Open Patella Fracture (Displaced Comminution) ORIF- Stuck at 30 Degrees

[brokekneeme]

Not the 1% I dreamed of being a part of but here I am. I'm a 31 year old active and healthy male. On July 26, 2019, after a night of drinking after a concert, came to on the bottom of concrete stairwell with knee bleeding. Took ambulance to ER and was found to have 1 left rib fracture, closed left ulna fracture, and open left patella fracture. You could see bone in my gashed left knee. Underwent emergency surgery (ORIF) where 4 patella fragments reassembled with 8 screws, wire, and mesh plate. They said procedure went well with excellent articular reduction and stable fixation ROM 0-30.

Pausing here to say this is the most irresponsible accident I caused from drinking. I was alone at the accident and hospital with no one knowing I was undergoing surgery as they took my phone away. This will forever be a consequence I need to learn from and improve my life for the better moving forward.

After procedure, I stayed in hospital for 4 days. Once discharged, it was agreed I temporarily go back home to parents as I needed assistance as my left leg and arm were immobile. Discharge notes were 1st week postop, WBAT in hinged knee brace locked in extension all times. 2nd week postop, WBAT in hinged knee brace locked in extension, OK to unlock with PT for ROM 0-30 while NWB, and sleep in brace. Starting at week 6, OK to increase ROM 30 degrees per week until full ROM.

• 2nd week postop: Saw new OS in hometown and had sutures removed. Large wound still present so advised wet/dry for a week.
• 3rd week: OS said to start PT. He set aggressive goal of 90 degrees in 3 weeks. At home, can start quad flexing and assisted leg bends. Only able to bend to 20 degrees at home.
• 4th week: Had 2 PT sessions. 1st session- 20 degrees flexion and 2nd session- 24 degrees flexion. I feel I was mostly nervous and muscle guarding with first time out of brace and PT manually flexing. Exercises given: isometric quad (towel under knee), heel raises, hip abduction, lateral weight shift, bend knee at rest for 5 minutes.
• 5th week: Had 3 PT sessions. 1st session- 30 degrees flexion, 2nd session- 35 degrees flexion, and 3rd session- 40 degrees flexion. I was greatly discouraged by lack of improvement. Same feeling of tightness in muscle and knee at 30 degrees. Additional exercises given: heel slides (lying and seated), half squats (in brace), and hip flexor.
• 6th week: OS reviewed updated knee xray and said looked good. He said I need to stay in brace locked until quad strength improves. I expressed concern for knee only being able to bend to 30 degrees for past weeks. He said it wasn't hardware and that it was soft tissue. Said to keep doing PT and if don't hit 90 degrees in 4 weeks will need to do MUA. Due to insurance, hold up in continuing PT as they have to approve every 5 sessions for more.

Concerns/Questions:

• Main concern is lack of bending and behind OS's schedule. I wanted to make sure it was not being caused by non-soft tissue issues such as hardware, ligament, or tendons. He just said it was only soft tissue without checking anything. Is it worth confirming it's not a non-soft tissue? Does MRI show that? Worried that if I do get MUA.
• What does it feel like when soft tissue is causing no bend? When my knee bends to 30 degrees I feel it reaches the max. It gets tight on top above and below the knee then with force pain and pressure behind knee on right side. Only at last session did PT start applying force when max bend is reached.
• At what point is finding a different OS or PT necessary?
• I'm doing my exercises 2-3x day and feel there is never improvement getting further than 30 degrees. Reading others experiences I feel the most behind so not sure if my case is anything different. I'm now waiting for more PT and will see where I'm at in 4 weeks.
• Bummed my life is on hold and out of work on medical leave for most likely the full 12 weeks I'm allowed. Trying to stay positive with meditation and gratitude and keeping busy taking coding classes and of course watching tv.

Thanks for the vent and hope to update soon with improvements!

[Pamela339]

Hi BrokenKneeMe,
This is my first post here, so thanks for inspiring me to dive in. How's the bending now? If it's better, how many degrees progress did you aim for a week?
In short I broke my knee in two pieces on 10/9, had ORIF surgery (yeah, that's probably not the right language) on 10/15, and after my second post op 11/4 I started PT. It's brutal, but I can't bend past 30 degrees yet. 6 times a day on my own I bend my knee, then bend it over rolled towels. Every couple of days I add another folded towel to the pile. My PT comes to the house twice a week, though next week we'll start three times a week. Also, I do 7 exercises twice a day, 10x2 sets. My quad is finally starting to fire.
The goal is to have me at 60 degrees by my next post op which is 11/25. PT is very aggressive, but I have no context as to what the norm is. There doesn't seem to be one.
I hope you're doing better. Glad you posted.