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 ......?

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...

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.