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Author Topic: Transverse patellar fracture - early arthritis  (Read 4020 times)

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iain

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Transverse patellar fracture - early arthritis
« on: August 09, 2002, 12:04:00 AM »
Haven't posted to kneeguru for about a year.  Just wondering if anyone is in the same boat as me.  After sustaining a tranverse patella fracture 2 years ago (ruptured PCL as well) I am now in medical limbo.  Seen over 5 (including knee specialists) OS's who all have said that I have damage to the articular cartilage as the fracture is still appreciated (called a good reduction rather than an exellent one!).  All have said nothing can be done and I should expect to have a TKR in a decade (am only 27) Since, I was medically retired from my public service job.  I can exercise by riding a bike but weightbearing is painful.  

The OS who seem to know about PCLs say that this can not be fixed without possibly aggravating the PFS and vice versa.

I now longer seek medical advice as I think orthopeadic is a opinion subject rather than an exact science -  whats the point if they all say I have to live with it...!

I am interested to hear other peoples stories.  I have read alot about undiagnosed PFS problems but have come across only a few people on the old kneeguru site who have a specific problem through trauma.

Iain
« Last Edit: August 02, 2003, 02:05:24 PM by admin »

Offline Ross

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Re: Still have problems after a patella fracture
« Reply #1 on: August 09, 2002, 02:32:20 AM »
iain, there is really precious little medical science that can produce a black and white result short of death.  The human knee is an engineers' worst nightmare, a weight-bearing hinge joint, read the description and I think you'll see the conflict of concept.  Everyone gets a different result for the same given therapy, seems to me that the best an OS can go for is not to make the pain and suffering worse, anything you get is a positive result from there.

TKR in ten hey, they told me that when I mashed the cartilage in my left knee nearly forty years back playing football.  Go figure, it clicks and bangs loud enough to attract the attention of my stone deaf mate but it still works and doesn't give much pain.

I smashed my right kneecap in a fall back in March, worked very hard at getting the muscle tone back and the swelling down to the point where I was seriously contemplating not having surgery and simply carrying on with a three piece kneecap.  The recovery was pretty good but the fusion simply didn't happen.  

I've had a couple of screws and some wire put in to hold the deal together.  I'm two weeks post op, swelling and heat are still up but I'm working on getting back the rotation of the joint and rebuilding my quads.  It load bears ok but has a couple of points at which it protests when I try to bend or straighten it, it will come good given a bit more time and a lot more work!

You have asked five OSs for an opinion, have you had any tactile therapy/massage?  What sort of a personal exercise regime have you instituted?  The bike is good, low impact but I'd be a bit concerned at the prospect of pain under weight bearing two years out.  You'd have thought that the muscular encapsulation would have built up sufficient strength to compensate for the damage in that time

Do you walk at all, have you tried water aerobics? Discuss a tailored exercise regime with a sports physio to suit your specific requirements.  

It's your knee, I reckon you have a right to take charge of your recovery.  Utilise the management techniques that we are all taught in business and if a sub-contractor is not performing get another!

Good luck with it iain,  stay in touch.

Ross
I'm a grumpy old bear with a busted knee.  The growling you hear is my tummy rumbling!

iain

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Re: Still have problems after a patella fracture
« Reply #2 on: August 09, 2002, 02:04:04 PM »
Hi Ross
Walking can be painful & because of the PCL rupture I usualy where a PCL brace to stop instability.  I was a racing cyclist & runner pre-accident and now just purely ride a bike.  Sometimes it hurts my knee like hell but as it is the only one thing (over than my wife!) that makes life bearable I am out on the roads most days.
I have seen several physios and even a chiropractor but no-one i have found has come across a combination of a patella fratcure & PCL rupture - so they all are hesitant in giving advice.  I have been advised by 2 of these physios not to swim as this may increase the instabily caused by the movement of the tibia on the femur  (due to the PCL) when the foot flexs against the force of the water.

I hope you are starting to recover well and it sounds you have the right mentality to approach your recovery.
Speaking of recovery whats your end goal? - are you intending to return to sports or just aiming to get a quality of life back?
Good luck
Iain


Offline Ross

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Re: Still have problems after a patella fracture
« Reply #3 on: August 11, 2002, 02:56:33 AM »
Iain, mate, I am a pathologically fit fifty, you have to be with the tendency I have for high risk activities, it shortens the recovery time if you follow me.  I'm aiming at being able to do everything I did prior or finding ways to compensate.  I can't help myself Iain, I've been a participant way too long to ever become a spectator!

Once the rubber band/low stability feeling goes out of the knee I'll start sprinting on grass again, just short stuff.  I've been walking/hobbling a couple of miles a day since the kneecap was reassembled.  I think it's very important to try to behave as normally as you are able as it keeps your squash from atrophy.  Life is about experiencing everything you can, how ever you can as often as you want.  I don't see that happening with a  remote, a pizza and a six-pack!

I've always dragged myself through the water on my arms so the legs have generally been pretty near locked at the knees anyway.  I take your point for a looser style of kick but folks my age were brainwashed into a more formal stroke and kick regime.  I've been staying well away from butterfly and breastroke though!

Iain, your mind is an omnipotent source of wellbeing, use it as the primary tool of your recovery.  Think a bit laterally, when you ride the bike and it hurts have you considered the possibility that the action may be mechanically wrong now, have you moved the seat height/position or played with the crank lengths?  What sort of weight were you leg pressing before?  What can you do now?  

Have you lost length on the busted knee's leg?  Here's a real weird one, the alignment of your hips affects your lumbar spine, get someone to measure up to the point of your hip from the floor on both sides, add the lengths and divide by two, subtract the shorter length and that is the amount of pad you may have to insert to get yourself straight at the hips.   It's probably the factor of crank length reduction you need for the bike too!

Our skeletal structure is just another machine, it needs to be operating in balance and harmony to get the best result.  You'll get there yet mate, use your mind to find tricks and compromises to get you back to where you want to be.  Nobody ever laid down hard and fast rules about what you are allowed to do to live a normal life.

You've tried to get the surgeons to provide the miracle, they're really only technicians, the miracle is within you!  Take personal responsibility for your own recovery and don't be afraid to cheat a bit, winning is totally about performing your chosen crime and remaining undetected!

Good luck and a speedy recovery.



I'm a grumpy old bear with a busted knee.  The growling you hear is my tummy rumbling!

Offline troydonovan

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Re: Still have problems after a patella fracture
« Reply #4 on: August 21, 2002, 06:02:12 PM »
Ian

Yep, know the story, snapped my left kneecap twice, recovered twice and then finally the patellofemoral cartilage wore out. All that over the last 20 years.

I hate to say it, as I know how some advice makes you want to rip the messengers head off, but the recovery is possible. I recovered from the first to a good level, starting at age 11 it took a lot of pain and very careful management. I couldnt run, but later I skiied, played basketball and all other stuff. After the second injury, I recovered and a few years later raced mountainbikes at expert level, training 400km a week. What has stopped me now is my cartilage wore out, thats a whole new problem I am still fighting to find a way through, but I'm bothered if I will give up the best years of my life.

Sorry to say, after bolting the knee back togerther, the surgeons cant do much more. Good surgeons wont do any more! Good PT will give you the basis to set your focus, but it took me years of dedicated excercise by myself after PT to get my knee and leg into a good state, the pain drove me nuts but I worked around it sensibly. You have to be prepared for a long and hard recovery if you want to enjoy that which you do still have.

Sorry for the glum news. Hope this give you a new start. If you want some advice, let me know by sending me your email.

Troy

Offline ceciliamidd

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Re: Still have problems after a patella fracture
« Reply #5 on: November 06, 2002, 07:31:12 PM »
Hi Iain,
Sorry to hear about your story, my problem maybe is not the same as yours, but I am having a very hard time with my patella fracture. Last year on 9/30/01 I slip and fall at Walmart on a single grape and landed with my left knee, after that I had 3 surjuries, including the removal of the pins, I walk ok, but I lock my leg backward. My PT and doctor think that is all in my head and by mechanism of protection I bring my leg backword.
I don't have a lot of pain but stiff knee when the weather is bad and I take Bioxx and go away for a while. I guess my quad is not strong enough yet and the doctor think that I need to give it more time.
Are you still on therapy?? do you limp?

Cecilia


iain

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Re: Still have problems after a patella fracture
« Reply #6 on: November 06, 2002, 08:03:01 PM »
Hi Cecilia
Sounds a bit unfair of your OS & PT to say its all in your head.  It sounds like (as you mention) you have no strength in your leg so you are over-compensating whilst walking - I managed to build my quad strength up by using a stationary bike (actually my road bike set up rollers) whist being careful not to apply too much pedal pressure through the kneecap.  Maybe this might work for you.

To answer your question..I still limp, 2 years after the accident - even when it isn't painful I do not have the confidence to fully weightbear as I know an intense pain could arrive if I try to.  I don't have PT as the cycling beats any exercise they can think of.

I'm sorry to hear about the pain you still suffer, but it is refreshing to hear the story of some-one else who has suffered similar trauma.  I hope you manage to find a way to build leg strength whilst also receiving more encouragement from your PT.  In my lowly opinion your compensation mechansim is not psychological - your leg is simply not able (yet) to cope with full and unhindered weightbearing.
Good luck
Iain

Offline ceciliamidd

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Re: Still have problems after a patella fracture
« Reply #7 on: November 07, 2002, 04:45:37 AM »
Iain,
What kind of fracture did you have??mine is called communited patella fracture and my doctor did the best he could, but my quad is weak and my left leg where the quad is, looks slender compare to the other leg, I try everything from squading,biking, climber etc I do ok on the exercises, but when I try to put it together :o I cannot do it.
I feel very depress about the whole situation. The assistant of my doctor mentioned to me the other day that it could be muscle invalance, but I need to wait if I could try it on my own.
I am so glad that I foud this web site and I can share my misfortune with others.
Please be patient with my English, I am from another country and it is hard to write at times, but if you understand I am happy to share my experiences with this fracture.
I slip and fall at Wal Mart on 9/30/01 and this store has not giving me a penny for my surjuries or medical needs. Thanks god I got some money saved to pay my bills, and I also got LTD from work but is only 1/2 of my based salary, which it comes more like 35% of my salary.

Take care of yourself and if you have any suggestions please let me know. :)

Thanks

Cecilia