Post-Operative Recovery from Patellar Fracture: Insights and Recommendations

Postoperative care for patellar fracture?

Hello Doctor, my son had a car accident on June 1, 2021, resulting in a patellar fracture and a comminuted femoral fracture.
The patella was stabilized with sutures and screws, while the femur was treated with a metal plate.
His recovery post-surgery has been quite good; by November, he was able to walk without crutches.
However, he is still progressing slowly in his walking, especially at the beginning when he needs to wait a moment before he can step steadily.
I would like to ask the doctor: Is his inability to walk at a normal speed related to the cartilage in his knee? Is his instability while walking and difficulty climbing stairs due to weakness in the knee? Additionally, he experiences a clicking sound in his knee; could this have any implications? What recommendations do you have? Would PRP treatment for the knee joint help him return to normal walking? He does not feel discomfort during rehabilitation walking, but he is not stable or fast enough.
Thank you, Doctor!

Xiao Min, 40~49 year old female. Ask Date: 2022/01/15

Dr. Chen Yongxue reply Orthopedics

Hello, due to the complexity of the situation and the need to refer to your son's X-rays and his mobility status, it would be best to consult with the attending physician.
Thank you.

Reply Date: 2022/01/15

More Info

Post-operative recovery from a patellar fracture, especially in the context of a complex injury like your son's, can be a multifaceted process that requires careful management and rehabilitation. Given the details of his injury and subsequent treatment, it is not uncommon for patients to experience lingering issues such as instability, difficulty with speed, and sounds like clicking or popping in the knee joint.

Understanding the Recovery Process
1. Healing Timeline: After a patellar fracture and associated femoral injuries, the healing process can take several months. While your son has made significant progress by being able to walk without crutches, it is important to recognize that full recovery can take time. The fact that he is still experiencing some instability and difficulty with speed is not unusual, especially considering the complexity of his injuries.

2. Knee Mechanics: The knee joint is a complex structure that relies on the integrity of bones, ligaments, tendons, and cartilage. After a fracture, the surrounding soft tissues may also be affected, leading to weakness or stiffness. The clicking sound he hears could be related to the movement of the patella over the femur or could indicate some residual issues with the cartilage or ligaments.

3. Muscle Strength and Coordination: The muscles around the knee, particularly the quadriceps and hamstrings, play a crucial role in stabilizing the joint. If these muscles are weak, it can lead to instability and difficulty with activities such as climbing stairs. Rehabilitation exercises focusing on strengthening these muscle groups are essential.

4. Soft Tissue Recovery: The soft tissues, including ligaments and cartilage, may take longer to heal than the bone itself. If there is any damage to the cartilage, it could contribute to the symptoms he is experiencing.

Recommendations for Improvement
1. Physical Therapy: Continuing physical therapy is crucial. A physical therapist can tailor a rehabilitation program that focuses on strengthening the muscles around the knee, improving balance, and enhancing coordination. Exercises may include squats, leg lifts, and balance training.

2. Gradual Progression: Encourage your son to gradually increase his activity level. This includes walking longer distances and incorporating stair climbing into his routine as tolerated. The goal is to build confidence and strength without overloading the knee.

3. PRP Treatment: Platelet-rich plasma (PRP) therapy can be beneficial in promoting healing in soft tissues and may help with knee pain and instability. However, the effectiveness can vary from person to person. It is best to discuss this option with his orthopedic surgeon to determine if he is a suitable candidate.

4. Monitoring Symptoms: Keep an eye on any changes in symptoms. If the clicking sound is accompanied by pain, swelling, or further instability, it may warrant a follow-up with the orthopedic surgeon for further evaluation.

5. Assistive Devices: If he continues to feel unstable, using a knee brace during activities may provide additional support. However, it is essential to ensure that the brace does not cause discomfort or restrict movement excessively.

6. Patience and Support: Recovery from such injuries can be frustrating, and it is important to provide emotional support. Encourage him to be patient with his progress and celebrate small milestones along the way.

Conclusion
In summary, while your son has made commendable progress since his surgery, it is normal for him to experience some ongoing challenges related to stability and speed. A comprehensive rehabilitation program focusing on strength, balance, and coordination, along with potential PRP therapy, may help him regain normal function. Regular follow-ups with his healthcare team will ensure that any concerns are addressed promptly and that he continues on the path to recovery.

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