a pin poking at me. Caused pins and needle feeling and made it tough to walk. My OS removed that pin at 3 months and took me out of PT until he removed all the hardaware a 6 months. My recommendation has ALWAYS been on this site to get hardwarre removed as soon as possible, because it's not a question of if it will cause problems, but when it will. Screws, pins and wires do not belong in a joint! they will move and shift and cause problems at  some time.


As for the VMO... VMO won't cause pain. It causes weakness. Trust me there. Been there, done that...My recoevery got way extened because my 1st therapist was a newbie and did not know what she was doing. When I switched OS's, got a 2nd opinion and got hooked up with a therapist that knew what he was doing, it was a night a day difference. He got my VMO dialed in and there was never pain involved.
5/2/09..Broken right patella
5/4/09..Surgery. 2 pins and wire
6/5/09..Began PT (60 degrees ROM)
6/12/09..Began walking out of immobilizer
6/29/09..2 month check up (130 degrees ROM)
7/12/09..Full ROM
7/22/09..Shifting pin
8/14/09..pin removed
11/10/09..All hardware removed

Offline alessio_db

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Re: Patella fracture - some early hardware issues?
« Reply #2 on: August 02, 2018, 01:06:16 AM »
Hi lostpirate,

Thanks for your reply - Iíve read through your stories, theyíve been a great help! I donít think my hardware is giving me as much pain as yours, but it doesnít feel great in any case. Generally moving is fine and flexing at any angle at no weight is fine, itís just with the PT exercises that involve getting the VMO to work - thatís where I feel like the hardware is causing the most pain and therefore stopping progress. PT said that the VMO is involved with the last 15deg of extension, and it has a primary role of keeping the patella in the femoral groove, which if it is weak means you can get knee pain because the patella is not being held in place properly. But he also thinks the hardware is an issue too.

My OS did say we could get the hardware out at 6 months if it was causing issues last time I saw him (at the 6wk mark), but I donít really want to wait another 3 months for that. I see him in a weeks time for the 3 month follow up, so hopefully a few more X-rays and some chats might explain the issues further.

It does sound like from this forum that a few people have had their hardware out quite early (3 and 4 months) and have gone on to fully recover with no issues. Hoping I might be able to come one of those people too  ;)

Offline lostpirate

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Re: Patella fracture - some early hardware issues?
« Reply #3 on: August 09, 2018, 01:15:04 AM »
Your story is similar to mine. I fractured my patella in 3 pieces also. As I said, my OS took out the pin that was the problem at 3 months and the rest a 6 months. Every OS is different. Some don't want to remove it at all unless it causes problems. Other want to make you wait a year before they remove it. Mine said 6 months. I am glad he did. No way, after that pin slipped and he removed it would I have waited longer then 6 months to get the rest out. I remember him saying to me after all the problems I had with my hardware that had he refused to remove it, I would have just found another OS who would have. So, there is a lot of disagreement between OS's about how long hardware really needs to be left in. I did just fine with mine being totally out a 6 months. I know others who have been too. I know of no one who has had it removed that early that has problems because of it. I know of no one who has regretted having it taken out that early.


From what I heard from my OS. It takes the bone a full year heal to 100% At 6 months he felt it was healed enough (like 80%) that risk of refracture was minimal. At 3 months when he removed the pin causing problems he was very relcuctant to take all the hardware out. Believe me, I asked him to. He said he could, but it would be a crap shoot if my knee would hold together. It would not take much to refracture it. He insisted on taking out the pin that was causing the problems and leaving the rest in, taking me out of PT and waiting until 6 month to take the rest out. I went along with that, since once that pin came out the pain went away and I was OK with waithing another 3 months to get the rest out.


« Last Edit: August 09, 2018, 01:26:12 AM by lostpirate »
5/2/09..Broken right patella
5/4/09..Surgery. 2 pins and wire
6/5/09..Began PT (60 degrees ROM)
6/12/09..Began walking out of immobilizer
6/29/09..2 month check up (130 degrees ROM)
7/12/09..Full ROM
7/22/09..Shifting pin
8/14/09..pin removed
11/10/09..All hardware removed

Offline alessio_db

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Re: Patella fracture - some early hardware issues?
« Reply #4 on: August 10, 2018, 04:12:32 AM »
I just had my review yesterday with the OS at the hospital outpatient clinic, including another X-ray. The OS said it looked to be a complete union, and he showed me the X-rays and it actually just looks like a normal bone now (apart from the hardware). He was also very happy that my ROM is back to normal, and said that is excellent in terms of this recovery point. I told him of my issues and while he agreed with them being the cause of the pain, the hardware on the X-ray hasnít moved at all, and he believed it to be still a bit too early to take the hardware out. He also was of the opinion that because my quads are still quite atrophied, if he removed the hardware now and I had a fall/other incident the muscles wouldnít be developed enough and therefore it could put too much pressure on the joint and potentially pull the fracture apart. He also told me of one patient that had his hardware taken out at 3 months by a different OS to the original, and that they suffered a refracture based on the quad strength issue and fracture weakness.

On the positive though, weíve booked in for another review in 6 weeks to checkup on quad development, and if Iíve made some progress then he is happy to book in the removal surgery after the review (ie so would be 1-2wks after depending on availability). I feel ok with that, like itís not great with it in but another 6-8 weeks I think I can deal with.

Had another PT visit yesterday, and the PT has given me a few different exercises in order to avoid the ones causing pain, and just told me to ride my bike as much as I can. Iíve been on the bike now say 3 days per week for the last 2-3 weeks (doing up to 30kms per day), and am definitely feeling the pain subside and strength slowly coming back. I even managed a couple of pedals out of the saddle today ;)

Hoping I can be good for a ski trip Iím trying to plan in January, though maybe itís wise trying to push it back to as late as possible.

Offline alessio_db

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Re: Patella fracture - some early hardware issues?
« Reply #5 on: October 02, 2018, 03:28:40 AM »
A bit of a news update - saw the surgeon at the outpatient clinic the other week, who said that the hardware now is probably doing more harm then good (ie pain) so he was happy to go ahead with the removal. Iíve been booked in for the removal on the 11th of October, which should make it about 5 months and 1 week from the fracture/op day. Pretty excited to get the hardware out, as has been causing a bit of grief and I really feel itís been hampering my recovery/rehab work.

Recovery wise Iíve been on the bike about 3-4 times a week, riding to work and trying to get in at least 30-40kms per ride. Still canít stand up and pedal with any ease, itís quite sore to put any sort of significant pressure on the injured knee past the 30-40deg mark.

ROM wise I think my left knee is better than my right, so thatís a positive.

Anyhow Iíll do another update after the removal surgery, to see how it feels after this annoying hardware is taken out.















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