Shinbone > Treatments
open Reduction with Internal/External Fixation
Preparing for Surgery
If you have a fracture of the shinbone (tibial plateau),
you may have to undergo surgery to have the broken bone
set internally and externally. 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.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling 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
surgery to have your fractured shinbone (tibial plateau)
set. If your surgery is going to be inpatient, there
may be a separate department, so be sure to ask your
doctor. 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 cast, brace, or bandage when you
leave the hospital.
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 help.
In a limited open reduction with internal/external
fixation surgery, a fractured bone is repaired internally
and also externally with wires and a rigid rod that
holds the bones in place so they can heal. 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 anesthesiogist will administer the anesthesia to
put you to sleep in the operating room.
procedure normally requires one or two small incisions
so that the broken bones can be set and held together
with screws. Externally, two insertions of wires are
made through the skin and into the two parts of the
fractured bone. The two parts are then held together
with a rod that is aligned horizontally to the leg.
incisions are sewn up and the patient is taken to the
recovery room. No cast is placed on the leg.
After surgery to repair your fractured
shinbone (tibial plateau), you usually 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; the nurse will provide
pain medication. Remember that it is easier to keep
pain suppressed than it is to treat pain once it becomes
present, so ask about medication when you feel the pain
coming on. Your temperature, blood pressure, and heartbeat
also will be monitored by a nurse. You will have to
use crutches, and you probably will not be able to bear
weight on your leg for as long as six weeks.
| Post-op in Hospital
After surgery to repair a fractured
shinbone (tibial plateau), some patients remain in the
hospital for at least overnight. 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.
After your fractured shinbone has
been surgically repaired, here is what you can expect
to do to cope with a cast immobilizing your leg.
most knee injuries, treat with R.I.C.E. (Rest, ice,
compression, elevation). Try to avoid putting weight
on your injured leg. 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. Elevate the injured
leg above heart level to help blood drain towards your
body. It often helps to sleep with pillows under your
your toes as much as possible to help circulate blood.
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.
patients can use a CPM (continuous passive motion) machine
right away; it is important to regain and maintain range
of motion in the knee while the fracture is healing.
Though everyone's rehab program is slightly different,
physical therapy for a fractured shinbone 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 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.
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.
strengthening exercises: Shinbone fracture
Once your fractured shinbone 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 each step.
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.