Patellar Fractures: Recovery, Rehabilitation, and Concerns

Patellar fracture

Hello, Doctor.
My mother accidentally fell on September 5, resulting in a fracture of the right patella.
The doctor said it was just a crack without displacement, so surgery was not necessary.
After about two weeks in a cast, it was removed, and the doctor advised purchasing a postoperative dynamic knee brace that can adjust the angle, with adjustments of 10 degrees each week.
I would like to ask:
1.
Is it too early to remove the cast after only two weeks?
2.
With this type of knee brace allowing for angle adjustments, could bending the knee too soon affect healing or lead to re-fracture since the fracture may not be fully healed?
3.
What should I do at home for appropriate rehabilitation? It has been 7 weeks, and there is still occasional pain; is this normal?
4.
During the second X-ray, the doctor mentioned there was a crack that was slightly larger than before.
Is this related? Each time I ask the doctor about the recovery progress, he just says it's okay, but there are still four weeks until the next appointment, so I would appreciate your clarification.
Thank you!

Xiao An, 20~29 year old female. Ask Date: 2010/10/25

Dr. Li Wenlin reply Orthopedics

Hello, in response to your question, based on your description, your mother's condition should gradually improve.
I personally suggest: 1.
These questions should be directed to your mother's attending physician (as I cannot see her X-rays or examine her in person).
2.
If you are not satisfied with the physician's answers, you may seek a second opinion from another orthopedic surgeon.
Generally speaking, the recovery from a fracture takes time; as the old saying goes, "It takes a hundred days to heal bones and tendons." Therefore, it is normal to still experience pain after 7 weeks.
It is important to maintain communication with the attending physician and follow their medical advice, and your mother should be able to recover soon.
Wishing you all the best.

Reply Date: 2010/10/25

More Info

Patellar fractures, or fractures of the kneecap, can be a significant concern, especially in older adults or those with underlying health conditions. Your mother's situation, where she experienced a right patellar fracture due to a fall, raises several important questions regarding recovery, rehabilitation, and ongoing concerns. Let's address each of your questions in detail.

1. Is two weeks in a cast too early to remove?
The duration of casting for a patellar fracture can vary based on the specific type of fracture and the individual's healing process. In cases where the fracture is non-displaced (meaning the bone fragments have not moved out of alignment), a two-week period in a cast may be sufficient for initial stabilization. However, the decision to remove the cast should always be guided by the orthopedic surgeon's assessment, including follow-up X-rays to evaluate healing. If the fracture is healing well, early removal may be appropriate, but if there are concerns, a longer period in the cast may be warranted.

2. Will using an adjustable knee brace affect healing?
An adjustable knee brace can be beneficial for rehabilitation, allowing for gradual mobilization of the knee joint. However, it is crucial to follow the physician's recommendations regarding the angle of flexion. If the brace is adjusted too quickly or if the knee is bent before the fracture has adequately healed, it could potentially lead to complications, including delayed healing or re-fracture. It's essential to communicate with the healthcare provider about the appropriate timeline for adjustments based on the healing progress.

3. What can be done for rehabilitation at home?
At home, rehabilitation should focus on gentle range-of-motion exercises, as tolerated, to prevent stiffness and maintain mobility. Simple exercises such as ankle pumps, straight leg raises, and gentle knee flexion and extension can be beneficial. However, it's important to avoid any movements that cause significant pain. If your mother is experiencing pain seven weeks post-injury, it may be a normal part of the healing process, but it should be monitored. Pain can indicate that the healing process is still ongoing, and any sudden increase in pain should be reported to her physician.

4. Is there a concern with the second X-ray showing more cracks?
The appearance of additional cracks or changes in the X-ray can be concerning and should be discussed with her orthopedic surgeon. It may indicate that the fracture is not healing as expected, or it could be a normal part of the healing process where the bone is remodeling. The surgeon may recommend further imaging or adjustments to the rehabilitation plan based on these findings. It’s important to have open communication with the healthcare provider to understand the implications of these changes.

In summary, recovery from a patellar fracture involves careful monitoring and a structured rehabilitation program. It is essential to follow the orthopedic surgeon's guidance closely, especially regarding the use of the knee brace and the timing of rehabilitation exercises. If there are any concerns about pain levels or the healing process, do not hesitate to reach out to the healthcare provider for further evaluation and support. With appropriate care and rehabilitation, many individuals can achieve a full recovery and return to their normal activities.

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