Shinbone > Treatments
Reduction with Internal/External Fixation
Preparing for Surgery
If you have a fracture of the shinbone (tibial plateau),
you may have to undergo arthroscopic surgery to have
it 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. Make 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.
Understand 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.
Any 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. If possible,
practice walking with your crutches in case you need
to use them after surgery. Most 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.
Make 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 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 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 arthroscopic-assisted reduction
with internal/external fixation, a fractured bone is
repaired internally via arthroscopic surgery
and also externally with wires and a rigid rod that
holds the bones in place so they can heal. The procedure
usually takes one or two hours.
anesthesia is typically used for surgery, though in
some cases a spinal or epidural anesthetic is used.
The anesthesiologist will administers the anesthesia
to put you to sleep in the operating room.
procedure normally requires one or two incisions. Using
the arthroscope and a X-ray, the surgeon can then see
what he is doing as he sets the broken bones with screws.
two insertions of wires are made through the skin on
the inside and outside of the knee 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.
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 (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. 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.
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.
After surgery to set a fractured shinbone,
some patients remain in the hospital for as long as
three days. 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. You will not be able
to bear weight on your leg for as long as three months;
therefore, you will need to use crutches to get around.
Ice also helps control pain and swelling.
If your fractured shinbone was surgically
repaired, you may have a cast or an immobilizer your
leg for three to six weeks. 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, and 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. Weight
bearing will not be permitted until about three months
avoid complications, only your doctor should remove
the cast with a special vibrating cast saw.
to call the doctor after surgery
Once your cast has been removed following surgery
to repair a fractured kneecap (patella), your physician
may recommend physical therapy to help strengthen the
muscles around your knee and to help insure your knee's
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.
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, with each step 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 and 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.