Post-Operative Care and Recovery Tips for Patellar Fracture Surgery

Patellar fracture - postoperative

Hello, Doctor.
On November 1st, I tripped and fell on my knee, resulting in a patellar fracture (broken into three pieces).
I underwent emergency internal fixation surgery and was discharged with a knee brace.
I returned for a follow-up appointment 14 days post-surgery to have the stitches removed, and the doctor allowed for 30 degrees of movement.
Currently, it has been 18 days post-surgery.
I have the following questions:
1.
With the knee brace set to 30 degrees, should I only move carefully while in bed or on a chair? Or can I unlock the brace while using a walker? When will I be able to unlock the knee brace while using a walker to allow for knee flexion? Since my knee feels very tight, can I elevate below the knee for extended periods to maintain a 30-degree bend, as long as I can tolerate it? Or should I be cautious and gently adjust to 30 degrees to avoid stressing the patellar incision? (I am concerned about the incision being pulled apart.)
2.
The skin on the inner side of the knee incision feels normal to touch, but the outer side remains swollen and hard.
There is sensation, but it feels numb.
Could this indicate nerve damage? How long might it take for recovery?

CK, 40~49 year old female. Ask Date: 2018/11/19

Dr. Shi Guozheng reply Orthopedics

After surgery for a patellar fracture, it takes time for the fracture to heal.
Before the fracture has healed, excessive force when bending the knee joint can cause the patella to crack again.
Therefore, it is necessary to use a brace to limit its flexion.
If the knee is not bent too much, a walker can be used for ambulation.
Limiting the flexion to 30 degrees can be gradually increased.
Generally, after about six weeks, the range of motion can be slowly increased, and it typically takes around three months for the fracture to heal completely.

Reply Date: 2018/11/19

More Info

Post-operative care and recovery following patellar fracture surgery are crucial for ensuring optimal healing and regaining function. Here are some guidelines and tips based on your situation and general medical knowledge.

1. Activity with the Knee Brace
After a patellar fracture surgery, it is common to be prescribed a knee brace to limit movement and provide stability. Since you mentioned that your brace is set to allow only 30 degrees of flexion, it is advisable to follow this restriction closely.
- Movement Restrictions: Initially, you should primarily move around in a controlled environment, such as your bed or a chair. Using a walker or crutches can help you maintain balance and reduce the risk of falling. However, when using the walker, it is generally recommended to keep the brace locked to prevent excessive movement that could jeopardize the healing process.

- Unlocking the Brace: The timing for unlocking the brace during walking should be determined by your orthopedic surgeon. Typically, this decision is based on your healing progress, which can be monitored through follow-up appointments and imaging studies. It is crucial to avoid any premature unlocking of the brace, as this could lead to complications such as misalignment or delayed healing.

2. Managing Knee Tightness
It is common to experience tightness in the knee post-surgery. While it may be tempting to elevate the leg or use props to maintain a bent position, it is essential to do so cautiously.

- Elevating the Knee: If you choose to elevate your knee, ensure that it does not exceed the prescribed angle of 30 degrees. Prolonged pressure or forcing the knee into a bent position could strain the surgical site and potentially lead to complications. Gentle, gradual movements are recommended to help improve flexibility without risking injury.

- Gentle Exercises: Engage in gentle range-of-motion exercises as tolerated, but always within the limits set by your physician. These exercises can help prevent stiffness and promote circulation.

3. Sensation Changes in the Skin
You mentioned experiencing numbness and hardness on the outer side of the knee. This could indicate nerve involvement during the injury or surgery.

- Nerve Recovery: Nerve injuries can take time to heal, and the recovery period varies among individuals. It is not uncommon for sensations to return gradually over weeks to months. Regular follow-ups with your healthcare provider are essential to monitor this aspect of your recovery.

- When to Seek Help: If the numbness worsens or if you experience other concerning symptoms (such as increased pain, swelling, or changes in skin color), it is crucial to contact your healthcare provider promptly.

4. General Recovery Tips
- Follow-Up Appointments: Attend all scheduled follow-up appointments to monitor your healing progress. Your doctor will assess your knee's stability and may adjust your rehabilitation plan accordingly.

- Physical Therapy: Once cleared by your physician, engaging in physical therapy can significantly aid your recovery. A physical therapist can provide tailored exercises to improve strength, flexibility, and overall function.

- Pain Management: Manage pain effectively with prescribed medications and follow your doctor's recommendations regarding dosage and timing.

- Nutrition and Hydration: Maintain a balanced diet rich in vitamins and minerals to support bone healing. Staying hydrated is also essential for overall health.

- Patience and Care: Recovery from a patellar fracture can be a gradual process. Patience is key, and it is vital to listen to your body and avoid pushing beyond your limits.

In conclusion, post-operative care after patellar fracture surgery involves careful management of activity levels, monitoring for complications, and gradual rehabilitation. Always consult with your healthcare provider regarding any concerns or changes in your condition to ensure a safe and effective recovery.

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