Patellar Fractures: Recovery, Exercises, and Concerns

Q: Patellar Fractures: Recovery, Exercises, and Concerns

Hello： 1. Within a pain-free range, it is generally advisable to move as much as possible while bending at a 90-degree angle. 2. This is normal. 3. It is permissible. 4. It helps reduce muscle atrophy. 5. This is normal.

Patellar fracture

On October 13, 2018, I slipped and fractured my patella into three pieces.
I underwent surgery for internal fixation and was discharged five days later.
Eight days post-surgery, I had a follow-up appointment, making it a total of 13 days (approximately two weeks) since the surgery.
During the follow-up, the stitches were removed, and the doctor advised that I could slightly bend and straighten my leg for repeated practice, but not to exceed a certain angle, which was not detailed.
I reported swelling in my calf and thigh, and the doctor mentioned that it was not serious and would gradually subside.
I was prescribed acetaminophen for pain, to be taken only when needed, and instructed to return immediately if I experienced any unusual pain or impact.
I am scheduled for another follow-up in about 14 days (two weeks).

I would like to ask the doctor:
1.
What is the approximate angle for slight bending and straightening during practice?
2.
Is it normal to feel tightness in the inner thigh muscles when bending?
3.
I found online that I can keep my leg straight, with my foot pointing forward and pressing down for about 20 seconds, then pulling my toes towards my body for about 20 seconds, repeating this 20 times.
Can I start doing this now?
4.
What benefits does repeating this exercise 20 times provide for my leg?
5.
Is it normal to feel weakness when trying to lift my leg?
Thank you, doctor, for your patience and for reviewing my concerns.
I appreciate it.

LKK, 60~69 year old female. Ask Date: 2018/10/27

Dr. Li Yongheng reply Orthopedics

Hello: 1.
Within a pain-free range, it is generally advisable to move as much as possible while bending at a 90-degree angle.
2.
This is normal.
3.
It is permissible.
4.
It helps reduce muscle atrophy.
5.
This is normal.

Reply Date: 2018/10/27

More Info

Understanding patellar fractures and their recovery process is crucial for regaining full function and mobility. A patellar fracture, particularly one that results in multiple fragments, can significantly impact the knee's stability and function. Here’s a comprehensive overview addressing your concerns and providing guidance on recovery, exercises, and what to expect during the healing process.

1. Range of Motion (ROM) Exercises: After a patellar fracture, it is essential to begin gentle range of motion exercises as soon as your doctor allows. Typically, the initial goal is to achieve a range of motion of about 0 to 30 degrees of flexion in the early stages. As healing progresses, you can gradually increase this range. It is crucial to listen to your body and avoid pushing beyond what feels comfortable. If you experience significant pain, it may be a sign to reduce the intensity of your exercises.

2. Muscle Tightness: Feeling tightness in the inner thigh muscles (adductors) during bending exercises is common, especially after a knee injury. This tightness can be attributed to muscle guarding, which is a natural response to protect the injured area. As you continue your rehabilitation and gradually increase your activity level, this tightness should diminish. Gentle stretching and mobility exercises can help alleviate this discomfort.

3. Specific Exercises: The exercise you mentioned—extending the leg straight and then flexing the foot to pull the toes towards your body—is a beneficial movement. This exercise helps to engage the muscles around the knee and improve flexibility. However, ensure that you perform these movements within the limits set by your physician. Start with gentle repetitions and gradually increase as tolerated. It’s essential to maintain communication with your healthcare provider regarding any new exercises you wish to incorporate.

4. Benefits of Repetitive Exercises: Performing exercises like the one described can help improve circulation, reduce swelling, and promote healing in the knee joint. Additionally, these movements can strengthen the muscles surrounding the knee, which is vital for regaining strength and stability post-injury. The repetitive nature of the exercise also helps in maintaining joint mobility, which is crucial for preventing stiffness.

5. Feeling of Weakness: Experiencing weakness in the leg, especially after a significant injury like a patellar fracture, is entirely normal. This weakness can result from muscle disuse during the healing process and the body's natural response to injury. As you progress through rehabilitation and gradually increase your activity level, you should notice improvements in strength and function. Incorporating strength training exercises, as advised by your physical therapist, will be beneficial in rebuilding muscle strength.

Additional Recommendations:
- Follow-Up Appointments: Regular follow-ups with your orthopedic surgeon or physical therapist are essential. They can monitor your healing progress and adjust your rehabilitation program as needed.

- Physical Therapy: Engaging in a structured physical therapy program can significantly enhance your recovery. A physical therapist can provide tailored exercises that focus on strength, flexibility, and functional movements specific to your needs.

- Pain Management: Continue to manage pain as advised by your physician. If over-the-counter medications like acetaminophen (Tylenol) are insufficient, discuss alternative pain management strategies with your healthcare provider.

- Activity Modification: While you may feel eager to return to normal activities, it’s crucial to avoid high-impact activities until your knee has fully healed. Gradually reintroducing activities will help prevent re-injury.

- Listen to Your Body: Pay attention to any signs of pain or discomfort during exercises. If something feels wrong, don’t hesitate to consult your healthcare provider.

In conclusion, recovery from a patellar fracture requires patience and adherence to a structured rehabilitation plan. By following your doctor's advice, engaging in appropriate exercises, and monitoring your progress, you can work towards regaining full function of your knee. Always prioritize safety and communication with your healthcare team throughout your recovery journey.

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