Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I met with an accident last year where my femur broke, and my patella was shattered. I underwent surgery one month after the accident, and I developed small lumps on my knee after a few weeks. These lumps developed from the wounds in the surgical site, and pus would start to ooze out. The doctor said I needed to undergo another arthrotomy, which was scheduled five months after my first surgery. After a few days, new lumps developed from the surgical wound and had pus in them.
I have attached a picture of the wound, wound culture result, complete blood count, and an X-ray of my knee for your reference. I still cannot bend my knee; it has been seven months since my first surgery. In addition, I have been taking Clindamycin as prescribed. Will I be able to bend my knee and walk normally again? I have no idea what to do next.
Please help.
Hi,
Welcome to icliniq.com.
I went through your query and understood your concern.
I have a few questions regarding your condition,
1. Regarding the culture you mentioned, is it the wound swab or the aspirate from the joint? (attachment removed to protect the patient's identity).
2. Did you regain knee movements post-surgery?
3. What is the status of the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), and collateral ligaments?
4. Did you have a high temperature?
5. Is this how the wound appeared after the arthrotomy and washout?
6. Were the patella fracture fragments removed, and how was the patella repaired with the tibia?
7. Did you receive physiotherapy?
Kindly follow up with the answers.
Take care.
Patient's Query
Hi doctor,
Thank you for your reply.
I can only bend my knee about 35 degrees now, and I did not have a fever before or after the surgery until now. The wound looked the same after arthrotomy and wash out. I am not sure about the status of ACL and PCL and the collateral ligaments, but as far as I can remember, the only problem I have had was with the patella. What should I do?
Please help.
Hi,
Welcome back to icliniq.com.
Has your fracture healed? Are the nails made of stainless steel?
I suggest you to undergo an MRI (magnetic resonance imaging) to assess the knee, and perhaps if the fracture is healed, then you can have the nail removed. MUA (manipulation under anesthesia) can be done if there are no intraarticular issues, followed by CPM (continuous passive movement). If the MRI report shows quadriceps adhesions, then quadricepsplasty can be done.
If MRI cannot be done, then arthroscopic assessment and intraarticular lysis of adhesions and manipulation can be considered; if there is no improvement, you can proceed with quadricepsplasty.
I hope this was helpful.
Take care.
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Orthopedician and Traumatology
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