Post-Patellar Fracture Surgery: Key Rehab Questions Answered - Orthopedics

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Post-patellar fracture surgery rehabilitation is a crucial phase in the recovery process, especially after undergoing internal fixation with wires and screws. Given your situation, where you are 56 days post-surgery and have been informed that the bone has fully healed, it’s understandable that you have several concerns regarding your rehabilitation and recovery. Let’s address your questions systematically.

1. Pain and Discomfort Beyond 45 Degrees of Flexion: The sensation of severe discomfort and the feeling of being "bound" when attempting to bend your knee beyond 45 degrees could be attributed to several factors. First, the presence of hardware (screws and wires) can sometimes cause discomfort as the knee flexes, especially if the surrounding soft tissue is still healing or if there is swelling. It’s important to differentiate between normal discomfort associated with rehabilitation and pain that may indicate complications. To improve this situation, consider the following strategies:
- Gentle Range of Motion Exercises: Gradually increase your knee flexion using gentle exercises. You might try using a towel or strap to assist in pulling your foot towards you while lying down, which can help in achieving a greater range of motion without putting too much strain on your knee.

- Ice and Elevation: Continue to use ice packs on your knee to reduce swelling and pain, especially after exercises. Elevating your leg can also help decrease swelling.

- Consultation: If the pain persists or worsens, it would be prudent to consult your orthopedic surgeon or a physical therapist. They can assess whether the pain is due to the hardware or if there are other underlying issues.

2. Swelling and Walking: Swelling in the knee can be a significant barrier to regaining full function. Generally, swelling tends to decrease with movement, but it can also be exacerbated by overexertion. Here are some tips:
- Gradual Weight Bearing: As you start to walk, do so gradually. Begin with partial weight-bearing as tolerated, using crutches or a walker if necessary. This can help manage swelling while allowing you to practice walking.

- Compression: Using a compression bandage or knee sleeve can help manage swelling and provide support as you begin to walk more.

- Monitor Activity Levels: Pay attention to how your knee responds to activity. If you notice increased swelling after certain activities, it may be a sign to scale back and allow more time for recovery.

3. Rehabilitation Options: While your physician has indicated that you do not need to see a rehabilitation specialist, if you feel that you are struggling with your recovery, seeking help from a physical therapist could be beneficial. They can provide a tailored rehabilitation program that focuses on:
- Strengthening Exercises: Strengthening the quadriceps and hamstrings is crucial for knee stability and function. Exercises like straight leg raises and quad sets can be introduced gradually.

- Flexibility Training: A physical therapist can guide you through safe stretching techniques to improve your knee flexion and overall mobility.

- Functional Training: They can also help you practice walking and other daily activities in a way that minimizes pain and maximizes recovery.

In conclusion, while you are making progress, it’s essential to listen to your body and not rush the rehabilitation process. Pain and discomfort are common, but they should not be debilitating. If you continue to experience significant issues, do not hesitate to seek further evaluation and assistance from healthcare professionals. Your recovery is paramount, and having the right support can make a significant difference in your rehabilitation journey.