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Author Topic: Patella Fracture Recovery  (Read 2881 times)

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Offline MHB

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Patella Fracture Recovery
« on: July 18, 2004, 11:26:26 PM »
Read some site Success Stories, saw that commenters sometimes asked for rehab documentation, so here's the uncomplicated story:

4/4/04:
Horizontal patella fracture, 2 pieces
ORIF with screws, figure of 8 wires

WEEKS 1-5

FWB with immobilizer, walker, day 1
FWB with immobilizer, cane, day 10 - 5 wks

PT AT HOME, wks 1-5[/i]
Restrictions -- no knee flexion
Straight leg raises from back position only (OS Rx 150/day)
Patellar mobilizations
VMO isometrics
Walking, indoors and outside

COMFORT AT HOME, wks 1-5[/i]
Icing with Auto Aircast -- frequently
Elevation while working at computer (using adjustable hospital bed in dining room)
Johnson's Emu Oil Arthritis cream applied to scar 3x daily (after incision was healed)
Alleve, Glucosamine/Chondroitin, MSM, Calcium with Vitamin D, Vitamin C -- 2x daily

WK 1 SCREW IMPINGEMENT ISSUE-- at times, medial screw from fixation impinged on soft tissue around knee when walking over uneven ground -- quite painful.

WK 6 SCREW IMPINGEMENT ISSUE RESOLVED -- Impinging screw pain was being caused by swelling/immobilizer slipping downward over screw area while walking on uneven ground. Over time, swelling decreased, which helped. Also, took care that immobilizer didn't slip downward while walking around outside.  After formal PT started, therapist-suggested exercise finally removed issue. (Sit on bed, legs swinging free, put pressure from moving thumb over screw point while continuing to swing leg back and forth)

WEEKS 6-12

FWB cane, 5 wks, ROM about 1-40 degrees

FORMAL PT, wks 6-8[/i]
Started wk 6 (2x wk for 2 wks, then 1x wk for 2 wks)
Restrictions - No weight bearing on bent knee exercises allowed
Activities - demonstrated home program, some propioception work
ROM 0-135/Gait normal, wk 7
FORMAL PT ended, wk 8

COMFORT AT HOME[/b], wks 6-12[/i]
Nike Airs for walking
Arnica gel applied to knee area after at home exercises
Icing with Auto Aircast after at home exercises
Elevation while working at computer (using adjustable hospital bed/laptop placed in dining room)
Alleve, Glucosamine/Chondroitin, MSM, Calcium with Vitamin D, Vitamin C -- 2x daily
Driving resumed, wk 6

PT AT HOME, wks 6-12[/i]
VMO Isometrics (sets of 25, reps held to 10 count, 3X daily)
Calf risers (sets of 50 2x daily)
ITB, hamstring, calf stretches (3 times daily, sets of 3, hold reps 30 seconds)
Straight Leg Raises (from 4 positions) -- set of 25 for each position, 3x daily, hold reps to 5 count, gradually added weights above knee to 3 lbs.
ROM flexion- sets of 8, 5x daily for 1 wk, then 3x daily for 3 wks, hold reps 30 seconds
Short arc extensions, added wk 7 (set of 100 3x daily)
Bridging, added wk 8 (set of 40 3x daily)

WK 7 MALTRACKING ISSUE[/i] - maltracking during ROM flexion, occurred when using seated on floor, back against wall, feet flat on floor position --  slide knees toward chest. (No maltracking from other ROM bending positions or in normal usage)

WK 8 MALTRACKING ISSUE RESOLVED -- ITB adhesion near upper lateral kneecap was probably causing the maltracking. Bridging exercises apparently tore most of it loose. (Strong, sharp, uncomfortable pull there for first 3 days when bridging. Knee appearance changed quickly about then, too -- lateral edge of quad tendon became sharply defined, when previously there was no obvious edge.)

ALTERNATIVE THERAPY -- 2 Rolfing appts (idea came from kneegeek Heather M's posts here -- thanks Heather)[/i]

Appt 1 (wk 10) -- Therapist released adhered ITB in 3 small areas along lateral quad and at point of femur, released adhered fascia on injured leg's hamstrings/quads. Suddenly they had more room in which to do their work, so massage effect was felt immediately in comfort level and measurably in ROM.

Appt 2 (wk 11) -- Checked the status of appt 1 work, then work on uninjured leg thigh muscles. Again, releasing the adhered fascia helped overall comfort level and balance. Also some lower vertebrae fascia work.

WEEK 13 - OS RELEASE

No more restrictions, home PT discontinued, gait normal, ROM 0-150, pain level 0. Hardware should remain unless troublesome in the future.

CURRENT ACTIVITIES: [/i]
Continuing SLRs with 3-lb. wt, VMO isometrics, stretching, short arc extns, bridging 1x/dy (will discontinue this routine gradually as alternative exercises take over)
Normal stair climbing (finally!)
Normal inside and outside chores
Nordic Track (no resistance, no incline) -- 30 min/dy (will gradually increase to 1 hr/dy)
Walking about 1 mile a day around the yards (8 laps) on grass over moderately hilly terrain

COMFORT AT HOME[/i][/color]
Icing with Auto Aircast after Nordic Tracking
Alleve, Glucosamine/Chondroitin, MSM, Calcium with Vitamin D, Vitamin C -- 2x daily until future date

Hope this helps someone else with patella fracture at some point. Best of luck to all kneegeeks.

MHB,  retired kneegeek (I hope!)
« Last Edit: July 31, 2004, 06:35:27 PM by HHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04

Offline MHB

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Re: Patella Fracture Recovery
« Reply #1 on: August 24, 2004, 06:20:16 AM »
5 MONTHS (20 wks)

CURRENT ACTIVITIES

Maintenance SLRs (3 lb. wt), VMO isometrics, short arc extns, bridging -- 3x/wk
Stretches -- 2x daily (added psoas stretch)
Nordic Track (no resistance, no incline) -- 1 hr  3x/wk
Walking 2 mi/dy on grass over moderately hilly terrain
Jogging slowly for short distances daily
Kneeling/sitting back on heels (at last!)

ISSUES

Small amount of swelling remains
Still a few "sticky" feeling areas

MHB
« Last Edit: August 24, 2004, 04:00:42 PM by HHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04

Offline MHB

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Re: Patella Fracture Recovery
« Reply #2 on: November 22, 2004, 02:27:20 AM »
EIGHT MONTHS (33 wks)

CURRENT ACTIVITIES

Stretching, walking, Nordic Track, normal outdoor/indoor chores and activities, working at computer as pre-injury, life seems fairly normal now.

ISSUES

Until 6 mos out, moderate swelling and heat, but not painful. Have been on Celebrex for the inflammation for almost two months. For the first two weeks of medication, no noticeable change, but then rapid decrease in swelling (very small amount remains below cap but tissue is soft now instead of tight and hard) and heat has disappeared entirely. Will continue on Celebrex for one more month.

Further on, the medial screw "fit" might be an issue -- seems to dig into quad tendon if certain postures are maintained for a long time (i.e., sitting at work) -- will just wait a bit longer to decide.

In the meantime, feel very lucky to be living with a knee that works as well as it did pre-injury and does not hurt -- no complaints, just gratitude. Was quite happy to say goodbye to heat, swelling, icing, the rest.

Take care all, best of luck in your own recoveries of course.

MHB
« Last Edit: November 22, 2004, 02:34:18 AM by HHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04

brattkids2

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Re: Patella Fracture Recovery
« Reply #3 on: November 22, 2004, 10:10:32 PM »
Its so nice to hear of success stories.

Gives those of us with problems HOPE that   one day we can be pain free.

Thank you
Paulette

Offline MHB

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Re: Patella Fracture Recovery
« Reply #4 on: April 05, 2005, 11:06:49 PM »
ONE YEAR -- April 4, 2005

CURRENT ACTIVITIES[/I]

Just the normal stuff, inside/outside. Some Nordic Tracking, stretching.

ISSUES[/I]

None to speak of really. Still small amount of "fill" below cap. Still have one screw tip poking out a bit, doesn't hurt. Also, the injured leg's circulation doesn't match the uninjured one -- sitting at work for long hours can puff up an ankle now and then.

On the whole, however, no complaints, knee is pain-free and seems to work just like the other one. Again, am so grateful to that terrific surgeon and for the information/support I could obtain here when I needed it.

Best wishes to all for complete, comfortable and speedy recoveries. -- MHB
« Last Edit: April 08, 2005, 08:06:56 AM by MHB »
4/4/04 - Horizontal patella fracture
4/5 - ORIF 2 screws, figure8 wire, immobilizer, walker
4/16 -  cane
5/10 - no immobilizer
PT -- 5/17 to 6/8
OS Release - 7/12/04















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