Knee > Fractured Shinbone > Treatments

   Arthoscopic-assisted 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.

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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:

   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 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.

   General 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.

   The 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.

   Externally, 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.

   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 (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:

   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, 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 ankles.

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

   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. Weight bearing will not be permitted until about three months after surgery.

   To avoid complications, only your doctor should remove the cast with a special vibrating cast saw.

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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.

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   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 three components:

   Daily 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.

   Muscle 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.

   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.