ORIF Patellar Fracture ORIF - (post tibial plateau fracture)

Lissygirl

new member
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Feb 5, 2021
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I am a little over 15 weeks post op for a fractured patella rehabilitating from ORIF surgery. The knee was fractured in to six pieces, four ligaments were torn and I ruptured or tore (not quite certain if it was one or the other but lots of stitches in it) the medial retinaculum. All from doing a somersault on water/detergent on a polished concrete floor in my kitchen. This happened in the same 12 month period that I had recovered from fracturing my tibial plateau (non displaced, no surgery required) and foot when my large dog pulled my down a bank on to some rocks. The second accident came as a huge shock given I had worked so hard at recovering my fitness and ROM with the tibia fracture.

I am a 65 year old woman who has always been physically active and fit. I have practised yoga for over 30 years at a reasonably high level, hike, swim and am generally participating in some type of daily physical activity. My bone density tests show a small amount of ostopenia but at the low end of the scale and my doctor isn't too concerned about it.

These accidents have made me rethink my diet. I have always eaten cleanly, almost a vegetarian plant based diet (a little fish and chicken) and have always had an interest in healthy food intake. I have concentrated this last year on making sure I have much more in the way of calcium/protein type meals adding lots of nuts, beans and calcium rich foods in to most meals. I make bone broth and drink that and smoothies with lots of stuff in them that help increase bone healing and bone density.

Fracturing your patella is not for sissies! The first four weeks were almost intolerable, a huge shock to the body and the pain and discomfort along with lugging the body around in a heavy immobilizer day and night and not being able to bend the knee or move well is a difficult thing to adjust to.
I must add I had been in an immobilizer for 10 weeks with the fractured tibia so I knew what to expect but as this injury was hugely more painful the immobilizer felt way more cumbersome!

In that first month I spent hours online reading stories from others, gleaning information from You Tube and Dr Google and generally trying to find as much information as possible.
My OS set the immobilizer to 30 degrees from the outset but suggested I did not try to do anything in the way of bending, heel slides or any other physio for the first few weeks. That was pretty much all the info he gave me so I visited the PT I had seen with my fractured tibia as I was very anxious not to lose the ROM I had got back to (140 degrees) after working so hard to recover it.
They explained to me how this accident was out on its on with how you recovered and stressed I worked super GENTLY and not even to the point of pain. That I went to a mild discomfort level only with anything I did in order to allow the bone to heal.

I actually listened to them LOL - usually I am very stubborn and push the limits with anything I do physically but my body was telling me this injury was substantially different. There were many days I was close to tears and feeling quite down about it all but usually I managed to pick myself up quite quickly by reading articles on people with way more severe injuries or long term disabilities. That is a sure fire way to stop feeling sorry for yourself!

I could write quite a lot more here but where I am now is this. I saw my OS yesterday for x-rays and he is really happy with my bone healing.
I have a problem with a couple of screws that are very prominent and burn and cause me quite a bit of discomfort. I have done daily physio on my own plus some help from a PT and although my ROM has slowly increased it is very slow and it feels like I have a very tight band across the top of my knee and that this will inhibit me reaching my ROM goals.
My PT manipulated my knee last week and said my knee feels like it can bend a lot further, he couldn't feel any blockages and over time my ROM would increase so that was good news.

The OS felt the same but was concerned how close to the surface and prominent my screws were and was anxious that if I knocked one of them it could tear the skin setting up for infection and problems. He has suggested early removal of my hardware - probably at the 7 month mark. I told him I would need to think about it as I had read that 12 months is usually the minimum length of time that most hardware is removed. He said my bone had healed really well and in a few months it would be ready for surgery.
He has suggested I wear a pad of some sort in the leg sleeve I am wearing (my knee feels way more supported wearing this). He kept stressing he did not want e to knock that area of my knee where the screws protrude so I am guessing that is why he wants the hardware out. I am not keen to undergo more surgery, let's face it, who does want to do that all over again. I realise this one will be less invasive and easier to recover from but there are still side affects to consider.

As far as knee strength is concerned I still have to work on my medial muscles as there are times my leg/knee feel a little weak. As mentioned I tend to wear an elastic support brace with straps when I am out and about, it feels more protective and I still get a little stressed about falling. I am sure that will go in time. So lots more short arc quad work and other exercises to keep building muscle strength. I might add that one of my legs is a little slimmer than the other which I understand from others often never gets back to being the same as the other leg. And I have a fat knobbly knee :)

So there you go, that's my journey to date. If anyone has been through all of this and are out the other side I would love to hear your story. If you want to know more about the tibial plateau fracture journey happy to chat. I have been relating to @Aplace2rest (Trey) who injured himself around the same time as me and along with the administrator he suggested I start a new thread. His story is interesting as well.

Look forward to hearing from others, this is a fascinating journey we are on for sure!

25 Oct 20 - fractured patella 6 pieces, tendon/ligament damage - surgery with K wire and screws
08 Nov 20 - dressing removed, stitches out - ROM 30
24 Nov 20 - ROM 50
15 Dec 20 - ROM 60 - xrays bone healing well
06 Jan 21 - ROM 80
31 Jan 21 - ROM 90
08 Feb 21 - ROM 105
09 Feb 21 - OS appointment, suggested hardware removal 7 month mark (May 2021) - considering
 
Welcome to BoneSmart, glad you joined us! :welome:

You and your knee have been through a lot in the last year.

My husband fractured his patella skiing about 40 years ago, he is 78 and is still skiing. It was a rough recovery, lots of PT and a year off from skiing allowing his knee to heal.

Your ROM is coming along and will continue to improve as you heal and your swelling goes down.
The tight band feeling is normal after your injury and major surgery, and will resolve with time and healing.
"Tight band" feeling across the front of my knee

Glad you are going to have the hardware out of your knee. You will want to discuss with your surgeon about having them removed at 7 months vs waiting a year. I am sure he will not proceed until your bones are adequately healed.

Please post your surgery date for your tibial plateau fracture so we can add it to your signature. Having both dates will allow us to better advise you.
Thank you,
Chris
 
I have been relating to @Aplace2rest (Trey) who injured himself around the same time as me
Welcome to Bonesmart! I’m glad you and Trey joined at the same time, it’s really so good to have someone else to chat with, with a similar experience.

Best wishes for a successful recovery!
 
Thanks so much for your lovely thoughtful reply. Good to hear how well your husband is doing.
Did he have the hardware removed from his knee?
My surgeon tells me he would like to remove it in a few months but I haven't committed to it yet.
It seems the obvious choice to make given the protruding screws and I feel a continued ROM problem. But I am anxious to have further surgery - ridiculous really when I have already done the big surgery. I really want my flexion to return to a near normal so probably this is the best outcome for me.
Thanks again!
Lisa
 
My husbands fractured patella was non displaced, he did not need surgery.
He was very fortunate in that regard.

With the screws protruding, I think having the screws out will be more comfortable for you in the long term.
Ask your surgeon for more information about the surgery. If all you have are screws right under the skin, they just make a small incision over the screw, and remove the screw. Much less invasive than opening your knee up all the way.
 
I really want my flexion to return to a near normal so probably this is the best outcome for me.
Sorry I have not replied to your post on my thread yet. I’ve been in a bit of a mental slump. I think that if your screws are sticking out as bad as suggested that maybe surgery for removal wouldn’t be such a bad idea. I only have one screw straight down the middle going from top to bottom so the head sticks out at the tip of my knee but is becoming only bothersome if I mess with it too much. But I’m not sure if it’s actually more bothersome than I realize as I have been very physical besides treadmill and biking. My rom is now bouncing between 105° to 110° depending on my pain level for that day, my knee just feels better if I don’t do anything for a few days than it does if I push myself to be physically active but we both know where that will lead! No strength to walk, no stability, health issues etc. However, my knee is looking more normal than it has since surgery, it is a tad bit bigger than my other knee and is obviously shaped different now. I’m sure the hardware plays some part in this. I’m wondering if the band feeling in your knee is actually the band that wraps around the kwires??? Sometimes when my knee is a bit swollen it feels the same way. But if I let the swelling subside and take it easy it’s a lot easier to move around and the tightness isn’t bad at all.
I agree that if you want your flexion to reach pre-surgery levels that you may need to have the hardware removed. Maybe ask the ortho if he can remove just the screws and not the kwires so less trauma is inflicted? If I were to have them open my knee back out I would have them remove everything they put in there. Blessings to you.
 
Hi Trey
I moved house yesterday so am pretty exhausted but it was so good to hear from you. I am sorry you have been feeling down, i know that feeling well. This is a darn of a journey and some days (most ha ha) seem really tough.
We are in such similar circumstances. My ROM exactly the same as yours. I can't seem to get past 105/110 either. My surgeon would like to take the whole hardware out in about three months. I have yet to decide. Since speaking to him someone mentioned to me maybe I could also just get the screws out so I will ask him about that on my 6 April appointment when we discuss hardware removal again. To have major surgery again is really not something I want to do. The surgeon mentioned that once hardware is out my ROM should improve significantly. He also said the knee would feel slightly unstable for up to 12 months. i have purchased a knee brace that is a wrap around one with velcro straps and when I wear this during busy days my knee feels really stable. But I have to position it exactly right otherwise it rubs on the screws. Like you when I have a day or two off doing exercises my knee feels good but I honestly think working it gently every day is the way to go.
I have a busy few days Trey but I shall PM you shortly with some exercises I mentioned helped me. The big one is getting those quads firing and straight leg extensions working well.
Keep your chin up and keep smiling. I really feel for you and glad we are knee buddies together in this ridiculous recovery process.
Thanks for being there.
Lisa
PS I wish I had a treadmill and bike - I need to join a gym once I recover from this big house move!
 
@Lissygirl
Good evening! I checked my ROM this evening and I’m now at 120°! I’m completely ecstatic . However, I’ve put on a few pounds since this whole ordeal started. I’m really having trouble eating healthy and I think it might be me coping in a way I’ve never experienced before. I hope you’re recovering from your move and that you’re in a happier place! I haven’t done anything to further my rom.. I had been standing for periods of time while cooking, etc and am no longer doing that because it would make it difficult to bend my knee afterwards. Today I noticed I can stand for a longer period of time without getting the right feeling. I’m thinking that time has been the best medicine so far. I really need to get into shape. I think I’m finally getting to a point where I can do more with my knee without suffering too bad and should take advantage of it. I’m just finding it hard to have the motivation. Unfortunately, self care seems to have flown out the window but I think I’ve been that way since this coronavirus started.. cause I’m at home all the time and I tell myself that there is no point... cause I won’t see anyone anyways lol. :)
How are you feeling lately?
 
Hi Trey
It was good to hear from you and congratulations on your ROM. Unfortunately I haven't been able to measure mine - maybe I will swing by the physio and see if he can do that for me or I do understand their are apps you can download to do this. Do you have an app or do you use a goniometer? I have a feeling mine has also improved but no way of knowing. I know for sure I can bend my leg way more than a few weeks ago.

During my move I didn't do any dedicated exercises at all as I was on my feet all day for a few weeks prior and have just finished unpacking and setting up home and am completely exhausted.

I have made a pact to get to the pool next week and have got back on my yoga mat as of today. The tight band on my knee is getting less and less and my knee is returning to looking a little bit more normal but as the swelling has gone down those three darn screws stick out rather badly. I still haven't decided on surgery yet.

My extension is still a little behind so I am working on that a lot - I find when I do straight leg raises I have a few degrees lag so it is still about fighting those quads in to submission.

Now my move is over I am also going to begin some dedicated walking every day to try and get this limp sorted - when I concentrate I walk almost normally but when I am busy and want to get from A to B quickly I do this silly little limp! I know it is just practise and I have been for months doing all the correct walking exercises - it's just when I am rushing bad habits creep in.

Shall PM you about other stuff - thanks so much for replying - it really helps me a lot chatting to you.
 
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@Lissygirl and @Aplace2rest

How are your rehabs going? My wife is around 110 ROM approaching 5 mo PO TPF, but knee is still stiff. Did you have HWR and how has ROM progressed?
 

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