Tibial Plateau Fractures

Part 2 - Recovery

Recovery Plan: General instructions for the procedure

Lungs: After surgery, you are encouraged to deep breathe and cough frequently (at least 3-4 times per day). This will reduce mucus from building up in your lungs and will reduce the risk of developing pneumonia.

You must stop all smoking: Smoking slows the healing process by interfering with the making of new DNA. Smoking also increases the risk of infection and pneumonia by slowing your body's white cells.

Blood Clots : Those at high risk of blood clots include patients who have long car or train commutes, may be overweight or have a history of cancer. It also includes women on birth control pills or males over the age of 40. These patients should be taking one baby aspirin per day after surgery unless they are allergic to aspirin. Doing the exercises Dr. Reznik prescribes will also reduce the risk of blood clots.

Diet: You may resume a regular diet when you return home. Most patients start with tea or broth, then crackers or toast and then a non-spicy sandwich. If you become nauseated, check to see if one of your medications is upsetting your stomach since most narcotics can have this effect. If your stomach feels acidy, try Tums, Zantac or Pepcid AC to settle it and drink some clear liquids.

Pain Control: Take medication as prescribed by Dr. Reznik. Please call our office with any questions regarding your medication. Use ice as needed (never place ice directly on skin). Elevate leg above heart level using 2-3 pillows. Elevating the leg decreases swelling and reduces most “throbbing” pain.

Note: Tibial Tubercle Transfer patients will have a cooling pad inside the dressing attached to an ice cooler (in the place of using ice packs) for additional pain control. Directions and Important Precautions with Ice Machine Use:

• Always keep a thin gauze or cloth between the skin and the cooling pad. Do not allow the pad to contact the skin directly as this may cause frostbite.
  
  
• After the first dressing change, inspect the skin regularly. Discontinue use and notify our office if any changes in skin appearance occur.
  
• Change the ice and water when you are unable to maintain a temperature of 52 degrees Fahrenheit. Lower temperatures may damage the skin.

Dressing and Bleeding : After ORIF, a moderate amount of blood tinged drainage is common (it is mostly Novocain). Sometimes this is brought to the surface of the dressing by bending the first few times or the first few steps at home. You may need to reinforce the dressing during the first 24 – 48 hours if this occurs. Applying pressure to the area will help reduce this drainage.

Remember to Call the Physician If: **You develop excessive, prolonged nausea or vomiting ** You have a fever above 101 degrees F **You develop any type of rash **You experience calf pain **There is excessive bleeding or unusual drainage from surgical site
Typical dressing drainage.

Procedure Specific Post-Operative Care:

Tibial Fracture Patients are to use two crutches for 6 weeks, putting no weight on the foot for the first three weeks and only toe touch for the next three weeks. Then they can increase the weight bearing as tolerated.

When you wake up in the recovery room, you will be in a long leg immobilizer and have a cold pad connected to an ice machine, wrapped in an Ace bandage on your surgical leg. The knee immobilizer is to be worn full time for six weeks to protect the knee. This includes during sleep. It is to be removed only for physical therapy and showers. When the knee is more stable, you will change into a knee hinged brace.

You may use the ice machine continuously (including throughout the night) the first 48 hours . To prevent frost bite, keep the temperature at 52 degrees Fahrenheit. You may disconnect the machine to go to the bathroom. At your first therapy appointment, the bandages will be changed. After the first dressing change, you may take a shower. It is recommended to use an antibacterial soap. Do not remove the small white “steri-strips”; they will be removed at your post-op visit along with any stitches or staples. Gently bend your knee a few times while in the shower. After your shower, place a small bandage over the front knee cap incision and Band-Aids over the other small incisions. When replacing the ice machine pad, do not place it directly on your skin as this can cause frostbite. Wrap it in a cloth or place it between Ace bandages.

On days 3 and 4, you may use the ice machine at least 2 hours on and ½ hour off. You may find that the combination of 3 hours on and 3 hours off also works well. You will start physical therapy. After the 4 th day, you may use the cooling pad only as needed to reduce pain or swelling.

You should change the ice and water when you are unable to maintain a temperature of 52 degrees Fahrenheit.

Return to work: Tibial Fracture patients have a longer recovery plan and usually cannot return even to light desk work for 3-6 weeks (some patients can start half days earlier, on a limited basis). Work requiring prolonged standing requires at least 12-14 weeks. Jobs requiring heavy labor need 16-20 weeks or longer.

Additional Precautions for all patients:  

Dental Work: Tibial Tubercle/Lateral Release patients CANNOT have any routine DENTAL WORK for at least 3 months after their surgery (including cleaning), or they will risk infection. After 3 months, they may see the dentist but will need to take antibiotics before and after dental work. They should continue this for one year from the date of surgery. If an emergency dental procedure is needed, the dentist should be notified of the need to give protective “prophylactic” antibiotics before and after the procedure.

Airline Flights : Lateral release patients may fly 3 weeks after surgery on short flights (only up to 2 hours) but should wait at least 6-8 weeks for longer flights. They should get up and walk frequently to avoid blood clots. All patients planning to fly the first 6 months after surgery should be on aspirin (81mg per day) at least one week before and 6 weeks after a flight (unless allergic). Tibial Tubercle Transfer patients should not fly before 6 weeks and also need aspirin protection for flying. Please check with Dr. Reznik or his nurse if you have any questions about flying or long trips.

Risk of Infection: Infection after surgery has been in the news recently. There is always a risk of infection. The risk of infection in regular surgery is less than 1%. However, the risk in arthroscopic surgery is less than 1 in 2000 (less than one twentieth of a percent). In addition, Dr. Reznik routinely uses antibiotics during surgery and post-operatively to reduce this risk as well.

8/09