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    Old 08-04-2004, 04:50 AM   #1
    dentalnitemare
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    Unhappy Broken patella

    A couple of weeks ago I fell out of a chair and broke my patella,(it's the bone behide the knee cap,along with cracking 2 others.The ER put my leg in a brace,gave me cruches and pain meds and told me to go to a specialist this would probably require surgery.I got up the next morning thankfully before my husband left for work,and fell again.The cruches (sp?) were for someone no shorter than 5'10" I'm 5'3" so they were too tall for me.I told them this at the ER but that's all they had anyway,I went to the doctor and got papers for a MRI.I go to find out if I have to have surgery.Has anyone else broken this same bone before and if so how did things turn out? I'm a very active person and this has been about to drive me crazy to have to sit around,and yes I'm thankful it wasn't any worse.I twisted my leg in the fall and broke it before I even hit the ground.The break was bad enough that I couldn't move the ambulance had to come get me.My little 4 year old went and got me help when this happened.The specialist wouldn't even take the brace off,he said from looking at the xrays he could tell the bones were very loose.Of all the doctors out there I got one that don't believe in pain meds too,here I am with no cast,the swelling is gone now,and the brace is too loose,but I'm not suppose to be in any pain.Yeah,right!Any advice or words of encouragement would be wonderful.Thanks!

     
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    Old 08-04-2004, 12:41 PM   #2
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    Re: Broken patella

    Wow, this sounds like a nasty injury! First of all, I'll give you a little anatomy lesson so you know what the doctors are talking about... The patella IS the kneecap. It is embedded in the tendon that goes from your quads (the musles at the front of your thigh) down to your tibia (shin bone) just below the knee. Basically, having the patella in there improves the mechanics and lets you generate enough force with the muscles to move the leg properly. The patella slides up and down over the end of your femur (thigh bone) as you bend your leg. The back of the patella is covered with cartilage, as is the end of the femur that it is sliding over. The femur articulates (forms a joint) with the tibia (your shin bone) at the knee. There is another bone in the lower leg besides the tibia, which is called the fibula. This bone is a lot skinnier than the tibia and is on the outside edge of the lower leg. You might be able to feel one end of it (on your good leg!) on the outside of the leg just below the knee. You can see the other end at the ankle (the ankle bone on the outside). If you look at your x-rays or do an internet search for leg bones you should be able to find a picture to see all this.

    If you haven't gotten the crutches taken care of by the doctor, have your husband go to the drug store and buy you some crutches that are the right size, as this will help you get around.

    This seems like quite an extreme injury for the actions you described leading up to it. Be sure the doctor looks into whether there were other contributing fractures, such as osteoporosis or something, just to be safe.

    It also surprises me that it's been a couple of weeks and you still haven't been able to get all of the diagnostic tests out of the way and have a treatment plan. I guess there's nothing to be done about that, but I'm sure it is frustrating having to wait!

    I can't really help you much on what to expect with surgery. They will probably use a plate or screws or whatever to hold the bones in place so they heal correctly. You really should have a brace that fits properly until then, though, so the bones don't move out of place. Call your doctor and explain to him that the brace you have is too loose now that the swelling has gone down, and ask him for a new one.

    As for long-term outcomes, you could have problems with arthritis after this, because when you broke the patella you probably damaged some of the cartilage on the back of it that helps it slide over the femur. Cartilage, unfortunately, is very bad at regenerating, so any damage to it is probably permanent. But the doctor, if you have surgery, should be able to smooth out any rough areas so that you have as normal of function as possible.

    I am so sorry that you are having so much trouble with this injury and not knowing what is going to happen. Write down a list of all of your questions and take it to the doctor with you. Make sure that he or an assistant answers them and explains things to you in words that you can understand. Don't let them brush you off. It is their job to explain what is going on to you, seeing as it is your body. Also, at the next visit with your doctor after the MRI, you should take your husband or a friend who can help you listen, since this will be the visit where the doctor explains everything that is going to be happening and it is easy to get overwhelmed and not remember everything that was said later. You might consider taking notes.

    Try to look on the bright side, though. You will get better eventually. It may take a while, and surgery is a pain (literally!), but it will all be over eventually, and you will be able to get back to your life. Good luck.

     
    Old 08-04-2004, 07:10 PM   #3
    dentalnitemare
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    Re: Broken patella

    Thank you,I go to the doctor tomorrow to find out what's going to happen from here.I did call the doctor about the brace they acted like I hadn't said a word,I also ask for a refill on my pain meds,he's already dropped the mg.on them by half! I also have a walker now instead of the cruches and a wheelchair that has been a lifesaver!When I was at the ER they told me the patella was the bone behide the kneecap.I looked up it up on the internet and I agree with you it is the kneecap.I looked like someone took a baseball bat to me when this happened.Some bruises took almost a week to appear.
    Again, thank you I needed advice and your words of encouragement.

     
    Old 08-05-2004, 12:17 AM   #4
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    Re: Broken patella

    I am so sorry that you ended up with one of those doctors that doesn't listen. You might consider finding a new surgeon if you are really uncomfortable with this one and your insurance will let you switch. It is important that the doctor actually listens to your concerns and takes them seriously.

    My doctor that did my ankle surgery was absolutely wonderful. He had a medical assistant whose job was to answer any stupid questions that I had. So at any time before the surgery and during my recovery that I had a question, I could just call and usually had an answer within a day. I'd ask all kinds of questions too, like whether I could take tylenol the night before my surgery and if my toes should still be turning purple three weeks after the surgery, and all that other stuff. Once I had a question that she couldn't answer, and she had the assistant surgeon call me back within 24 hours. Anyway, my point is that this surgeon took his patients seriously and answered all of my concerns, no matter how silly they may have seemed to him, as if they were important. Because any concern a patient has IS important. So if you feel as if you are being blown off by this doctor with your concerns now, I would not choose him do any surgery on you because the treatment probably won't change. He may be an excellent surgeon, but but if he doesn't explain things so that you can understand, take your concerns seriously, and actually look into a problem that you alert him to, then he has lousy patient management skills and I would not feel comfortable under his care. What if you call the office after surgery complaining that you have some weird pain and they tell you that it's normal and blow you off and it turns out to be an infection? This is your health, and you need to make sure that you feel comfortable with the person to whom you are entrusting it.

    Good luck with your appointment tomorrow, and be sure to post how it turns out.

     
    Old 08-05-2004, 08:04 PM   #5
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    Re: Broken patella

    This is one post I hate to have to post.I went today to find out if I would need surgery or not,of course I do.I have torn tendons that cannot and will not ever heal without them replacing it with a donor's tissue,and I have to have a screw put in my kneecap.I couldn't just fall and break my leg,I had to do it right didn't I?I've cried,I've got mad and of course nothing has helped.All he would give me was Darvacet and I had to beg for that.I did get another brace that allows me to bend my knee which is alot better.As for insurance I don't have any at all,so that makes all this just wonderful.I can say this tho I have been very lucky to have the doctors that would allow me to set up a payment plan,which will take the rest of my life to pay for.I know I probably sound ungrateful,I don't mean to.I'm to the point of depression with this and I have a little one that misses mommy playing with him,he's so bored.Thanks to all who took the time to read this and reply.My surgery is Wednesday morning at 7 a.m.I'm so scared I've never been put to sleep or had anything that required a stay in the hosptial other than having a child.I"ll go for now,but will check back in later tonite or tomorrow.

     
    Old 08-05-2004, 11:58 PM   #6
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    Re: Broken patella

    Wow, I am so sorry that you don't have any insurance. This is definitely a burden that you didn't need! I can't imagine you trying to run your house and take care of the kid and all. I don't know how you do it. So try not to get depressed about all the things that are hard, but focus on how well you are doing despite the challenges.

    It is disappointing to know that you have to have surgery, but at least there is now a light at the end of the tunnel. You will have the surgery, you will rest, you will do physical therapy, and you will get better. Remember that... you will get better. It will take a long time, and it will not be pleasant, but you will get better.

    It is okay to cry and to be angry, just don't let that overtake your life. This is a crappy thing that has happened to you, so go ahead and acknowledge that. Just make sure that you still take joy in the fact that you are still healthy, you have a son who loves you, a husband to support you, etc.

    The surgical procedure doesn't sound unreasonable. The screw will hold the bones together so they can heal. You probably don't have to get it taken out again, unless it bothers you later. As for the tendon, don't worry about it. It seems a little creepy that you're going to have somebody else's tissue in your body, but it is clean and safe.

    It's funny, because my surgery was on a Wed morning at 7 am too. So here's what to expect. You may or may not have to go in to have blood drawn and pee in a cup and maybe get an EKG (they just put these little stickers on your chest that are hooked up to a machine, no pain involved) a few days before surgery. Then the night before you can't eat after midnight. Then, since you are scheduled for surgery at 7 you will probably have to get there at 5 or 5:30. So you'll get up in the middle of the night and be horribly nervous. I was so nervous (plus I don't do well with getting up in the middle of the night) that I almost threw up. Wear comfy clothes. I would recommend either a pair of pajama shorts of pants with really wide legs. After surgery you'll probably have a huge bandage, so you want to make sure that the pants or shorts you bring fit over it. So you'll show up at the hospital and sign in, then you get to sign all kinds of paperwork saying you won't sue them and you will pay them and all that stuff. Then the nurse comes and gets you and takes you back to a little room. You get a lovely hospital gown and grippy-bottomed socks to wear. You may or may not be allowed to keep your underwear. My friend who had knee surgery was not allowed to keep it, but when I had my ankle surgery I was, although they stained it with iodine or something, so wear old underwear just in case. They might have you pee in a cup. They take your temperature and blood pressure and pulse and all. They will ask you to tell them what you are having done to make sure that you understand what you are getting yourself into. At some point they will probably take a marker and make an X somewhere on the leg that you are having surgery on, so you don't go to sleep worrying that they might cut open the wrong leg.

    So after all that you get to go to the pre-op area and sit in this big comfy chair and put your feet up. They have these blankets there that they keep in a warmer, so if you are cold they will give you this very nice warm blanket. Then they put the IV in. I had mine in the back of my left hand. They might start you on some antibiotics if the doctor has ordered them. If you are really nervous, they might be able to give you something to help you relax, as well. Then you sit around and wait. The surgeon will come by and chat with you for a few minutes. The nurse will probably scrub the surgical area then wrap it in a towel.

    Then you're off to the OR. At this point, you have to leave your husband (or friend, or whoever you take with you) in the waiting room. They did let me take my stuffed Eeyore with me (yes, I am 23 and by all accounts a full-grown adult, but he helped) and my camera (I wanted them to take pictures of the surgery). So this big comfy chair they have you in has wheels, and they just roll you down into the OR, then have you slide over onto the table. So the slid me over and left the blanket on me and tucked Eeyore in with me. They didn't even say anything to me when they were about to put me out, but it didn't take long at all. I didn't even feel anything weird. I was just laying there holding Eeyore and then I was in the recovery room.

    So you'll wake up in the recovery room. The first thing I was aware of was that I was awake. There was a nurse right there, so I of course had to ask her if it was over, and she said yes. Then I told her I was cold, so she got me another one of those heated blankets (and Eeyore). Then, once that was taken care of, I realized that my ankle really hurt (duh, it was just cut open....), so I told her that and she came right over and injected my IV. When they put the pain meds in your IV they take effect fast, so I felt better almost instantly. At some point in all of this they had gotten my mom back from the waiting room. Then the nurse came back and asked how my pain was and I got some more drugs. Oh, and right when you wake up you will have an oxygen mask over your mouth and nose blowing cold air at you. Pretty much once you are conscious and talking they will take that off. Also, they will give you ice water if you want it too.

    This is the point where I ran into problems... Remember that I had just had two injections of pain meds into my IV. The nurse asked me if I wanted to go home at this point or stay in the hospital. (Apparently I was only allowed to stay in the recovery room for an hour, so I had to decide right then.) So I decided that I felt pretty good, and that I was going to go home. So my mom had my bag of clothes and I put on my comfy pants and my T shirt. Then I got up and went to the bathroom, they took out my IV, and I got in the wheelchair and out to the car. I put the seat all the way back and reclining and had my foot up on the dashboard. But less than halfway home it really started to hurt. I figured that maybe when we got out of the car and stopped bouncing it around it would feel better. So we stopped and dropped off my prescriptions at the pharmacy, then my mom got me settled on the couch and went out to pick up the drugs. I took one of each, then waited. It didn't help the pain at all, so I took more (as directed), and it still didn't help. So I was sitting there practically crying from the pain and waiting for the meds to kick in. But apparently the way those things work is that if you let the pain get out of control it is very hard to get it back under control.

    The lesson here is that you want to get your post-op pain medicine prescriptions from your doctor ahead of time and have them filled before you need them. (Or have your escort to surgery go out and get them filled while you are being sliced and diced.) Also, be sure to take more as soon as the pain starts to come back (as long as it has been long enough between doses!); don't wait until the pain gets bad. It will be helpful to write down when you take pills so you don't forget. It is even more helpful to have somebody else write it down so they don't forget, then have them do the math and tell you when you can have more.

    So anyway, I ended up going back to the hospital and got admitted. On the way back, the pills finally started to kick in, but not enough. They put in another IV and started giving me morphine, which didn't do anything for the pain. So they gave me more. Then they gave me so much at once that they had to give it as a shot in the arm rather than through the IV. Still nothing. (Pause here for another helpful hint... If the nurse asks you if you want the shot in your arm or your butt, go for the butt... My arm hurt for three days after that, but I got maybe 3 shots in my butt and had no pain at all.) So I finally got it through the nurse's head that the morphine wasn't doing anything, and asked for what they gave me in the recovery room (demerol). That worked instantly. Remember that not everybody responds to all medications. There are people like me, who you can give lots of codeine or pump full of morphine, and it won't do anything at all. So if what they give you doesn't work, ask them to try something else.

    The most annoying thing about being in the hospital was having the IV. I had already had the one in my left hand, so when I went back they tried my right hand but messed it up. So then, since she was already on my right side she put it in the crease of my elbow on that side. So I had this IV in my elbow on the side of my dominant hand. Until I got used to it, I was afraid to bend it, but I got used to it in a few hours. The other problem with the IV was getting up to use the restroom. I was on crutches, which takes both hands, so I had to call a nurse to wheel the IV pole. Then there was this one who kept saying "let me know when you are done" and then kept opening the door before I let her know I was done.

    But really, you will only be in the hospital as long as you need to be for pain management, and while your pain is being managed in the hospital you will probably spend most of your time sleeping. So don't worry too much about being bored.

     
    Old 08-05-2004, 11:59 PM   #7
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    Re: Broken patella

    And now for part II.... Apparently there is a limit to how long a post can be...

    I was there for two nights, although I probably could have gone home after one. I was worried about going home to early after my previous episode. Also, I had hockey tickets for that thursday night, and if I wasn't going to be able to go to the hockey game, it was going to be because I was in the hospital, not just sitting at home on the couch! I did watch the game on TV. I remember that there was an octopus thrown on the ice (it's a detroit tradition), and I am pretty sure that I talked to my friend on the phone. I definitely got another shot of demerol, and after that I can't tell you much of anything! I ended up getting mostly shots even though I had the IV because when they give meds to you through your IV they act faster but also go away faster. If they give you a shot in the muscle it lasts a lot longer. Again, go for the leg, not the arm.

    Eventually in the hospital I was feeling good enough to just be taking pills, so I went home. I did a lot of sleeping and ate a lot of jello and graham crackers. (That's the other nice thing about the hospital... you can get jello, ice cream, graham crackers, and peanut butter any time you ask... just be sure not to get graham cracker crumbs in your bed!) In a few days I had the daytime TV schedule memorized. I was glad that I have a phone line extension so I could surf the internet from the couch.

    If you have time now, you might want to cook some meals and freeze them in individual serving containers, especially if you will be spending time alone at home soon after your surgery. Also, get some books or magazines or whatever you want to spend your time with. Nothing that requires brain power, though. Maybe get a new game or two that you can play with your son while laying on the couch.

    You will have pain after surgery, but it will become reasonable after a few days. I had surgery on Wed during my spring break, and on the next Monday I was sitting in class. Of course, I was completely drugged up and had my leg sitting up on the desk, but I was there. You won't be able to drive while you are on medication, so keep that in mind now before you have surgery. Be sure you have enough laundry detergent, shampoo, etc.

    So I hope that helps with your fear about surgery. It is scary, but I think that is mostly the anticipation. Once I was at the hospital I felt much better. And it will hurt, but that will get better. You know that this is something that has to be done, so just grin and bear it. Be prepared for the recovery to take longer than you expect. You will be frustrated that you still have pain, or that you still can't put weight on it, or that it's taking so long. Go ahead and cry, then remind yourself of how far you have come and that it will get a little bit better every day.

     
    Old 08-06-2004, 08:11 PM   #8
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    Re: Broken patella

    Thanks again for all the info and encouragement,but you guys won't believe this.The doctor's office calls today,I have til Monday to come up with half the money for surgery or the doctor will not perform the operation on me.His words.I have to come up with 3200.00 I couldn't do that if my life depended on it.Now I guess I'll just let nature take it's course as they say.I have no choice.I can't get a loan,I don't have any credit cards,so I'm just out of luck either way.I don't know if I could find another doctor to work with me or not.I didn't realize when they said set up a payment plan they meant I'd have to come up with half of money for surgery.Sounds like a greedy doctor to me.

     
    Old 08-06-2004, 08:13 PM   #9
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    Re: Broken patella

    I'm glad this is not a life threatening illness,if the doctor is so worried about getting his money I probably would be better off to find another doctor.

     
    Old 08-06-2004, 10:04 PM   #10
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    Re: Broken patella

    Wow, that really is disappointing. I bet if you call around you will be able to find somebody who will do it now and actually set up a payment plan that you can do. Although now that I think of it, I had to put $3500 down on mine. Even though I have insurance, the doctor who was recommended to me (who was very well-qualified) did not participate with my insurance, so I had to pay 20% out of pocket. Also, They made me pay a $1000 deductible even though my deductible for the year had already been met. So eventually, whenever they are satisfied that they have gotten all of the money that they're going to get from the insurance company, I will the that back. But for now it just means that they've been collecting interest on my $1000 for 6 months now. Maybe I should send them a bill... Anyway, I'm really sorry that you have to delay the surgery. Now you just have to sit around and anticipate it. That's the worst part about the surgery (besides the pain, the recovery time, etc...). Okay, so there's a lot of bad parts.... but the anticipation and not knowing what to expect was not pleasant. I would call around and see if you can get anybody to take pity on you. Good luck.

     
    Old 08-06-2004, 11:39 PM   #11
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    Re: Broken patella

    I asked the dr.if I refused surgery what would be the outcome of my situation.He said I would end up with chonic arthritis,and that I would be able to walk again.I'm going to have arthritis anyway,but if I did have the surgery I'm sure I would be alot better off.I don't know what I'm going to do from here.I am going to look for a dr. that will work with me.I'm sure there's bound to be one that will,I just hope it's one that I like and am able to feel comfortable with him doing the surgery,that's alot to ask for.Right now I feel like I've forgot how to walk,I don't think I could put one foot in front of the other if I had to.Time will hopefully take care of all of this,and believe me I've done my share of praying too,especially when I was laying on the ground waiting on the ambulance.My little one has been so good through all this,I don't know what I would of done without him,he's the one that went for help when I fell.He's my little hero now.He tells everybody too,I want to get better so I can take him trick or treating and get ready for Christmas.I know that's a little ways from now,but I feel I have a long way to go.I wanted to put up 2 trees this time,and really fix the house up good,he starts school next fall and I want us to enjoy our time together before he has to start school.

     
    Old 08-07-2004, 12:12 PM   #12
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    Re: Broken patella

    If you decide not to have surgery, you should ask your doctor when you should start trying to walk on it again. You might ask about physical therapy. If you went for one or two visits you would be taught some exercises that you can do at home to help. Whatever you decide to do, I wish you luck.

     
    Old 08-08-2004, 09:26 PM   #13
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    Re: Broken patella

    I have no idea when to even try to put weight on my leg,much less trying to walk again.I would love to go to physical therapy.Having no insurance doesn't help at all.I'm scared to death with this whole deal.I don't believe I'll ever be able to walk again without some therapy.Thanks for your input you have been alot of help and given me alot of encouragement.

     
    Old 08-08-2004, 11:16 PM   #14
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    Re: Broken patella

    Try not to worry. If you don't give up and keep calling around, you may find a surgeon who can help you. If you don't want to go that route, call your doctor back and ask if he can either tell you how to manage your case non-surgically over the phone or to see you again and explain it to you. Just make sure that he will actually tell you what you need to know, not just push a surgery on you that you can't afford. If you don't think that you are going to get the information you need from him, go back to the list and start calling around and find somebody who will help you manage this. You don't want to start walking on it if you will do more damage at this point, but you also don't want to wait longer than necessary because your joint will stiffen up and your muscles will start to atrophy (shrink and get weak).

    So anyway, be persistent and don't let the doc just leave you hanging with nowhere to go. That would be just plain unethical of him! He either needs to treat you with the course of treatment that the two of you have agreed upon, or refer you to somebody who will treat you. Some orthopedic surgeons are just in the business to make money. Surgery is their main money maker (despite the outrageous fees they charge for an office visit). So some of them aren't interested in patients that they can't treat with surgery, and may advocate surgery when another doctor might try other options first.

    As for physical therapy, you do need a prescription from a doctor. But if the doctor puts on the prescription that you are there for training in a home exercise program and you make your financial situation clear to the therapist, they should be able to provide you with instructions on what to do at home in a visit or two, with maybe another visit after a few weeks to see how you are progressing.

    Just watch out for yourself and make sure that you end up getting the care that you need.

     
    Old 08-09-2004, 07:59 PM   #15
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    Re: Broken patella

    The doctor's office called twice today to see if I had any money yet.That's a joke.They are going to call again in the morning.When I went to the dr. Thursday they told me I would be able to walk again without surgery.Today I asked the nurse when she called when should I try to start walking again if I can't have this surgery she says well you won't be able to without this surgery,you have no choice but to have this done.They don't even want to give me more time to come up with any money,but they also won't do the surgery without any money.It just don't make any sense to me.

     
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