Knee > Fractured Shinbone > Treatments

   Open 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.

   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.

   Getting a second opinion is advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at (919) 929-7103.

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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:

   You 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 anesthesia.

   Since 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.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

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 help.

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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.

   General 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.

   The 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.

   The 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 so.

   Incisions 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.

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:

   The 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.

   Keep your plaster cast dry. Wrap it in a plastic shower bag whenever you may come in contact with water.

   Like 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.

   Elevate the injured leg above heart level to help blood drain towards your body. It often helps to sleep with pillows under your ankles.

   Expect pain, so take pain medication as prescribed by your physician. It should decrease after the first few days.

   Move your toes as much as possible to help circulate blood.

   Depending on the severity of the fracture, your surgeon may not want you to put weight on the leg for up to four weeks.

   If you develop a rash or irritated skin around your cast, call your physician.

   If 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.

   Straight 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.

   To 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.

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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.

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   Knee 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 three components:

   Daily 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.

   Muscle 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.

   Recreation - 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.