Shinbone > Treatments
Reduction and Internal Fixation
Preparing for Surgery
If the pieces of your fractured shinbone are too far
out of place, you may have to undergo surgery to open
your knee and have the fracture set internally. The
decisions you make and the actions you take before your
surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers. You should receive
prescriptions for any of these from your doctor when
your surgery is scheduled.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
a second opinion is advisable, particularly in rare
or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at (919) 929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your fractured shinbone surgery. If your surgery is
going to be inpatient, there may be a separate department,
so be sure to ask your physician. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will walk or ride
on a stretcher to the operating room. Most patients
are not sedated until they go into the operating room.
Here are some important steps to remember for the day
of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
Take it easy. Keeping a good frame of mind can help
ease any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television, chatting
with visitors, or talking on the telephone can also
to take to the hospital
In an open reduction-internal fixation
surgery, the skin is opened and the broken bones are
put back together by the surgeon. The procedure usually
lasts about two hours.
anesthesia is typically used for surgery, though in
some cases a spinal or epidural anesthetic is used.
The anesthesiologist administers the anesthesia to put
you to sleep in the operating room.
procedure normally requires one incision to expose the
area of the fracture. This can vary from a very small
incision, if screws are used, to a five-to-seven-inch
incision if screws and a plate are used.
fractured pieces are held together and secured by metal
wires or screws, or screws and a plate. This hardware
is usually left in place forever; however, if they become
uncomfortable, your surgeon might remove them, but normally
will wait a full year for complete healing before doing
are sewn up, an immobilizer or cast is placed on the
knee to restrict movement, and the patient is taken
to the recovery room.
After surgery to repair your fractured
shinbone, you usually will stay in the recovery room
for at least two hours while the anesthetic wears off.
You will be given adequate pain medicine, either orally
or through an IV (intravenous) line, as well as instructions
for what to do over the next couple of days. In addition,
you will be given an appointment to return and a prescription
for pain medicine. Your knee will be bandaged and may
have ice on it. You may have significant pain early
on and you will be given pain medicine as prescribed.
Remember that it is easier to keep pain suppressed than
it is to treat pain once it becomes present, so ask
the nurse about medication. when you feel the pain coming
on. The nurse will not give you more medication than
is needed or is considered to be safe. You should try
to move your feet while you are in the recovery room
to improve circulation. Your temperature, blood pressure,
and heartbeat will be monitored by a nurse, who, with
the assistance of the doctor, will determine when you
are ready to leave the hospital or, if necessary, be
admitted for an overnight stay. You may be able to bear
some weight on your leg, but you probably will have
to use crutches while a cast is on your leg. As soon
as you are fully awakened, you are usually allowed to
go home. You will probably be unable to drive a car,
so be sure to have arranged a ride home.
| Post-op in Hospital
After surgery to repair a fractured
shinbone, some patients remain in the hospital for as
long as 24 hours. There will likely be pain, and you
can expect to be given pain medication as needed. Be
sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
Ice also helps control pain and swelling.
If your fractured shinbone is surgically
set and requires a cast, here is what you can expect
and how you can cope with a cast immobilizing your leg:
first concern is to monitor swelling for the first 48
hours while wearing your cast. If your swelling decreases
dramatically, the cast may become too loose. If swelling
increases, circulation can be dangerously cut off. In
both cases, you should usually see your physician for
a new cast.
your plaster cast dry. Wrap it in a plastic shower bag
whenever you may come in contact with water.
most knee injuries, treat with R.I.C.E. (Rest, Ice,
Compression, Elevation). You may or may not be able
to put some weight on your leg, depending on your physician¹s
recommendation. Wrap ice into a well-sealed plastic
bag and drape around the cast at knee level for 20 to
30 minutes, two or three times a day.
the injured leg above heart level to help blood drain
towards your body. It often helps to sleep with pillows
under your ankles.
pain, so take pain medication as prescribed by your
physician. It should decrease after the first few days.
your toes as much as possible to help circulate blood.
on the severity of the fracture, your surgeon may not
want you to put weight on the leg for up to four weeks.
you develop a rash or irritated skin around your cast,
call your physician.
you notice any abnormal wear or discomfort, contact
your physician as early as possible. In general, do
not try to "grin and bear it" if discomfort
does not go away within a few days.
leg raising, which exercises the thigh muscles (quadriceps),
usually are recommended after one or two days. Range
of motion exercises are very important during the early
stages of recovery.
avoid complications, only your doctor should remove
the cast with a special vibrating cast saw. In most
cases the cast is removed after four to six weeks.
to call the doctor after surgery
Once your cast has been removed following a fractured
shinbone (tibia plateau), your physician may recommend
physical therapy to help strengthen the muscles around
your knee and to help insure your knee¹s range
of motion. Though everyone¹s rehabilitation program
is slightly different, physical therapy for a fractured
kneecap follows a general pattern. Range of motion is
extremely important. Movement may be painful at first,
but it is important to not allow the knee to stiffen.
Rehab progresses to resistive exercises those
involving weights to keep the muscles around your
knee strong. You should eventually be able to resume
functional activities like stair climbing, single leg
support, swimming, and driving. You will be able to
begin more vigorous activities as your kneecap heals
and your leg gets stronger.
strengthening exercises: Shinbone fracture
Once your fractured kneecap has healed,
building muscle strength around your knee can help you
avoid further injury. Contact sports and activities
increase your chances of re-injuring your knee. Many
of the exercises and activities that are popular for
fitness put stress on your knees. To prevent further
knee injuries it is important to learn knee-sparing
exercise techniques by dividing your activities into
Living The average person takes between 12,000
and 15,000 steps a day, exerting a force between two
and five times your body weight on your knees. After
a knee injury, take it easy on your knees during the
day whenever possible to save them for activities and
exercise. Avoid stairs when there is an elevator, take
the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock.
Strengthening/Conditioning Activities themselves
are not a substitute for conditioning. It is essential
to adhere to the muscle strengthening program you learned
in rehab throughout the remainder of your life. The
best strengthening programs are low-impact and non-weight-bearing,
like stationary bikes and certain weightlifting programs,
so that the knees do not have to absorb shock.
- Your sport or activity of choice helps maintain mental
and physical well-being, but it is not a conditioning
program. Sports that require twisting and quick direction
changes put great strain on your knee.
A discussion with your physician or physical therapist
can help determine the appropriate exercise program
and activity level for you.
A small amount of pain is normal during
physical activity, but if you feel so much pain in your
knee to warrant taking a painkiller before an activity,
you should consider cutting back or stopping. Do not
play through the pain after a fractured shinbone- it
may be a sign that your activity is putting too much
stress on your knee.