Patellar Fractures: Recovery, Rehabilitation, and Complications

Patellar fracture

Hello, Doctor! In September of this year, I unfortunately had a car accident that resulted in a patellar fracture.
Initially, it was a hairline fracture, and the emergency doctor applied a cast, stating that surgery was not necessary and that I should wait for the bone to heal on its own.
After five days in the cast, I switched to a self-paid brace (the doctor said the angle could be adjusted to 30 degrees).
However, three weeks later, during a follow-up X-ray, it was discovered that the bone had displaced (the doctor mentioned that surgery could be considered, possibly due to the pull from the quadriceps and patellar tendons).
Before the surgery, I sometimes felt twitching in the thigh muscles, which I couldn't control, and I wondered if this contributed to the bone displacement.
Eventually, I opted for surgery, and the doctor said they would use a tension band wire to stabilize it, 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 the patella begins to form callus, can this 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 effects, as I enjoy sports (running and hiking)?
5.
Is it necessary to surgically remove the tension band wire? If it can be absorbed, how long does the body typically take to absorb it? The surgeon mentioned that it is tied to the patellar tendon; could this cause tendon injury?
6.
Could a slight initial fracture of the patella later displace due to the pull from the quadriceps and patellar tendons?
7.
Is the area of the patellar fracture, being closer to the inferior margin, adequately stabilized with the tension band wire?
8.
Does the location of the patellar fracture affect the speed and time of bone healing?
I apologize for the many questions, and I appreciate your patience in answering them.
Thank you! 🙏

A-Ying, 20~29 year old female. Ask Date: 2021/12/03

Dr. You Dianqi reply Orthopedics

Hello, I would like to clarify that responses on the internet, without direct patient contact, should primarily rely on the opinions of the operating surgeon.
If misunderstandings arise in the doctor-patient relationship due to online responses, it is not the intended purpose of online consultations.
However, as this is part of my job, I will provide the following answers for reference:
1.
Yes, it is a pale white color.
2.
Generally, it takes about 2-3 months.
3.
As time progresses, your rehabilitation should include more exercises in the coming days, such as quadriceps training.
4.
I need to see you in person along with all relevant imaging to understand the subsequent issues.
I acknowledge that for this type of surgery, my personal approach does not involve the use of screws, as using screws may carry a risk of loosening.
Instead, I drill a tunnel in the bone and pass a suture through the tunnel to secure it to the superior margin of the patella.
Your doctor chose to use screws, which are typically not removed unless there are complications.
Thank you.

Reply Date: 2021/12/03

More Info

Understanding patellar fractures, particularly in the context of recovery, rehabilitation, and potential complications, is crucial for anyone who has experienced such an injury. Your situation, involving a patellar fracture that initially presented as a hairline fracture, has progressed to a more complex scenario requiring surgical intervention. Let's address your questions one by one.

1. Can X-rays show the formation of bone callus?
Yes, X-rays can indicate the formation of bone callus during the healing process. As the fracture heals, new bone tissue begins to form, which can appear as a white area (radiopacity) on the X-ray. This is a positive sign that the healing process is underway. However, the visibility of the callus may vary depending on the fracture's location and the individual's healing response.

2. How long does it typically take for the patella to heal and return to normal activities?
The healing time for a patellar fracture can vary widely based on the fracture's severity, treatment method, and individual factors such as age and overall health. Generally, it may take anywhere from 6 to 12 weeks for the bone to heal sufficiently for normal activities. However, complete recovery, including regaining strength and range of motion, may take several months longer.

3. What does rehabilitation involve?
Rehabilitation after a patellar fracture typically includes a combination of walking, range-of-motion exercises, and strengthening exercises. Initially, the focus will be on regaining mobility and reducing stiffness. As healing progresses, more advanced exercises targeting the quadriceps and hamstrings will be introduced to restore strength and function.

4. Will there be long-term complications or residual effects?
While many individuals recover fully from a patellar fracture, there is a risk of long-term complications, such as chronic pain, stiffness, or weakness in the knee. Athletes or those who engage in high-impact activities like running and hiking may be particularly concerned about these issues. It’s essential to follow your rehabilitation program closely and communicate any concerns with your healthcare provider.

5. Is it necessary to remove the fixation device (suture anchors)?
Whether or not to remove the suture anchors depends on several factors, including the type of anchors used and your specific situation. Some suture anchors are designed to be bioabsorbable, meaning they will be gradually absorbed by the body over time. If they are not bioabsorbable, your surgeon may recommend removal if they cause discomfort or if there are concerns about their impact on surrounding tissues, such as the patellar tendon.

6. Can the quadriceps and patellar tendon pull cause the fracture to displace?
Yes, the tension from the quadriceps muscle and the patellar tendon can contribute to the displacement of a fracture. If the muscle pulls too hard on a fractured bone, it can exacerbate the fracture or cause it to shift, leading to complications that may require surgical intervention.

7. Is the fixation with suture anchors sufficient for a fracture at the lower edge of the patella?
Suture anchors can provide adequate stabilization for patellar fractures, especially when placed correctly. The effectiveness of the fixation will depend on the fracture's specific characteristics and the surgical technique used. Your orthopedic surgeon will assess the stability of the fixation during follow-up visits.

8. Does the location of the fracture affect healing speed and time?
Yes, the location of the fracture can significantly influence the healing process. Fractures near the joint surface or those involving the patellar tendon may take longer to heal due to the increased stress on these areas during movement. Additionally, the blood supply to the fracture site can affect healing; areas with better blood flow typically heal faster.

In conclusion, recovery from a patellar fracture involves careful monitoring, rehabilitation, and adherence to medical advice. It's essential to maintain open communication with your healthcare team to address any concerns and ensure a successful recovery. Engaging in a structured rehabilitation program will be key to returning to your desired activities, such as running and hiking, while minimizing the risk of complications.

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