Patellar Fractures: Recovery, Rehabilitation, and Surgery Insights

Patellar fracture

Hello, Doctor! I had an unfortunate car accident in September this year that resulted in a patellar fracture.
Initially, it was a hairline fracture, and the emergency physician applied a cast, stating that surgery was not necessary and that I should wait for the bone to heal on its own.
After using the cast for 5 days, I switched to a self-paid brace (the doctor mentioned that the angle could be adjusted to 30 degrees).
However, three weeks later, during a follow-up X-ray, it was found that the bone had shifted (the doctor said surgery could be considered, possibly due to the pull from the quadriceps and patellar tendons).
Sometimes, I feel involuntary movements in the thigh muscles.
Eventually, I opted for surgery, where the doctor used a tension band wiring technique to stabilize the fracture, as my fracture was near the inferior margin of the patella.
Since the surgery in mid-October, the doctor has recommended maintaining a 30-degree angle.
I would like to ask the doctor the following questions:
1.
When does the patella start to form callus, can it be seen on an X-ray? Will there be white areas on the X-ray indicating that healing is occurring?
2.
How long does it typically take for the patella to heal enough to return to normal activities?
3.
Is rehabilitation limited to walking and increasing knee flexion?
4.
Will there be any long-term consequences, as I enjoy sports (running and hiking)?
5.
Is it necessary to surgically remove the tension band wiring? If it is absorbable, how long does the body take to absorb it? The surgeon mentioned that it is tied to the patellar tendon; could this cause tendon injury?
Thank you for your patience in answering my questions.

Nono, 20~29 year old female. Ask Date: 2021/11/30

Dr. Wang Jiacheng reply Orthopedics

1.
It is usually noticeable.

2.
Approximately three months.

3.
The knee joint should not be excessively flexed.

4.
It typically does not occur.

5.
It can also be left in place; it only needs to be removed if it interferes with the mobility of the knee joint.

Reply Date: 2021/11/30

More Info

Understanding patellar fractures involves a comprehensive approach to recovery, rehabilitation, and surgical insights. Patellar fractures can occur due to trauma, such as in your case from a car accident, and they can significantly impact mobility and quality of life. Here’s a detailed response to your questions based on current medical knowledge and practices.

1. X-ray Detection of Bone Healing: Yes, X-rays can show the formation of callus (bone healing) around the fracture site. As the bone begins to heal, you will see a radiopaque area (white) on the X-ray, indicating new bone formation. This process typically starts a few weeks after the injury, but the exact timing can vary depending on factors like age, overall health, and the nature of the fracture.

2. Timeline for Returning to Normal Life: The time it takes for a patellar fracture to heal and for you to return to normal activities can vary widely. Generally, it can take anywhere from 6 to 12 weeks for the bone to heal sufficiently. However, full recovery, including regaining strength and range of motion, may take several months. Factors such as the severity of the fracture, your age, and adherence to rehabilitation protocols play a crucial role in recovery time.

3. Rehabilitation Activities: Rehabilitation after a patellar fracture typically includes a combination of walking, range of motion exercises, and strengthening activities. Initially, the focus will be on gentle movements to regain knee flexion and extension. As healing progresses, more dynamic exercises will be introduced to strengthen the quadriceps and hamstrings, improve stability, and restore function. Physical therapy is essential in this phase to guide you through appropriate exercises and prevent stiffness.

4. Risk of Long-term Complications: There is a possibility of long-term complications following a patellar fracture, including chronic pain, stiffness, or even post-traumatic arthritis. However, many individuals return to their pre-injury activity levels, including running and hiking, especially if they follow a structured rehabilitation program. Staying active and maintaining muscle strength around the knee can help mitigate the risk of complications.

5. Surgical Hardware Considerations: Regarding the use of wire or fixation devices, many surgeons prefer to leave the hardware in place unless it causes discomfort or complications. If the fixation is absorbable, the body can take several months to a few years to fully absorb it. The risk of tendon injury from the fixation device is generally low, especially if placed correctly. However, it’s essential to monitor for any signs of complications, such as increased pain or swelling.

In conclusion, your recovery from a patellar fracture will involve careful monitoring of healing through X-rays, a structured rehabilitation program focusing on mobility and strength, and ongoing communication with your healthcare provider. While there are risks of complications, many patients successfully return to their previous levels of activity with proper care and rehabilitation. Always consult with your orthopedic surgeon or physical therapist for personalized advice tailored to your specific situation.

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