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Author Topic: Broken Pattela in 5 pcs with minimum displacement  (Read 1078 times)

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Offline axand

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Broken Pattela in 5 pcs with minimum displacement
« on: August 07, 2018, 09:25:23 AM »
Hello,

I've been reading the topics of other cases similar with mine and I find it interesting that the recovery treatment mentioned by the OS is different (this might be due to age, physical condition, weight, region, etc).

So to start I am from Romania, I am 1.96cm, 90kg, 30yr old and I had fell on my knee while I was having my 3yr old dautgher in my arms, I broken my latella in 5 pieces, it was like an x and one more small piece. I've had to wait 7 days until I had the surgery, where they put 3 screws and 2 wires around the patella. After the surgery:
- day 1: I stayed in bed, no leg movement.
- day 2: the kinetoteraphist visited me and told me what exercises I should do.. but because of the 7 days waiting, my qvadriceps where not responding so I was just doing some akle pumps and trying to keep the leg in full extension for 2-3s, I was also told that I can walk and put 30-40% of the weight in the leg, so I was using cruches.
- day 3: the doctor told me that I can put my full weight in the feet if I don't feel pain and I was able to leave the hospital.
- day 4-5: I had added some more exercises staying in my feet and using a walking frame, which improved my qvadriceps, but I had headache from surgery and it was dificult to make them, I was doing 2-3 times a day for 30-40min. Also i was walking having my full weight on the feet.
- day 5: I also had my knee checked by the doctor and had a puncture done in the knee, where the doctor extracted some blood or so.. but this made my knee to look much better. And the doctor told me to set the brace to 30degrees flex.
- day 6: I managed to get enough strength in the feet to make the exercises while staying in bed.
- day 7: I added more complexity to the exercises and walking 4-5min thru house with only 1 crutch.

Today is day 8 after surgery. I also have a TENS/EMS device, the doctor told me I can use it, but I am not sure if it is good to use it so early after surgery..

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #1 on: August 13, 2018, 11:10:05 AM »
Just keeping my progress here also updated:
- from day 8 until today (wich is the 14 day from surgery, so 2 weeks now), I am able to bend my knee to 30degrees and also I now feel confident walking thru the house with no crutch... however I still keep 1 in my right hand but don't use it, just for backup :). While doing my exercises I also bought 2 weight bags for the leg, I started with 0.5kg and now I am at 1kg on the leg while exercising + I just upgraded to using also a medium elastic band.

What is a bit concerning is the fact that my right knee is still swalen compared with the good left one. The knee is 4cm biger.. based on your experiences how long did it took for the swalen to go away?

Offline mjeffrey

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #2 on: August 14, 2018, 06:40:28 PM »
It took mine ages. It was still swollen when I had the hardware removed at 6 months. But everyone is different so it doesn't mean yours will be anything like that. A lot people recommend icing and elevation but it didn't do much for me so maybe mine was worse than most. It does take time.
Fluid in the knee can inhibit rom but it will improve gradually.
Check with the kine if you can use the EMS device to keep up muscle strength. you'll be surprised how the vmo is inhibited and won't react but it will improve with time.
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 axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #3 on: August 15, 2018, 08:25:05 PM »
Thanks mjeffrey for the feedback. I never had any type of surgery so I can't determine how normal should be in this case, but my knee is swalen around the kneecap compared with the good one.

I think I've managed to restart all my leg muscles, I can't see all as on the good leg... but I can feel them while working so I think this is a good think. As for the EMS the doctor told me to use it, buy the kinetotheraphist told me to use it only 1/3 or 2/3 from the hip to the knee.. so I can't use it yet with the VMO.

Also I had my staples removed and progressed to aprox 70ROM, but not in all knee positions I can reach this, but it is a start.

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #4 on: August 22, 2018, 11:13:18 AM »
Week 3
- improved ROM at 75degree (the OS told me that only after the 4 week mark I can advance to 90degree)
- started doing short walks outside. I am walking on flat but there is also a road in a ramp. So I try going flat, up, down the road. I started with 1500steps per day.. now in 5 days I've reached 5000steps and I do a walk in the morning and one in the evening. I feel that the knee is more resistent to walking each day.
- also I am using a type of bike that helps my ROM: https://aloshop.tv/sanatate-si-frumusete/vitarid-r?gclid=Cj0KCQjw5NnbBRDaARIsAJP-YR8DA7nrVaH422nNU2vjPU91GZ4Hp708OTOgE0VMWTZiN1_4GsJOfdMaAqE0EALw_wcB
- keep doing my strength exercises
- elevate and ice the knee.. but still can't see any improvment in swalen.


« Last Edit: September 04, 2018, 02:48:28 PM by axand »

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #5 on: September 04, 2018, 02:47:15 PM »
Week 5
- ROM reached at 120degrees
- daily walks around 4km on different terrains, no cruch needed
- doing some strength exercises with 7kg on the feet
- stationary bike around 30-35min with 8-10 brake

- I'll have my 5 week check at the end of this week to see if the bone healed.

I still have the knee swalen, with 4-5 cm bigger than the good one, I'll ask the OS to see his opinion...

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #6 on: September 15, 2018, 08:02:19 AM »
Week 7
- I'm not sure what my ROM is exactly.. but for sure os over 120, I'd say I'm around 130-135 and it starts to be more complicated to advance;
- at the 5 weeks check up the x-ray still showed that the bone had cracks unhealed, and it is still swalen;
- continuing with PT and home exercisesing;

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #7 on: December 20, 2018, 06:18:40 AM »
Hello all,

Just a short update, I am now 4 months after surgery. I still have my right knee more swollen then the left, and now that is winter here I think this is causing a little more pain. But as for walking, going down/up stairs I can do but not 100% as I used to.. there is a some pain. I can also do a very short running, like when needing to cross the street or so :). I can knee but with a bit of pain, I can drive, but initially I was able to stay in the car for 15min.. then I would need to stretch my leg due to pain, now I can stay like 30-40min... so hopefully this is improving :)

What is worrying me is that in the 3 months x-rays I haven't seen to much improvement. I've posted them below so that maybe some advice compared with your experience can be given.
My doctor says it is OK...
 

September Front

November Front


September Side


November Side

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #8 on: February 05, 2019, 07:23:26 AM »
6 MONTHS UPDATE

I'm just keeping the update here to help me tracking my progress, but also maybe someone might find it useful. So I've been on hold with the PT from about 3 months when I had a OS visit because at PT I was starting to use 5-7kg on the leg while exercising during PT and my OS considered that this might affect the bone pieces to move. However in January when I had my 5 months visit to the OS the bone was still not fully healed and there where still visible fractures (I'll attach below the x-rays) but he told me that I can now start again the PT an use 5-10kg during exercising and to be guided by pain.

So I've restarted PT for about 2 weeks. The knee is still swollen and also I've decided to buy a LIPUS device to help the bone healing (after reading about several devices, I've decided on the OSTEOTRON IV, I've started using it yesterday for the first time so I'll see how it goes, it takes 20min/day for the treatment).

The next steps now are to regain the strength in the quadriceps and to have the fracture healed.

Below the last x-rays:



 

Offline axand

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Re: Broken Pattela in 5 pcs with minimum displacement
« Reply #9 on: October 10, 2019, 08:15:12 AM »
15 MONTHS UPDATE

Long time since my last post. Just wanted to add some additional information, after passing the 1 year mark:
- I had my 12 months check and the x-rays looked much better then the one from the 6 Months, I have been using a LIPUS device for 6 months, and I think that this helped the bone healing, the OS said that everything looks OK but is advising to keep the hardware in until I'll have 1 year and 6 months from the surgery. I have no pain due to the hardware, but I think it is limiting me to use the full force.
- I've noticed that I am now able to run without such a visible limp anymore, I have done only short distances so I am not sure how the knee will behave on long runs.
- I have almost full flexibility, what I can't do is 100% leg extension, I would say that there is a small difference compared with the good leg. Also I still can't kneel so that my but can touch the heel :), when I try to do this I feel pain in the knee.
- My muscle is much smaller then the one from the good leg, and I still don't have the same force.
- I am still protecting the leg with the surgery at subconscious level, but I feel that there is an overall improvement visible month after month, but is very slowly visible.


« Last Edit: October 10, 2019, 01:01:30 PM by axand »