Patella fracture post-op help

Tibial plateau fractures, femoral fractures, fractured patella
hjmblondie
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Patella fracture post-op help

Post by hjmblondie »

Hi everyone! I have been reading everything I can find to read on this site regarding patella fractures. It seems like there are a lot of people with some solid knowledge on the subject. I did not get much info form the doctor or nurses after my surgery on 11/21/06 and I don't go for my check up until 11/30/06. Maybe you all could help me figure out a few things.

Here is some background info:
I received the injury as a result of a car accident on 11/15. I think my knee hit the steering wheel. My knee cap broke in half horizontally and was approx. 1/2 inch apart in the x-rays. On 11/21 the OS repaired the fracture with an implant using a figure 8 configuration. Once he opened my knee he found that I also suffered a lot of cartilage damage. He tried to clean everything up as best as he could. He is a highly recommended surgeon so I at least have confidence in his skills.

Maybe someone could help m figure out the following:

1. I have an immobilizer on my leg going from my upper thigh to my ankle. How long until I can shower? I have been reading that I should not be putting any weight on the leg. Not sure how to shower or when. I have been sponge bathing and could really use a real shower!

2. My whole leg feels tight and painful anytime I get up and start moving around on crutches. I can't even lift my leg up on my own to get in bed or on the couch. How long until I might be able to do these simple tasks.

3. I have a lot of pain at night in my legs and I was wondering if anyone has taken Unisom with Vicodin? I am assuming that would be ok to get me to sleep. It is just so hard to get comfortable.

4. Is it normal to have bruises & swelling on my ankle? For some reason this has occured and I'm not sure if it somehow from the surgery or how the ankle hangs where the immobilzer ends. Even when it is elevated it hurts. I have also started having bruising and tightening of my thigh and muscle around my shin. Is this common?

Sorry for all of the questions but I am just trying to figure everything out. Also, if anyone has had a similar injury what can I expect as far as recovery time? Thank you everyone ahead of time for any help.
Last edited by hjmblondie on Mon Nov 27, 2006 10:17 pm, edited 1 time in total.
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Megwi
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Re: Patella fracture post-op help

Post by Megwi »

Hi,

I didn't have a fractured patella but may be able to help on a few points as I did have surgery to repair TPf and had a scope to remove meniscus.

1) I had an immobilser as you describe but after my bandages came off I couldn't stand feeling so dirty so took it off and showered. As long as you keep the wound dry and can easily get in and out of the shower cubicle you should be ok. I was able to weight bear so it wasn't too much of a problem...but do be really careful not to slip over etc.
2) Don't know what your pain meds are as I'm in the UK. I think its pretty much a given that sleep is an issue. Getting comfortable in those braces as well as post op/injury pain will make it very hard....I was taking all the pain meds I was given but didn't have any sleeping pills. It does get better once you get used to the brace and the pain eases.
3) I had a very painful ankle for a long time. It was swollen and bruised. Don't forget its another joint which isn't moving as it should, and is lower than your knee so fluid blood etc will all drain in that direction. Theres not much you can do abou it to be honest. Mine still aches occasionally even now...(nearly 1 year post injury).
4) it was months before I could lift my leg fully. Don't forget your muscles atrophy very quickly. You have suffered a major trauma and now surgery. You need to have time to recover. It takes about a month just to rid your body of the anaesthetic alone. I still experience aches in my leg most of the time. I still don't have full ROM back so if its not being fully used you have to expect aches and pains.

Hopefully your recovery will go well but you do have to prepare yourself for a long recovery. I wouldn't bank on it being fully better for at least a year........hard to hear I know!!

Best advise I can give is that you take each day as it comes and try to find something positive to focus on each week recovery wise.

We have all been through it and come out of the other side ish...........be patient and keep your chin up.

Meg
Ski fall Dec '05
MRI scan Jan 06
Surgery Feb 06 (TPF with ACL 1 screw, arthro meniscus removal)
Out of immobiliser May 06 and into PT
Scar tissue/ROM issues.
57 PT sessions.
Finished PT Jan 07 with nearly full ROM PT said "youve got more than I ever thought you'd get."
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Re: Patella fracture post-op help

Post by jm121205 »

Hey, welcome to the site. Sorry you are here because you have been through this.

Showering: I put my foot in a garbage bag and taped the top closed. You should be off water restrictions soon, so then you have more options. The other thing I was able to do because I had two braces was to wrap the wound in plastic wrap, like you use for food and then wash. It is a drag, but they are trying to keep the incision clean and dry. So that is why they are not letting you shower. My partner put in a hand held shower head so it was much easier, so if you have that option, I would highly suggest it.

Meds: Call the pharmacist. For some reason people think they can only get this from the doc, but actually the pharmacists know this stuff as well or better and they are easier to get ahold of. DO NOT TAKE ASPRIN with out an okay from your surgeon

Leg lifter: They gave me a leg lifter which is looks like a dog leash but has a metal rod in it. I hooked the end around my foot and hoisted my leg up and down when getting in and out of bed and the couch.

Brusing: You have been through two traumas, the accident and the surgery. The brusing is normal. Ice helps as does the vicodin for the swelling.

It will be a year for me in two weeks. I know how frustrating this is to hear but you are going to have to give it some time.

Take care of you and remember to be nice to yourself as you continue down the road of recovery. It's a bitch. Judith
11/1/05 clean patella fracture
12/12/15 shattered patella, emergency surgical repair
2/06 to 4/06 attempting to convince them something was not right
4/26/06 recheck with surgeon: original break not healing and wires from surgery broken
5/26/06 Second Surgery
8/16/06 no more brace
hjmblondie
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Re: Patella fracture post-op help

Post by hjmblondie »

Thank you so much for your responses so far. It is nice to hear from others that have been through this. I am trying not to let the recovery time get me down. It's really hard not being able to walk or stand up without crutches especially since I have a 7 month old baby. I feel bad that my husband has to do everything for us. I am pretty active so that is the hardest part. The pain seems to get better every day but the sleeping is still an issue. I will try calling the pharmacist as suggested. Also, the strap for lifting the leg sounds very helpful...I think we will try to make something like that.

One more question: when do you generally start physical therapy?
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Re: Patella fracture post-op help

Post by cah7 »

Hi! Sorry to hear about your injury - it is definitely not an easy thing to go through................but it does get better, so hang in there!
Your OS should let you know when it is okay to get the incision wet in the shower. Until I could do that I used one of those shower stools (I had one from when my mother broke her hip some years ago) but I think any kind of seat could work. I set it so that my injured leg could stick out of the shower to the side and I also wrapped the leg in a plastic trash bag. It was kind of awkward and I got a lot of water everywhere, but the leg stayed dry! And it sure felt great to be able to wash my hair in the shower. And I still remember my first "stand up" shower when I was finally allowed to weight bear - it felt so great I think I stayed in there until the hot water ran out! :)
It was awhile before I could lift my leg at all on its own - several weeks after I finally got out of the hospital. I did lots and lots of quad sets and was finally able to lift my leg a whole shaky inch, but it felt like a great achievement! I remember "showing off" to some friends who had come to visit. :) My PT explained that besides the atrophy from not using the muscle and the trauma to it from injury and surgery, your body also shuts it down as a means of "self-protection". It knows you're hurt and is trying to protect the leg and keep it from moving. So you have to "wake up" the muscle again.
Everyone's recovery time is different.....a lot depends on the specific injury and how your body heals and that will determine when you start PT. Your fracture has to heal enough to be stable for PT. Your OS can give you a better timeline. He might also be able to suggest some simple NWB exercises that you will be able to do at home before you start PT. He will not let you start PT until he thinks the bone is strong enough to stand up to the exercises. My OS was conservative on starting PT since my fracture was not well stabilized by the surgery in Russia and my post op infection slowed down the healing process. As he put it..........he didn't want me to have come so far and then damage it again by starting PT too soon. It was frustrating, but I knew he was right.
I know it seems to take forever, but you will get there! I didn't always feel like I was seeing progress day to day or even week to week , but then when I would look back I would realize how far I had come. I set high goals for myself in recovery and always kept those in mind, but also learned to celebrate all of the small achievements and milestones along the way.
Take care!
Cathy
7/30/05 fell backpacking in Russia patella fracture
7/31-8/5 ORIF& postop infection Russian hospital
8/5-8/13  flew home-hospital in States
8/13 out of hospital NWB straight immobilizer
9/21 Bledsoe brace
9/26 PWB
10/17 no crutches
11/1 wrap brace,PTstarts
11/28 back to work
1/31/06 PT ends
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Re: Patella fracture post-op help

Post by hopes »

hjmblondie,
11 months ago, my patella was broken [displaced fracture; three pieces; large damage to articular cartilage; ORIF with two pins and figure 8 tension band]; after immobilization for 5 weeks, surgical clips were removed and PT started.
Some points that may help:
a) Get clearance from OS to do certain excersizes at this time while you are immobilized
b) Before you start your PT, get clear instructions from your OS as to what are the restrictions [not to do] and what are the ermissible [to do]. There are certain excersizes that MAY cause more damage to the cartilage.
c) The VMO is of great importance. Work hard to strengthen the VMO
d) I was cleared for FWB from the second day. Move around in your house.
e) Follow up with your OS to make sure the patella is healed and "united". Some cases it heals with "fiber tissues". Once it is healed and united, you may go for hardware removal

ONE FACT YOU HAVE TO KNOW: Patella fracture is the most notorious fracture; frustrating; long way to go

Best of Luck
HMG
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Re: Patella fracture post-op help

Post by JAZZY »

I had a TPF so don't know too much about patella--but
1. A shower chair really helps a bunch. I put it in the tub and then my husband helped me get my weight into the chair. I rested my leg on the side of the tub. It is awkward but it is better than nothing. After they removed the staples I could get my leg wet. Best shower in the bathtub in my life and boy did I make a mess.
2.My ankle sometimes bothered me more than my knee did, and my foot turned a gorgeous shade of pink (still does a little) and really was painful when I could first lower my leg--going to the bathroom was very painful. If you have problems get one of the handrails that go around the toilet. It will make it easier.
3. I think it was quite a while before I didn't have to lift my leg with my hands when I was moving. I don't think I could even begin to until I was out of the immobilizer so that was about 8 wks.
4. My leg still feels tight around my knee and is numb around the incision where they put in the plate. Most everybody says that their knee feels different. Mine still feels like there is a block of wood that I am trying to bend around and it has been 16 wks.
5. Elevate and ice are your friends now. They will help with swelling and pain. And take the pain med before the pain hits 10. Manage your pain--you aren't being a wimp!! If what you are taking doesn't seem to help talk to the doctor. I agree that you don't want to mix medication until you talk to the doctor or the pharmacist. Sleep is really elusive for quite a while. Sorry I can't give better news in that dept.
6. Make a written list of questions to take to your doctor. And if you can have another pair of ears in there next time you go. They may remember a question that you forget.
7.If there is one thing I have had to learn with this it is patience. This is not easy to get over and will take a lot of time. Hang in there, and talk to us. Believe me, we understand just where you are coming from. Someone around this board can help with just about any question. And we all know exactly how you feel. As so many have said before....not that misery loves company...Hang in there!!!! ;D
8/11/06 Lateral TPF with displacement
8/12/06 9 Screws,plate
9/5/06 Begin PT, ROM only
9/19/06&nbsp; PT-ROM, 25% PWB
10/9/06 PT Adv. WB, ROM 67-13
10/27/06 WB, Rom 75-8
11/19/06 WB, cane ROM 88-8
12/5/06 WB, cane ROM 107-8
1/3/07 WB, cane ROM 114-3
1/25/07 ROM 120-0
8/11/07 Keeping hardware
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Re: Patella fracture post-op help

Post by rye_70 »

Sorry you had to even look for this site, but welcome. I love everyones suggestions so I don't have much to add. This is a great site to have so you don't feel all alone with your injury. Feel free to ask any question, because I'm sure someone here has delt with it or heared about it.
9/1- tp fracture
9/6- plate & 8 screws
       immoboilizer brace
9/19- bledsoe brace & ROM exersises
10/17- four more wks of ROM exersises
11/14- 10 wk app. OS called in sick  lol
11/21-WB with cane or crutch
12/1- back to work(construction)
12/8- gave up cane
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Re: Patella fracture post-op help

Post by ellie1 »

I'm so glad I stumbled (pun intended) onto this site. I read your message with great interest and empathy. I had surgery for my patella fracture on 11/22/06. Your questions and the replies have been helpful. Thanks. I do have another question, though. How soon did folks feel okay to go back to work? My workplace can modify my job somewhat, but right now I get exhausted from even the smallest effort and still have a hard time getting and staying comfortable. I also interface with patients and families most of the day (I'm a nurse in an outpatient psychiatric setting) in groups and one to one and have not quite mastered a graceful transition in sitting to standing, etc. I love my job, but I also promised my spouse and doctor that I would take care of me first. I'm working on staying positive, but, as you all know, those blahs can sneak up on you. Your wisdom and experience is most appreciated.
11/16/06: fractured patella
11/22/06: surgery 2 screws; figure 8 wire
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Re: Patella fracture post-op help

Post by JAZZY »

I was off work for 12 weeks and even now (16 wks.) I am doing most of my teaching from a wheelchair. It is not that I can't walk with my cane, it is that I just don't have the strength to do it all day long -- and especially not with a smile on my face. I also stumble when I get tired. Don't rush going back if you have the option to stay home. Your body will thank you for giving it the time to regain strength and mobility. This is a major trauma and your body will take time to regain your former oomph. All of us are different about the time that we feel we can go back to work. Some go very quickly and others take quite a while. Listen to your body--you know it better than anyone else. I've taken a lot longer than many, but I am 54 and have quite a bit of arthritic damage to the joint as well, which has slowed down therapy and my recovery. Everyone here knows all about the crying fits that you can have with this. It does feel as if the world is passing you by after a while, and I know all about going nuts staring at four walls. But hang in there for a while and rest as much as you can. Enjoy being waited on for a bit. Read a good book or watch a great movie or too. Or catch up with old friends on the phone. You will be glad you did.
8/11/06 Lateral TPF with displacement
8/12/06 9 Screws,plate
9/5/06 Begin PT, ROM only
9/19/06&nbsp; PT-ROM, 25% PWB
10/9/06 PT Adv. WB, ROM 67-13
10/27/06 WB, Rom 75-8
11/19/06 WB, cane ROM 88-8
12/5/06 WB, cane ROM 107-8
1/3/07 WB, cane ROM 114-3
1/25/07 ROM 120-0
8/11/07 Keeping hardware
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Re: Patella fracture post-op help

Post by mtsarpilot »

I had surgery on a Tuesday, and was back at work the following Monday. My job is primarily desk or in meetings, so I don't have to be on my feet much. I was able to get around on the crutches, and because my patella fracture is the left leg, I was able to drive (don't know if that was smart). I propped my leg up on a 2nd chair with an ice bag on it a lot of the time. I also used a daypack to put stuff in when moving about because my hands were on the crutches. My OS basically said the limitation was pain. As long as the leg was in the brace and I was not putting weight on it, there was no risk in being at work.

Now for the caveats. I am an endurance cyclist, so I came into with a lot of strength. That reallly helped. My wife constantly tells me I have a very high pain threshold, and thus was able to get away with this and other things I do. Without these two, I'm not sure going back to work that soon would have been viable. My primary reason for getting back to work was because I was going nuts laying around at home. I needed something to do.

Your job sounds like you are on your feet (or crutches in this case) far more than I. That will make the days much longer and more fatigueing. When you get off the crutches and start walking, your leg with fatigue pretty quickly if you are up and around a lot for that first week back. Plan your days accordingly, maybe making them shorter days to start with.

Joel
9/05 - Patella fracture - 5 pieces in rock climbing fall, ORIF, 3 screws & figure 8 wire
5/06 - HW Out
7/06 - Back to full activity
7/09 - Custom brace created to support knee during activity
11/15 - Surgery to clean up meniscus, remove osteophytes, attempt to get more life out of knee
11/16 - TKR
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Megwi
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Re: Patella fracture post-op help

Post by Megwi »

Ellie,

I was signed off for 4 weeks but as soon as I started to feel better I was really bored. I work in the city of London so have to face trains and tubes and a walk to get to work, but do sit on my backside all day once I get there. I had a trial run at the beginning of the 3rd week and as that went ok I went to the hospital to plead for them to sign me back on to work. I went back on a Weds and was exhausted by Friday. I worked for about 2 months doing 2 days in one day at home 2 days in, and then went back full time. Just do what you feel you can cope with. At the end of the day your recovery is way more important than work and you need to make sure you don't do yourself any further damage.

Hope this helps

Meg
Ski fall Dec '05
MRI scan Jan 06
Surgery Feb 06 (TPF with ACL 1 screw, arthro meniscus removal)
Out of immobiliser May 06 and into PT
Scar tissue/ROM issues.
57 PT sessions.
Finished PT Jan 07 with nearly full ROM PT said "youve got more than I ever thought you'd get."
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Re: Patella fracture post-op help

Post by hjmblondie »

Just an update on my progress. My husband, baby, and I all came down with the flu last week so that was a little rough! It is a bit of a challenge to get to the bathroom quickly when your leg is straight and you have to hobble on crutches. :-[

I saw my doctor on Nov. 30th for my post-op check up and x-rays. Everything seems to be healing nicely and he gave me a new ROM brace which is much more comfortable. It is still locked at zero for two more weeks then he will adjust it to 30 degrees, then 10 degrees every week after that. I might be able to actually sit properly in a chair in 6 weeks. woo hoo ;D My pain has started to subside and is now more of an annoyance than anything. I am still having a hard time sleeping at night and getting comfortable. Also, my doctor is hoping that I will not require physical therapy if I try to strengthen my muscles by flexing them while in the brace.

I am still working from home as my job requires driving and meeting with clients in the office. I have to work on the computer from home until I can drive again. I am getting really frustrated by not being able to do simple things like bring a glass of water for myself into the living room or carry my daughter. Other than that I am trying to keep my head up and not get too bummed. Thanks everyone for the advice and support...I enjoy reading all of the advice.
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Re: Patella fracture post-op help

Post by Garnet »

Hi hjmblondie,

I have just had a surgery to my patella where the surgeon had to cut it in half and remove 3 mm from the centre, I had lost all the cartilage and wore a hole through my patella. I have two screws joining it back together and have had periosteal flap added to the back of the patella. I was immobilised for a while but coming up to five weeks post op i only have where the splint which goes on the whole leg when I am out and about or doing anything that might make me fall. The reason why he wants me to try not wearing it is because due to past injuries my quad and vmo has already wasted. But without that splint or brace as you call it if I fell I could break my leg and do lots of damage so I have to be really careful.

Like you I cannot lift my leg off the bed yet,I use my other leg to lift it up on the bed, my surgeon and physio said it will come but takes some time, they wont tell me when. I have gotten from 30 degrees knee bend to 70 or 80 at present so that is good. Although the forcing of it is making me really sore, and I am not sure my surgeon really wanted me doing that hard because in the letter to the physio he told her to not be to hard on my exercises in extensions, etc. Its hard when you cant carry anything about, but because I am further down the track than you, I hang a bag on my californian crutches and carry things in that. I also have rented a walker.
I am surprised that the hospital physio did not tell you to get a shower chair. My husband bought a hose shower head, took the doors out of the shower and sat the chair in their. With the splint on we got a garbage bag and pulled it over the splint and leg and taped it to my leg up the top. The nurses taught me this in hospital. I then use the walker to safely get up incase its slippery, but just get your husband to dry the floor before you get up. I started doing that about the third day in hospital, i spent a week in there. So when I came home I could tape myself, its hard with a straight leg especially when non weight bearing, but got easy when I went to partial weight bearing. Just dry yourself while sitting in the chair. Finish the rest off when you get out.

I also have a toilet chair we rented. Real help you can grab the arms on it.

Take care, I know it gets a bit frustrating at times. I see my surgeon soon.

Best Wishes
Wyn :)
Lt TKR July 07
Lt thinning of patella,osteotomy, periosteal graft,
hole in patella,loss of cartilage Oct 06
Lt lateral patella release/chondroplasty Feb 06
Rt shoulder acromioplasty
Back injury,disc bulges,one degenerated
Hip bursitis
Cortisone lt knee,lt hip,rt sacrolliac joint,2 rt shoulder
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Re: Patella fracture post-op help

Post by mtsarpilot »

hjmblondie wrote: ... Also, my doctor is hoping that I will not require physical therapy if I try to strengthen my muscles by flexing them while in the brace.
hjmblondie,

Sounds like you are making good progress on the healing. Each OS has a different way of going about the ROM restrictions and how they increase it over time. It will take you a little while to obtain the ROM when the OS opens up the brace. I gained ROM at an average of about 2 degrees per day (averaged across a week, some days more, days zero). Others have gotten it a little faster or slower.

Although your doctor is hoping you won't need PT, you might want to ask him/her for it anyway. Gaining ROM back is hard work, and guidance is an important part of that. You'll probably get your ROM back faster with PT guidance. Without it people find themselves wondering if they are doing the right exercises the right way, is it supposed to feel like this, etc.. With PT guidance, you know you are doing the best for yourself. The reassurance is worth a lot just by itself.

Hang in there, you'll be mobile soon :D

Joel
9/05 - Patella fracture - 5 pieces in rock climbing fall, ORIF, 3 screws & figure 8 wire
5/06 - HW Out
7/06 - Back to full activity
7/09 - Custom brace created to support knee during activity
11/15 - Surgery to clean up meniscus, remove osteophytes, attempt to get more life out of knee
11/16 - TKR
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