Fracture of Patella

[shubbaz]

Hello from Australia . Just a few questions please. Nearly 6 weeks ago I fractured my patellar in a fall. I have been in a plaster cast from thigh to ankle since then, and walking with crutches. I am due to get the plaster off on Tues 19th Oct, yeehaa! This is great as the darn thing feels very tight right now. I'm just wondering what sort of rehabilitation I will be needing, and for how long.? I didn't have to have surgery as the kneecap was not displaced. I will have to have another xray(the 4th), when the plaster comes off to make sure it has knitted properly. Are there any complications likely? How long does it take to get the knee back to normal flexion? How soon will I be able to drive again.? OMG I hope its knitted properly, don't know if I can stand too much more of this inactivity.

A local GP who I saw when I first went into hospital, sent in a report to Work Cover, saying I would be fit for work on the 20th(day after the deplastering?) What an idiot! Doesn't he know I would have to have rehabilitation for it, whether it is hydrotherapy or physio? I've told work cover, I will go by what the Orthopedic Specialist says, not that other local doctor.

Ok, hope that is not too many questions, Cheers Cheryl

[sienna]

hello from another aussie.

Well I have spent most of the last year and 1/2 dealing with wc so you could say I know it fairly well.
Your med cert should be written by your os anyway. I only got one from my gp when I knew I needed to cover a gap between appts and the cert was running out.

Obviously you will not be able to return to work immediately after having the cast off. Your leg will be stuck fairly much in the one spot. I had a splint for 6 weeks which I took off to bathe and my leg was stuck bent except for a few degrees. and don't forget the muscle wasting you will have.
I strongly recommend hydro as well as pt. I hate gyms so that was not an option for me and hydro is much more supportive. If you come across any part of rehab you don't like, say so and make sure your os is very specific with what he wants. Wc have a standard rehab they like to follow even when it is totally inappropriate. Do not let your os tick the 'yes' box on the gym request form unless you are happy to go to a gym for 4 wks with a personal trainer. If not, he should tick the 'no' box and then write hydro and pt down in the comments section. The pt should be able to come up with a hydro prog to suit you and they can monitor it. Otherwise you end up fighting wc which is not very nice.

Don't pay for anything. wc will not always reimburse you the full amount.

Don't agree to a return to work (rtw) plan that you think is too fast. Speak up and fight it. Their motto is to return you as fast as possible with little regard for your actual welfare.

Now before I scare you anymore, please understand that I am not trying to. It is easier to rehab if you know how wc works. As far as they are concerned, you are a number and they don't care.

Please feel free to IM me if you have any questions about wc etc.

Good luck with the cast removal. I hope that your patella has knitted well and you will be off to rehab in no time.

Take care and keep us posted. 8)

[shubbaz]

Hi Sienna, thanks for your reply. Its nice to get some input from other people that have the same sort of injury. I'd like to know a bit more about what sort of pain I can expect from a non-surgical fracture of the patella during rehab. Do you think the hydro option is the best at first? Should I visit my physio first and get assessed as to what sort of rehab I need? Or should I take the Ortho guys advice first up? Am I allowed to go and see a Physio straight up? Cheers Cheryl

[shubbaz]

Hi Sienna, guess I should have asked you a few more questions? Well, we live about 13 kms out of Renmark SA. So what happens if I can't get a ride into town for my rehab? If I have to get a taxi, can I get the Taxi guy to give me an account, and send it to WC? Actually, the taxi guy is hubby's cuz, so probably wouldn't be a problem with it? this is cos' you said don't pay for anything. I can only get into town at the moment, if it is convenient for hubby's mum. She is an old age pensioner. Nearly 80. Can't expect her to haul me into her car all the time hey? WC have told me to pay for any taxis I might need and they will reimburse me? I haven't got $28 on me all the time to pay for this? Ok Sienna, any ideas from you will help. Cheers Cheryl

[sienna]

Hi Cheryl,
With rehab, your os will more than likely send you to pt first as it will be the pt who will design the hydro program. The pt will assess you and then should go to the pool with you and show you what s/he wants. You will also probably need some hands on treatment as well. don't go beforehand unless you have approval from your wc case manager otherwise they may get stroppy. But as soon as your os says so, go.
Travel wise, I had to pay up front for the taxi to pt while I couldn't drive and then send it in for reimbursement. When I said don't pay for anything I meant in terms of medical appts. Sorry I should have been more clear about that point. I found that my wc case manager fairly prompt with payment of taxi fares, one of the few things she was prompt with. Just send in the receipts with a sheet outlining what they are for. If your cuz is willing to come to some arrangement then you are lucky.

Just to clarify things, I didn't injure my patella. I had a meniscal repair. That is why I had my leg in a splint for 6 wks. That is why I know about knees that have been immobilised for some time. I did have a friend who fractured her patella and I know she was quite sore for some time. I'm guessing it is because your patella is central to the mechanics of your knee. You could try posting down in the patella section for some more ideas about rehab. But I'm thinking that it may be similar to what I had to do.

Do you have a sedentary job? You may only need a few days after the cast is off before you feel that you can handle some return to work. I would think that straight after the cast is off, you should go and see the pt. The quicker you can get going, the better. Ring your os office and ask him if he is going to send you to pt. And ask him to let wc know so you can book the appt for the same or next day after cast removal. Don't worry, they will be gentle......for the first time, after that, well.....You've read the 'I hate pt' post. ;D

How is your work? Are they supportive? I hope so.

Well I hope I've answered your questions so far.
Take care. 8)

[shubbaz]

Hi again Sienna. Yes, you have covered a lot of my queries, thankyou very much for that. I have already talked to my physio about my knee and he said they would assess me and probably send me off to hydro first up, so will see what the os says on Tuesday. Cheers Cheryl

[shubbaz]

Hi again sienna. Forgot to say that I am a gaming manager and bar attendant, so my job is on my feet. And yes my work place is very supportive, no probs there. Off to get plaster off in the am. I guess I will still need my crutches for a while? Cheers Cheryl

[sienna]

Hi Cheryl,
It's great that you have a good supportive workplace.
Not so good that you are supposed to stand up all the time. Can you get a stool to rest on?
Good luck getting the cast off. Your leg will look awful (yeah thanks for the encouragement, she says ;D) But it will be good to get rid of the cumbersome cast. Did everyone sign it for you?

Just make sure you have told wc that you will be getting another med cert. You should be able to fax it to them first, then send on the paper copy.

I would expect that you will be on crutches for a bit longer. I guess it will depend on how fast you can stand weight bearing and what the os wants you to do. Just be careful as your leg will be vulnerable and so are you.

Let me know how it goes.
Good luck,
Tanya

[shubbaz]

Hi there Tanya, well got the plaster cast off yesterday, complete with lots of signatures and AFL footy scores(grand final and semis). Like you said knee looks pretty darn awful(very swollen). It really doesn't feel like the leg really belongs to me at all. Very weak and still on the crutches. Can bend the knee very slightly. Off to the physio tomorrow, so he can work out a hydrotherapy program for me. That's what the OS wants me to do first up. Doesn't want me forcing anything at all. Told me to be very careful. I must not fall over. I got a referral form for the physio, and also a medical certificate till 19th of Nov. After that I have to deal with local GP if I need any extension for rehab. He said I probably won't be able to drive for another week or so till my leg has more flexion and strength. OS said that once I can drive, I could possibly go and do some office work or some other sedentary job(folding serviettes maybe?). Oh well, we'll see how it goes eh? Will fax OS medical cert. in today to WC. Actually, WC case manager left me a message to ring her. I'll wait till she rings back. Why should I pay for the phone calls? That's the second time she's done it. Cheers Cheryl

[sienna]

Hi there,
Swollen, hey. What did he say to combat that? Ice and elevation?

Yes I should have sent in for phone call reimbursement seeing as I made enough of them. But my 5th case menager was such a you-know-what. She was very unprofessional at times. I should have reported her but what would have been done? Probably not much. And I had enough hassles at the time.

Glad that you are off to hydro. Is the pt going to do any ultra sound etc? and your os is right. Do not fall over. I know how much you want to. I know you will be careful.

So you are off til the 19th. Hopefully by then you will be more mobile and off crutches. How are your folding skills? Did you pass serviette folding 101?!
NOt driving will drive you insane but os is right. It was more than 8 wks before I drove and then only short distances. You'd be surprised how much movement is required when driving.

good luck at pt/hydro. Make sure that wc pay for the pool membership, too. And make it clear that this is what the os wants.

Take care,
Tanya

[shubbaz]

Hi Tanya, well faxed in Med Cert from OS to WC. and then waited for Case Manager to ring me back. She hadn't received fax, but I read out what was said on the cert. She was rather peeved that the OS had given me another month off for rehab. I said that as soon as I can drive on my own, he said that I would be ok for some sedentary work - office work, serviettes or whatever. She doesn't sound very nice to me. But I will follow OS advice, and will go to local GP of my choice for any further advice hey? I see the physio on Thursday for assessment, and hydro program. Will keep in touch. Oh, and the OS never said anything about swelling. Ticked no further review on the med cert. Guess the physio will give me more advice tomorrow? At least I'm sitting here now at the puter with my leg slightly bent. Still very weak, and using crutches. Cheers Cheryl

[sienna]

H,
So let me get this straight. The os ticked the 'totally incapacitated' box and also 'no further review' box? I find that strange. This means that he doesn't want to see you again to check on your progress. Is he assuming that you will be fine and that a GP can check your progress? Nothing against GP cos I love mine but she is not qualified to make the sort of decisions that your os is assuming they can.
I would be querying that one with his office. He should see you at least 2 more times. One at the end of this cert, to see how you are going, and another in about a month's time after that, to see that you are still on track and if anything further needs to be done. I would insist on this. He is supposed to be the qualified one who oversees your recovery. That is part of his job.

As for your cm, she can get stuffed. I had expected her reaction. Ignore it. Their motto is to get you fixed and back to work as fast as possible to save money and time. It is on their website page, no less. They don't care if you are better or not. Don't let her bully you into returning until you are ready.

Towards the end of your current med cert, you will probably be sent to an OT who will look after your return to work prog. (rtw). Do not let this person bully you into a prog that is too fast. I had to fight mine all the way. I even had 2 of them because I complained about one of them. But they were both the same. Interested in getting me back to work as soon as possible. If you don't like something, don't sign it and speak up. I am guessing that your rtw will be slow because my friend who fractured her patella had probs for some time and ended up having to take 3mths off because she came back too fast.
You have got up 6mths before things change a bit, but I will tell you about that another time.

Your work will have a rtw person too. Hopefully this person will be on your side. It does help. You said before that your work was very supportive so you shouldn't have any probs from them.

Good luck with the pt today. The water should feel good for your knee. I loved it. Just remember pools are very slippery places so be very careful and take your time.

Catch you soon.
Tanya

[sienna]

PS With the swelling, you should ice it and keep it up. Your pt will probably tell you this. If it continues, then you may wish to ask for some anti inflammatories. There are some good ones on the market today, and they are much gentler on the stomach. I used celebrex. It was fabulous.
I forgot to ask how your pain levels are. I hope it is not too bad.

[shubbaz]

Hi Tanya, thanks for all your advice. Its nice to know that there is someone out there who can give me an idea of what to expect hey? Actually, at the moment, pain level isn't too bad. But there hasn't been any manipulation as yet. Ankle was up last night like a balloon. I will be getting the ice onto knee today, and keep it elevated a bit more. Yes, I thought it was rather strange that the OS didn't want a further review, but if required I will be demanding it don't worry. The reason I worry about my low pain threshold, is that if I'm in a lot of pain, my blood pressure goes up sky high! Something like 200 over 120 or there abouts. It happened when I fractured the kneecap. They were quite concerned while I was in hospital, and taking blood pressure every 2 hours till it went down. Took 2 days, but finally went back to normal. It's happened before also. Ok better go and get ready to head for town and Physio. I will take it easy in the pool no worries. Regards Cheryl

[sienna]

Have you discussed the blood pressure prob with your GP. Perhpas you need to take some mild meds to keep that in chek because once the manipulation starts, lots of pain. Well there was lots for me and I have a fairly high tolerance.

Good luck,
Take care,
Tanya