Hardware Removal Experience

*Warning - long, rambling post coming up!

Well the deed is done and the pins are out! So far, so good, relatively little pain and getting around slowly. This is how my surgery day went ....

Up very early, after not that much sleep, nothing to eat and just clear drinks until 7am. Then we left for the hospital, to check in at the day case arrivals for 7.30am. We were shown to their arrivals area, where many others and their relatives were sitting waiting too. It was bedlam there actually, nurses running around doing bits and pieces and doctors, anaesthetists and physio therapists popping in and out to see everyone before they were sent off the the operating theater.

First I answered the admissions questionnaire, then saw the surgeon who had come to draw an arrow pointing at my knee. Next a visit by the physio who had come to issue crutches and tell me how to walk on them - I told him I'd got my own and after 6 months, I think I'd got the hang of it by now.  Next, I was taken to a booth where I got changed into my theater gown and after my blood pressure was taken, we were left to wait for the "call up". My cousin is a nurse in theater and she text messaged me to say I was second on the list and they were waiting for me, so I wouldn't have to wait much longer now. Just as well, because my nerves were getting a bit wrecked by now.

At 10am I was taken down to theater in a wheelchair and my cousin met me there to check me in. She stayed with me whilst I was put to sleep and hers was the first voice I heard, waking me up just over 30 minutes later. She got me a warm blanket and some water to sip and then kept a check on me for a while. She told me the surgeon was pleased with the procedure and although some of the metalwork was a little bit tricky to remove, he did manage to get it all out without causing anymore damage.

As I woke up a bit more, I became aware of a stinging in my knee, well, more above and around where I imagined the wound to be actually. I told her this and she said I'd had a morphine shot but she would get me some codeine once I'd been taken to the day case ward to recover further. Once she was happy with my progress, she took me down to the ward to hand me over! I was given codeine and left to snooze it off for a bit. Apart from the stinging, my knee actually felt fine. Although I was apprehensive about when the moment arrived for me to stand up and walk!

After an hour I was given a dismal cheese sandwich to eat and a cup of weak coffee. I ate the sandwich dutifully, as this was the first step towards my discharge later that day. A couple of hours rest and a visit by the physio team and then I was allowed to dress and get up for a trip to the bathroom.The second condition leading to my discharge! Success again, a bit shaky when I first stood up but not too painful, just sore when I moved around the wound area. No bone pain at all. I walked to the bathroom and back, very slowly, on my two crutches and then in the light of this achievement, was signed off and given the ok to go home.

Waiting to be discharged from Hospital

My bandaged knee

By 4.30pm I was safely installed on my sofa, feeling very relieved it was over, and even more relieved that I was relatively pain free. Eating dinner, trips to the loo and generally moving around was all fine. I kept up the codeine doses for the rest of the day and snoozed on and off until bedtime.

On waking this morning I got quite a surprise! Immediately, my thoughts went to my knee, in search of the pain that would be there as I was due for more codeine by now. Nothing! No bone pain, no stinging, nothing! I tested the water a bit, wriggling my toes and flexing my muscles, still fine. And when my muscles went into an involuntary morning stretch, for the first time in 6 months I didn't feel like I had to stop quickly because my knee was being crushed in a vice of some sort! I was quite elated, and stretched away to my hearts content! Whoooppee, this was good news :)

When I got up, I did have a bit of stinging and soreness in my knee as I walked around but nothing too bad. I'm using my walker today, not because of the pain, but because I know I can move around more confidently with this and I want to keep walking about as much as possible. I've halved the medication dose but if this progress keeps up I will probably ditch them tomorrow and just take my ibuprofen, as usual, for swelling.

I've been given the ok to do some gentle heel slides and start bending it as far as pain will allow, keeping an awareness for the fact that the staples (yes, more staples again this time) go over my knee and will be restrictive at the moment. Static quads exercises feel fine and as these are the safest exercises for me to do at the moment, I'm doing them as often as I can whilst sitting on the sofa here. Tomorrow I will try some more tasks from my physio regime, reverting back to some of the stage one exercises and taking it very slowly initially.

Feeling very positive at the moment and definitely no regrets about getting the surgery done. I know there's still a way to go yet, but hopefully, this is the beginning of the end of a long ordeal. I think the information I've read and lessons I've learned since my injury are standing me in good stead, no nasty surprises and plenty of ideas for what I should and should not be doing, and more importantly, what works for ME. Happier days ahead!

Hardware Removal "Eve"

Hmmm, well this is my last night with a knee full of metal! Got my hospital bag packed this afternoon, ordered the shopping in to cover the next few days, spoiled myself with a take away dinner and had a LONG, luxurious soak in the bath - it could be the last one for a couple of weeks until the staples come out.

Have to admit, I'm not feeling so confident right now. Yesterday, I felt fed up with the whole thing, just wanted to get it over with but at the same time a bit miffed that I have to go through yet another trauma. By today I feel kind of weird. I know the hardware has to come out - I can't bend my knee properly until it does, and its more than time to move on now. I'm not worried about the surgery either but feel a bit scared of the after pain when I come round and how I will manage to get into the house when I'm discharged later that day.

At least I know what to expect - thanks to the helpful posters at KneeGeeks! I guess the wound will hurt for a few days until it starts to heal so I have my pain killers at the ready and plan to sleep through it with the help of my codeine! By all accounts, the pain isn't nearly as bad as it was after the original surgery and once it begins to calm down I will feel (and see) a huge difference in my knee, for the better. Well, the KneeGeeks have been right about most things so far, so here's hoping they're right on this count too.

Wish me luck .... will update as soon as I can write something legible ;)

Getting a Switch Stick Walking Cane

I never thought I would see the day when I would actually be excited to open a parcel that contained a walking stick! Ha, well today I got my brand new Bubbles Switch Stick walking cane, and have to say ... I love it!

Shhhh though, don't tell my Physio terrorist about this, I don't think he'd approve. Progression was meant to be walker > two crutches > one crutch > zilch! To be perfectly honest, I CAN walk around the house by now without crutches, but its in a very Frankenstein style fashion and I limp like hell. I always thought that even when I can walk about outside without the crutch I will want to carry something with me, as a safety blanket and also as a "Get-outta-my-way-coz-I-can't-get-outta-yours-so-fast" warning to others. Have you noticed how ignorant of disabilities other people can be? How they expect you to dodge them, even though you are on crutches and struggling to put one foot in front of the next? Was I like that before this injury? hmmmm .....

Anyway, I did some research, and checked with the KneeGeeks club, and decided that I would try a stick. So I went out a couple of times and tested some frail looking versions, which did more to put me off than encourage me. I'd read on the Internet about Switch Sticks and not only did they look more sturdy than some others, they also came in great funky colours and styles! Then last weekend I was at a garden centre and spotted a stock of Switch Sticks. I decided to take one for a test drive and on the first step I just knew it was going to be more reliable than the others I'd tried out. By the time I'd walked several steps, I also knew that it was going to be perfect to help me make the progression from crutch to walking unaided. It felt more independent than walking with the crutch (no elbow support for a start) but yet my walking gait (stepping style) was more natural than when I try to walk without support.

I already knew that I could pick one up cheaper on the Internet, so I came straight home and ordered one. I knew I wanted the Bubbles design, I love bright funky colours and patterns and this has both. So it arrived today, I've tried it out around the house and for the first time in months I actually feel like I'm just walking around my home rather than making a huge deal of getting from A to B. Brilliant, will continue to report here on how its going with the Switch Stick, although it may be put on hold for a bit after I get my surgery next week. But I will be eager to get back to where I left off, and back to my shiny Bubbles "Broomstick" too!

Hardware Removal Surgery Scheduled

So on 25th April, the specialist decided that the pins need to come out! He thinks that I've progressed "better than I thought you would" and that it was time to give me some help by removing the hardware. The Xray didn't show any significant shifting, but on comparison to earlier ones, the whole arrangement of pins and wires does appear to have moved downwards. It makes sense. All of the places where I feel to pokes and twinges have areas of spikes, knots or wire loops under the skin somewhere.

Bye Bye Pins, you did your job but now its time to get the hell out of my leg!

I realise that if they're not removed I'm just not going to progress any further as the anticipation of when the next stab is going to strike is just too restrictive during physio therapy sessions. He said he would mark my surgery request as urgent, but it could take up to 3 months! So I resigned to just "getting on with it" and doing what I can in the meantime. Until last Friday .....

I got the call to tell me my surgery had been scheduled for 16th May, to be fair to the hospital, just over 3 weeks after the request, now that is pretty good going for the NHS! I went in to sign permission forms on Monday and am due for a pre-op assessment tomorrow.

So instead of starting back to work full time next week, I'm preparing to be inactive again, for a couple of weeks at least. Oh well, one step forward and all that jazz ......

Back to Work

Yesterday was "back to work" day! Starting a phased return over a month. 50% for 2 weeks, 60% for 1 week, 80% for 1 week, then back to full time. I had been looking forward to it until I had a particularly bad day with pain in my knee the day before, so this did put me off a bit. Although I'd been hoping to take just the one crutch to work, I decided to take 2 because of the pain the day before.

My colleague gave me a lift in, because I still haven't attempted to drive yet (hoping to work towards this over the next few weeks). Walking outside was the worst bit as I hate using the two crutches anyway. I'm so nervous of falling again! It took me quite a while to get from the car park into the building, which was a bit embarassing with people around wondering why on earth I was going so slowly! Once in my office I found that my computer chair was much more comfortable than I'd expected. I just had to make sure I wedged it in the corner of my desk before sitting down as its on wheels and I didn't fancy ending up on my butt on the floor! The chair was just the right height for me to keep my leg down comfortably all day and I surprisingly didn't feel the need to put my leg up at all. I just used the one crutch around the office and when I went out at lunch time, although I did link arms with my friend for a bit of added security then. My job is mostly sitting down, so once installed at my desk it there wasn't a problem getting on with it.

It was great to see everyone, even though I got the impression they were all wondering why I'm still so immobile. I found myself explaining to them all that "its not the break that the problem, its the rehab ... and my confidence" and I also kept pointing out that its a 12-18 months rehab at that. The 6-weeks-to-heal-a-broken-bone theory brings with it false expectations for recovery duration, I am struggling to accept it myself so no wonder other people find it confusing.

I'd thought a bit about physio arrangements whilst I'm at work, not sure how much I can manage to do and fit in whilst I'm there. So I just did some quads exercises before I left in the morning and then worked through my regime when I got home. I've read about people who push their PT hard to make up for time missed whilst at work and this just causes more problems, so I've decided to just do what I can on the days I'm working and carry on with the regime on my days off.

Overall, it was good to be back. Don't like being so dependent on colleagues and found it a bit embarassing getting around but I guess I'll have to just get over that. Hoping that being back at work will do my confidence some good and help me get over this silly fear of walking that I have developed.

Shifting Pins

The problem with this knee injury is that when one problem starts to get better, another one raises its head! Over the past few weeks, I've been plodding on with the exercises, working on the ROM and quad strength simultaneously. Having finally got the quads to fire up again and the ROM past 90 degrees it now appears that the pins have shifted again and are causing a range of stabbing pains at various points around my knee cap.

Initially, when I get a "new" pain I tend to wonder "what's causing that one now?!" ... and then I check the Xray (see previous post) and realise that the pain is actually happening in or around an area where a pin or wire either goes into, comes out of or curves around a piece of bone! Its seems that as the swelling and scar tissues are healing, the hardware is becoming more prominent and alllowed to move around more easily. The latest thing this week is the appearance of a "bruise" where the pins are poking into the skin - I haven't knocked or bumped it so can only assume I'm bruising from the inside out?!

View of the bruise below right of my knee cap

Bruising from the inside out ?!

The protruding pins that are causing the bruises

Hence, as I'm working through my regime I'm getting new pains and twinges on a daily basis. Its like a guessing game, which bit will dig in today?

I have to admit its very frustrating! I still want to work on the ROM and the strengthening exercises, but each day there is something new to hold me back. A few weeks ago, a shifting pin at the top of the knee cap dug into the tendon so bad that I was unable to exercise the quads properly for a while and they began to fade away again. I don't want this to happen again, so I am dealing with it by only doing the exercises each day that don't give me pin stabs. If today the wire under my knee cap catches when I try to push the ROM, I will just concentrate on the quads. If tomorrow the pins at the top or side of my knee are digging into a tendon, I will just work on the ROM instead. Luckily, I haven't had a day when ALL of it hurts together yet!!

I can't have the hardware removed yet because the skin over and around my knee is still shiny and mottled. This apparently indicated some minor nerve damage that is still not healed and until that calms down the surgeon won't cut through the tissue again. Not sure how long it will be, a few months perhaps, but it will have to come out eventually and I can already imagine how much better it will feel when its done.

Stage Two Exercises

Increasing the strengthening exercises mostly involved just building up the stage one exercises by increasing the number of holds and repetitions. The following have also been added to the routine.

Short arc quads

This is the next stage in the quads regime and aims towards achieving the straight leg lift (below). The idea with this one is to raise the knee using a wedge (rolled up pillow or towel will do) preferably on a solid surface and then to push the knee into the wedge in order to try to raise the foot. Once the lift is achieved, hold for 5 seconds and slowly lower, keeping control of it as you lower it down. 

Straight leg raises

See separate post on this one. But basically it goes like this ... flex ankle upwards, push knee down into bed to lock leg straight, then raise your foot until the leg lifts off the bed. Try to raised it about 10 inches off the bed, hold for 5 seconds, then lower slowly back down. Try not to let the leg bump back down, this one's about control. Repeat 5, then 10, etc.

Full arc extensions

This one builds on the short arc and helps to make the straight leg raises become easier by working on the quads again. Sit on a firm chair with leg bent at 90 degrees. Slowly start to raise leg, aiming to get it straight out in front of you (you may not make it that far at first). Hold for 5 seconds, repeat 5-10 times. Increase reps and holds as it becomes easier.

Standing wall slides 

This one will work the quads and improve lower leg strength. Stand near wall, feet slightly apart. Place your hands on the wall for support (but don't lean on them), slowly slide up and down 10 times. Progress to holding for 5, repeat 10 etc. You don't need to bend too far to begin with, just as far as is comfortable. Try not to lean to one side, favouring the good leg - I did this, and its apparently "cheating"!

MUA Cancelled, Hardware Removal Postponed

Well the jury is out on the MUA and my doctor has decided that it doesn't need to go ahead. He feels that although my Range of Movement progress is slow (70-90 in two weeks), it is nevertheless steady and the strength in my quads is building (also slowly) so he doesn't want to disrupt that. 

The sudden pain that started last week, just above my patella is apparently a shifted pin, digging into the ligament there. It only occurs when engaging my quads when my leg gets to about 20 degrees. Before 20 degrees, no pain - past 20 degrees, no pain hence the feeling that its a shifted pin causing it. He felt that the hardware should probably be removed, but because the skin over my knee is quite tender and shiny, indicating possible scar tissue/nerve healing problems, he doesn't want to go ahead and cut it open again just yet. So I have to wait a little while longer for that, and basically keep doing what I'm doing with PT for now.

He also suggested that I need to move onto using just the one crutch now and agreed that I can arrange a date to return to work. Driving may be a bit more of an issue, so I'll need to find a way around that for now, but the doc said that as soon as I feel confident enough to have a go at it I can go ahead and try.

So all good I guess ... not sure my Physio Therapist will see it that way when I see him tomorrow, he was quite keen to have me get the MUA done! To save him some work maybe ......?

Squidoo-ing Knee Injuries

Dealing With a Broken Knee Cap

Filling in my time since I've been off work by experimenting with blogging and other forms of online writing. I've found out lots of useful information about knee injuries on the Internet but have to admit its quite tricky to find. I've already mentioned below the Knee Geeks forum, which is great for getting advice and ideas from people who have been through similar experiences. But there is so much out there!

I've recently come across Squidoo, which is kind of like a blog, but more of a hub to pull together ideas and useful resources related to a specific thing. I've created a "lens" (that's what they call their pages) about Dealing With a Broken Knee Cap that pulls together some of the hints and tips I've picked up along the way. Its quite addictive though, I'm now creating other lenses on anything and everything I can think of!

Considering Manipulation Under Anesthesia (MUA)

13 Weeks Post Op - Quad Atrophy

After three weeks on the Physio rolling program, my range of motion had increased from 48 degrees to 72 degrees and my quad muscles had finally begun to wake up and I could do a straight leg raise. I had completely ditched the support brace and had learnt to walk more confidently on crutches (I still have the zimmer frame, but only use that if I'm having a bit of a wobbly day). My leg was feeling generally stronger and my confidence was gradually coming back. It felt like progress to me, considering that less than a month before I was a dithering wreck unable to take even the tiniest step without panicking.

My physio therapist said that he would update my orthopedic doctor ahead of my six week check up the following week. When the day arrived I waited in the cubicle whilst the physio and doctor "discussed" me the other side of the curtain! Then the doctor came in to see me, saying that he'd been told I was struggling with the strength and bend in my knee and that they were considering an MUA. He explained to me that there is only a small window of time in which to carry out the MUA and its important to get it right. Wait too long and the scar tissue and adhesions may become too hardened to do the procedure effectively - do it too soon and it could cause further set backs. I don't know what these set backs are, but imagine they have something to do with muscle soreness and confidence. I'd read about MUA's on KneeGeeks so it wasn't complete news to me, I'd kind of expected that this may crop up sooner or later.

The doctor examined my knee and asked me to demonstrate the bend and a short leg raise whilst sitting in my chair. He seemed surprised to see how much I could do with it and that it was "better than the picture" he'd had from the physio. I explained to him that there had been hold ups with my commencing proper physio therapy and that I felt there had been a lot of progress generally since I'd started the program. He agreed that this seemed to be the case and said that he would have more concern if there was no progress at all in that time. He decided to give it a couple more weeks to see how things go and revisit the possibility of MUA when I next see him on 14 March.

I was fairly happy with this, it seemed like a reasonable bargain, so now its down to me to see how much I can work on the ROM and improve my quads before my next appointment. Scare tactics to make me push it more perhaps? Whatever it is, it seems to be working because by the weekend my ROM was at 80 degrees, it would be good if I can achieve 90+ by the time I see the doctor again ... but will that be enough?

The Straight Leg Raise Challenge

A few weeks ago, one of the physio therapists I saw told me that until I could do a straight leg lift, I wouldn't be able to begin to think about walking without some sort of support (aka frame or crutches). Well, finally, 12 weeks post-op, I managed to do three! It hurt like hell but I did them and felt rather smug afterwards too.

A straight leg raise is one of the initial tests for a broken patella. I was asked in A & E on the night of my accident to lift my leg and was met with a knowing look from the doctor when I failed dismally. The mechanism for carrying out the straight leg raise involves the quad muscles, the patella and the ligaments above and below it. If the patella is shattered, there is no sturdy lever to facilitate the raise. So, given the nature of my injury combined with the state of my wasted quads by the time the fracture was fixed, a straight leg raise was going to take some time!

The physio showed me how to carry out the actions necessary to trigger the movement, even though I couldn't actually see it through. This involved pulling my foot back at the ankle, pushing my knee down to lock the leg straight and then engaging the quads to give the power needed to lift the leg. Well, she may as well have been asking me to lift a ten tonne weight! There was no way on earth my leg was going to lift off the bed, not yet anyway.

For three weeks after she showed me the procedure, I religiously went through the motions at the end of my increasing physio routine. Ankle back, knee locked, quads engaged .... nothing! Well, nothing apart from the pathetic shaking and trembling up and down my thigh.

Acknowledging that my quads had by now finally started to wake up and say hello, the physio announced that "we" were actually going to do a straight leg lift now. I began to go through the motions again, not imagining for one second that it would achieve anything other than a wobble. She told me that it was ok for me to bend my knee just a tiny bit in order to get the lift going. Then as she shouted at me to "go on, lift, lift, LIFT" I felt a sharp tugging just above my knee cap and suddenly, my leg started to lift slowly off the bed! Instantly, I shut my eyes tight and concentrated on slowly lowering it the 20 or so inches back down, terrified that it would crash back down with a bump. I'm not sure who was the most elated, her or me! She made me do it again, this time with my eyes open to "train" my brain to work with my leg again.

So the straight leg lift was now added to my physio regime and I can now (2 weeks later) do a set of 10 lifts, raising my leg higher than I can lift my good leg!. The first couple still hurt like hell, and I'm still wary of my quads giving way (not that they have at all), but the strength that I'm building up as a result of being able to do this is helping my walking progress no end. Like they say, no pain, no gain...

3 Months Post-Op Update

After I got the walking frame, more physio cancellations held me up for a while, but eventually I was seen by a senior therapist. She tweaked my exercises and booked me in for the “rolling programme”.

Here’s a round up of achievements for the last weeks.

Week 9

• Walking more confidently with support brace unlocked and frame for support
• Out and about more
• ROM at 40 degrees

Week 10

• Stood up and walked without brace (using frame) at physio
• ROM at 48 degrees after therapy

My Scar 10 Weeks Post Op

Week 11

• Started rolling programme
• ROM from 53-55 degrees during therapy
• Walked using just one hand for support on parallel bars
• Increased strengthening exercises
• Ditched brace completely

Progression (or Regression?) to a Zimmer Walking Frame

After a week of rubbish attempts at walking without my splint I finally got to see my physio. She confirmed that there is a slow progress with my range of movement in my knee (now at 40) but was concerned to see how wobbly I was on my crutches. The problem was that I was so scared of my leg giving way, I was trying to compensate with the rest of my body and holding myself way too stiff to make any decent attempt at walking. 


She decided to try me out walking between parallel bar in the gym, which I managed surprisingly well, without panicking too! So from there she suggested I tried a walking (zimmer) frame until I build my confidence up a little more. This worked great and I was even able to walk with my brace let out to 90% ... I'd still been trying to walk with it locked until then! 


I've been using the walker at home for 4 days now and have progressed from a stooping dithering wreck, to being confident enough to stand up straight and tall and take "real" steps, with one foot in front of the other, instead of mini shuffle steps. Today I actually sat at the table to eat a meal instead of having it on my lap, first time in 2 months! Best achievement of the week though has to be making it to the loo on my own ... time to start regaining some dignity at last!


The exercises are still very hard work and a few extras have been added. Now that I can sit with my leg to the floor I can do some heel slides from that position, and I also have a bolster for under my leg to try short leg raises when I sitting on my bed. I'm still not able to get my leg from bed/sofa to floor and vice versa without some help, but I guess as my confidence continues to build I will experiment with some ways to achieve this.


What a difference a week makes ... this time last week i was ready to give up and feeling very sorry for myself, ... this week I can see some of the light at the end of the tunnel ...even if it is a long way off yet.

More Tips .....

Gel Ice Packs
I'd bought these a couple of weeks back after reading about them and anticipating that I may need them after my physio sessions. One evening my knee was swollen and hot so I used the ice pack for the first time. After about 10 minutes, the soreness had gone and after 20 mins the redness and swelling had also started to disappear. So now I use the packs after each exercise session to stop the swelling before it has chance to start. I only need to ice the joint for about 20 mins but it certainly does the trick! It also helps to ice the joint for 10 mins or so before I start the routine - I've read somewhere that the cold numbs the area somewhat and so makes it more tolerable to push the boundaries slightly.

Hanging my Heels
This is probably the best tip I've been given yet and it was given to me by a Knee Geeks member. I slide down to the bottom of the bed and start by just letting my heels slightly overhang the edge of the bed. Gradually, I shuffle down further towards the edge, letting my heels dangle further over, testing the water for tension (and any likely pain!) as I go. This has the effect of allowing gravity to gently work on the bend in my knee, therefore improving my range of motion. The first couple of times I did it, I only shuffled far enough to be able to feel the gentle pull on my muscles but the last couple of times I have been able to let my heels move closer to the floor. The effect is amazing! After sitting there for about 30 mins, shuffling further every 5 mins or so, move back up the bed and try your heel slides again ... you will be pleasantly surprised!!

Knee Geeks

Knee Geeks

I came across this website shortly after my accident and had been reading it for several weeks. Left to my own devices when my physio appointment was cancelled, I decided to write a post of my own to seek the support of members with similar experiences. Almost immediately, I received responses offering advice and encouragement for my predicament. It was so reassuring to read and some of the feedback has proven extremely helpful already.

One member wrote about the hinge brace she had used once her splint was abandoned. I was relieved to know it was very similar to the one I’d ordered, I had chosen the right one after all! Another member suggested ways to improve my range of motion, in particular, hanging my leg off the bed and letting it bend slowly under its own weight.

I would recommend this forum to anyone with knee injuries. There is a bulletin board for almost every type of injury/problem and also a diary post area where members record their progress, blog style. There is so much helpful information on the threads its invaluable. The support the members offer is honest and because these are real people, who have experienced the highs and lows of recovering from a knee injury, their advice is second to none.

First Steps in My New Hinge Brace

This week began with the news that my physio appointment was cancelled and I would have to wait over a week for the next one. I was immediately disheartened because it had already been a week since the doctor had told me to start walking without the splint and I'd been hoping that the PT would be able to help me out with this. So it looked as though I was on my own with it for now, another week was too long to wait without doing something to try to advance my progress.

That same evening, I trawled the Internet for information about various knee supports and braces. What a mine field that is! There are so many different types, for various problems, and just selecting which one would be appropriate was quite nerve wracking ... I didn't want to buy the wrong one and do more damage! In the end I settled for a lockable hinge brace. I felt that I needed to be able to lock it straight to begin with, until I get used to not having the security of my splint, and then slowly let out the flexion as my range of motion improves. After much internet research, I decided on the PhysioRoom Elite Hinged, see below.

The brace arrived in two days and I was both excited and terrified at the same time! The first thing I did was inspect the hinge adjustments to make sure they locked securely and set it at zero range for added security! I tried it on for size and the immediate impression was how much lighter than my splint it was. Time to stand up and test the water next .....

It turned out that standing up was the easy bit. On the other hand, taking my first steps was an absolute disaster! I was convinced that my muscles would not be strong enough to hold me and that my knee would give way when it took the weight as I moved my good leg forward. The first step was kind of ok once I finally managed to pluck up the courage to move my good leg, at least there was no pain. But I was so nervous, I tensed up every muscle in my body and on the second step my knee jolted backwards because I was holding it so stiff. It didn’t hurt but I hadn’t been prepared for movement in that direction  ... I totally freaked out and gave up there and then!

The following day I resolved to try again, determined that if I didn’t master this then everything that followed would be an even bigger mountain to climb. The brace in place, I got to my feet and took a deep breath. This time as I was about to lift my good foot forward, I let my injured knee bend forward slightly – it couldn’t bend too much as I’d locked the brace in place. Success! There was no backward jolt, no pain and although I was shaking like a leaf I managed to take my first few unsplinted steps in seven weeks! The more I concentrated on the steps and movements, the harder and scarier it got, to the point where I almost froze to the spot so to take my mind off it I sang nursery rhymes as I plodded along! Ridiculous almost to the point of insanity, but I swear it worked! I rested for a bit and then tried again, this time all the way to the living room and back. And then later another attempt, from bedroom to bathroom to living room. I’d only covered a short distance, but it felt like such an achievement I may have actually just walked on the moon!

There is still much confidence building to be gained through practice before I can say its time to release the hinge a little, but practice makes perfect they say, so all I can do for now is keep at it, again and again and again....

Search for More Knee Braces here...

Tips

I am coming across little things each day that help me either with my physio routine or with stuff generally. So I though I would set up a post to add them to as Tips as I come across them.

They're not major things, but as they say "Every little helps"!

Stop Watch

Now that I have to do my physio exercises every hour I found I was forgetting the time and missing out on a few sets. So now I set my stop watch on my phone for 60 mins to remind me. Simple but effective!

E45 Massage

Before starting the physio routine, I use E45 lotion to massage my whole leg. This helps to warm up the muscles before I start to work them. Initially, I did it to "test the water" as I was very scared of touching my injured leg, especially around the knee area, so the massage helped to remind me that it was fine and build my confidence a little before starting the routine. The massage also has the advantage of moisturising my skin and keeping my leg silky smooth!


Toilet Roll
Yes, I know this sounds weird, but I've found that when I'm doing my quad presses a half used toilet roll placed underneath my knee is way more helpful than a hand or rolled up towel. It has sufficient "give" to allow the knee to press down without discomfort that is caused purely by having something rigid underneath of it. As the range of movement increases, I will be able to use a bigger toilet roll to give me more to press down on.

Counter Flexing
When I'm doing either knee bends or quad presses, after a little while I feel as though my joint is beginning to "lock". I've found that its helpful to release the muscle slightly by doing a counter action. For example, when working on heel slides to bend the knee, do an occasional quad press to release some tension and then continue with the heel slides.

6 Week Check Up

Yesterday was my 6 week check up with the hospital. The X Ray showed good results and I was told the fracture has healed well.

X Ray showing my healed fracture and the hardware used to fix it
(6 weeks, 2 days after surgery)

Now all that remains is to get my knee bending again and to build up the quad muscles enough for me to walk again. The doctor proposed to remove the splint and progress me to a short hinge brace. However, the nursing staff would not fit this and instead tried to squeeze my knee into a sort of sleeve support that was a size too small, they didn't have a larger one in the size I needed. When it was realised that this wouldn't fit my swollen knee, it was announced that I would have to make do with a tubey grip bandage instead. I objected to this, as my PT had said the day before that my quads weren't strong enough for me to walk without something to support me yet.

So the doctor was sent for again and he eventually agreed that I could keep the splint to get around with for now, on condition that I remove it and try to do as much as I can without it once I was home. I have to say it wasn't a pleasant experience, and the nurse would really benefit from improving her bedside manners in future! I am not due to see my physio again until next week, so in the meantime I will just do what I can with getting used to not wearing the splint and building my confidence enough to stand and possibly try walking without it.

On the plus side though, although the stiffness in my knee was causing me some discomfort, there was no actual pain when the various inspections and procedures were carried out. This has given me a bit more confidence to try to do more with it and its encouraging to know that 6 weeks of doing nothing has helped to heal the break .... even if it HAS made my muscles disappear and my joint stiffen up big time! Can't have it all ways I guess, so back to the exercises for now ......

Early Stage Rehabilitation Exercises

These are the exercises I've been given to do so far.

All of them are carried out sitting upright in bed with my back supported and my "good" leg flexed up for support.

I have no idea what the official "names" for these exercises are, so I've just made up my own!

1. Ankle Circles

• Circling the ankles clockwise and anticlockwise, 5 times each way to warm up

2. Ankle Stretches

• Pull my foot backwards towards me until I feel the stretch in my calf muscle, hold for 5 seconds, release, then point toes forward away from me as far as possible, hold for 5, release. Repeat 5 times.

 

• An extenstion to this when the ankle needed extra work was to use a ribbon (or other non-elasticated object such as towel) to hook under the foot and use to pull my foot backwards towards me, hold for 5, release.

3. Knee presses

• Push the back of the knee down into the bed/sofa/floor. Hold for 5. Repeat 5 times. I find it useful to place a rolled up towel, pillow or even hand underneath the knee to give something to press down onto, it helps to get the exact movement that you need to work the correct muscle in the correct way.

4. Knee presses with quad squeezes

• Flex foot backwards, push back of knee down and squeeze quad muscle at top of thigh. Hold for 5. Repeat 5 times. (I'm not sure if this exercises my quads or my bum more, but either way it has to be beneficial!).

5. Supported Heel Slides

• I only move onto these after I've done the exercises above so that my leg is sufficiently warmed up. Place a plastic bag or something slippy underneath my heel. Someone holds my foot in one hand and slides the other underneath my knee for support. Slowly pull my heel back towards me, hold for 5 (if possible), then slide heel back down. Flex ankle to help release the stretched muscle. Repeat 5 times. REST!!!
• See diagram below - plus hands for support

6. Unsupported Heel Slides

• Like it says on the box ... as above, but without the support. I find that I can't achieve as much bend like this, but still do them as I feel its building my confidence and quad strength even if its not improving the ROM.

* At the moment I am just doing 1/2 sets of each exercise during each "workout", depending on how sore and/or tired I am. I am trying to do at least some of the exercises every couple of hours for now.

(Diagrams in this post are credited to the websites they are linked to)

Starting Knee Bends

4 January 2012

The second physio session was quicker than the first. Some progress with my ankle flexes and related calf muscle strength. The PT had spoken with the consultant who confirmed that it was ok for her to begin some knee bends. After a few quad exercises, she supported my foot and underneath my knee to try a few bends with her taking control of the movements. The range of movement was still pretty dire unfortunately. She showed us how to do commence some supported heel slide exercises, this time with me working to pull my knee up, with gentle support underneath to help build my confidence. A plastic bag was placed underneath my foot to help my heel to slide up. We were shown how to remove my splint so that I can see properly how the muscles are working when I exercise.

My quads are still not strong enough to support me to try walking without the splint. I am to continue with the exercises as often as possible until next Tuesday, when she will assess me ahead of my next appointment with the consultant.

The First Physio Therapy Session

30 December 2011

Four weeks and four days after my surgery I went to meet my physio therapist for the first time. The session took over an hour and was bascially an assessment of how things were doing. We chatted about the details of my accident and injury and then she took a look at my leg. With the splint removed I felt very vulnerable. My leg felt weak and the muscles in my thigh had shrunken down to almost nothing. She was very gentle though and worked with me to build my trust and confidence as she started by gently running her fingers over my leg and progressing to very gentle massaging movements around my knee. The tissue around my knee had hardened in places and she showed me how to massage it slowly with lotion to start to losen it. Despite doing lots of foot flexes over the weeks, I wasn't able to flex it back far enough to her liking so she showed me how to exercise this to improve and strengthen the range of movement in my ankle. She needed to check with the consultant how much she was allowed to push my knee, so for now, she did a couple of test flexes ... which revealed a rather dire Range of Movement (ROM) in the joint, almost zero in fact! She showed me another exercise for my quads and checked how I was walking with the crutches to make sure my posture was ok. I got the ok to open the splint myself at home for washing, massaging and exercising my ankle and quads.

Getting Around in a Splint

So for the next 3 weeks I split my time between bed, sofa and laps of the living room to keep me moving. Walking on the crutches was slow and hard work. But it was the getting up and down that I found difficult as I was unable to get my leg from bed/sofa to floor and vice-versa unaided. I think this was partly due to the weight of the splint causing pressure and pain on my knee, partly due to the increasingly useless quad muscles in my bad leg, and partly due to the injury itself as a straight leg lift is virtually impossible with a fractured patella. I need someone to lift my leg whilst I turn myself around and then place it to the floor for me. I think someone needs to invent a device that will help with this, how people who live alone would manage I'll never know!

To make things worse, this was Christmas time! No shopping, no dining out, no cinema, no pantomime! I did manage to get out on Boxing Day though, after a family effort to get me into our car. This involves putting the front seat flat, lowering myself down onto the seat, having someone lift my leg from the floor whilst I slide my bum up the back of the seat far enough to be able to turn my leg into the car and then lower it down into the footwell. Quickly place a pillow under my leg to support it, raise the seat again and off to go! .... Yes, driving is a long way away yet!

Moshi Monsters checking out my splint

Pamper time!
Getting a foot massage

Out and about on Boxing Day
(that's a wafer sweet by the way, not my knee cap poking out of the splint)

From Cast to Splint and Staple Removal

14 December 2011

"Having staples removed is always fun" was a quote posted on my Facebook page! Well, I guess I was about to find out. After having the cast cut away with that macabre looking saw tool, I lay on the bed for the nurse to "whip out" my 24 staples. For anyone who has never had the pleasure of this experience, I would say, really don't worry, its not as bad as it sounds. A few tiny stings at the worst and most of them I didn't feel at all. Just don't make my mistake and Google it first, as pictures of the little blighters will make their extraction appear excruciating, if not impossible!

This is my scar 2 weeks after the staples had been removed

The deed done, I was taken to Xray to find out how things were doing 16 days after surgery. Ouch! Why do Radiographers always require broken bones to be placed into the most inconvenient positions for their snapshots?! I think my words were, "this really isn't feeling good right now" before he moved it into a slightly more bearable position. Very polite I thought, given the circumstances.

I didn't get to see the consultant back at the clinic, but he apparently surveyed my Xrays and his registrar came to deliver the news. Not the exact words, but it went something like this .....

"Yes, it was a very bad fracture, but the surgeon has done his best to repair it. Expect to experience early onset of osteo-arthritis though as the underneath of the bone is not quite smooth enough"

Didn't exactly fill me with glee to be honest, but I was relieved to know that my, by now, throbbing joint was going to put into a splint and left alone for the next four weeks ... well, apart from a little "gentle" PT (Physio Therapy) that is.

First Orthopedic Checkup

7 December 2011

A short visit to see the orthopedic knee specialist at my local hospital. The hospital system was unable to open the files showing my original Xrays that had been sent there. After a brief discussion with the consultant, it was decided that my cast should stay on for another week. I was to continue with partial weight bearing with the crutches and keep on the pain meds. Appointments were made for the following week.

Surgery and after ...

28 November 2011

At 10am the next morning I was taken to the operating theatre. The surgery lasted 2 hours. My shattered knee cap was fixed with 3 pins and an arrangement of surgical wire around its circumferance to hold the displaced fragments together. The wound was closed using 24 metal staples and my leg was immobilised in a velcro splint to allow time for the swelling to go down. I was dosed up with painkillers and prescribed a course of 4 antibiotic shots to keep away any potential infection in the wound. Also, due to my mother's medical history, it was decided that I was at high risk of developing a DVT and I was given an anticoagulant shot to try to prevent this. I was told that I should be able to leave the hospital the following day, once the antibiotics course was complete. The orthopedic specialist came to see me and told me that the trauma team had been divide over whether or not the damage was too much to try to repair, but that the surgeon had felt it was worth a try. They appeared to be very pleased with the results and he was very complimentary to the surgeon for managing to repair the mess inside my knee.

The next morning, my leg was put in a full cast, from just above my ankle right up to the top of my thigh. Some more Xrays were taken and I was able to see my "before" and "after" images to see for myself what the fuss was about. A physio therapist came to see me to show me how to walk on crutches, partial weight bearing on my injured leg. Crutches forward, bad leg, good leg, crutches forward, bad leg, good leg ...

My case notes and Xrays were forwarded to the hospital in my home town, a supply of painkillers provided and at 4pm I was discharged. Unable to fit my immobilised leg into our own car, my aunt and uncle travelled to collect me and I was propped up with pillows and duvets on their back seat to commence the four hour journey home.

The Fall

Sunday, 27 November 2011

Away for a weekend break with my hubby and friends, having a brilliant time! Decided to go and grab some food before settling down to watch another entertainment act. We ate our food and were just leaving the fast food diner when the accident happened. The step was shallow and unmarked and the lighting inside the food hall was poor. I didn't notice that it was even there when my left foot unbalanced on the edge of the step and my ankle twisted, sending me crashing down onto the floor below the step with my right knee taking the brunt of the fall. I rolled back into a sitting position with my knees bent up in front of me, and this is when I noticed the jagged lumps on my knee cap protruding underneath the material of my skinny jeans. We didn't need to be medical experts to know that this was going to need more than an ice pack to fix it!

A First Aider was called who took one look and telephoned for an ambulance immediately. Unfortunately, there was no ambulance in the area at the time - the nearest A&E department being over an hours drive away, so a paramedic was sent to assess the situation in the meantime. He checked my knee, my pain levels and made sure I was kept as comfortable as possible until the ambulance arrived, two diversions and an hour and a half later. I was stretchered into the ambulance and given entinox as pain relief whilst the knee was examined. By this time, my knee had a swelling the size of a tennis ball on the knee cap and was already bruising nicely. The initial protrusions were no longer visible due to the swelling and the ambulance medic suspected that my patella was dislocated. The entinox was increased whilst he tried to manipulate it back into place.

Over an hour later, with the help of the entinox we made through the winding lanes to the hospital A&E department. A doctor made a quick assessment and two Xrays were taken. I was told that I'd "made a good job of it". An orthopedic doctor was sent for to explain further.

Fractures of the Patella.
(Mine was a comminuted displaced fracture similar to the 4th diagram here)

I was diagnosed with a comminuted displaced patella fracture, which basically meant my knee cap was broken into at least four pieces. I would require surgery as soon as possible to pin and wire it back together. I was put on the trauma list for the following morning, my leg was put in a plaster of paris half cast splint and I was taken to the orthopedic ward where I was given diamorphine, ibuprofen, paracetamol and codeine for pain relief. It was a very long night, and the beginning of a long road to recovery.