Tibial Plateau Fracture Treated With ORIF – Brief Information

A tibial plateau fracture is a break in the bone that forms the bottom of the knee joint (tibia or shin bone). The top of the tibia has a flat, smooth surface (tibial plateau). This part of the tibia is made up of softer bone than the shaft of the tibia. If a strong force is directed at the tibial plateau, the tibial plateau can collapse or break away at the edges.

Open reduction with internal fixation (ORIF) is a type of surgery that may be used to treat a tibial plateau fracture. You may need this surgery if your fracture is displaced, which means that one or more pieces of your tibial plateau have been moved out of their normal position. In this surgery, a surgeon will move the bone pieces back into the correct position. Then, the surgeon will put in screws or other types of hardware to hold the bones in place.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Excessive bleeding.
• Infection. This can cause screws or surgical hardware to loosen.
• Allergic reactions to medicines.
• Damage to blood vessels that supply the knee.
• Nerve damage.
• Improper healing. This can result in an unstable knee.
• Long-term pain and stiffness (arthritis).
• Blood clot. This can form in the leg and travel to the lungs.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Plan to have someone take you home from the hospital.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital. This is important.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• The surgeon will make an incision through your skin over the area of the fracture.
• The broken bones will be returned to their normal positions. The surgeon will use screws and a metal plate or different types of wiring to hold the bones in place.
• In some cases, a piece of bone from your hip (bone graft) may be used to help repair the knee. If a graft will be used, a small incision will be made over your hip to remove a piece of bone and place it into your knee for support.
• The surgeon will close all incisions with stitches (sutures) or staples.
• A bandage (dressing) will be placed over your incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given medicine for pain as needed.
• You may need to wear a hinged knee brace. When you wear the brace, your health care provider will be able to gently move your knee to prevent stiffness.
• You may be given instructions about how much body weight you can or cannot safely support (bear) on your injured leg (weight-bearing restrictions). You may be given crutches, a cane, or a walker to help you move around so that you do not bear any weight on your foot.
• While in the hospital, you will be helped out of bed so you can begin moving around. This is important to improve blood flow and breathing.

Summary

• A tibial plateau fracture is a break in the bone that forms the bottom of the knee joint.
• To repair the fracture with ORIF surgery, the surgeon will move the bones back into place and secure them with screws or other types of hardware.
• You may be given crutches, a cane, or a walker to help you move around so that you do not support (bear) any weight on your foot.

Tibial Plateau Fracture Treated With ORIF, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Swelling.
• Stiffness.
• Tingling or numbness.
• A small amount of fluid from your incision.

Follow these instructions at home:

If you have a brace:

• Wear the brace as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Keep the brace clean.
• If the brace is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness.
  • More swelling or pain.
  • Blood or more fluid.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths.
• If your brace is not waterproof, cover it with a watertight covering when you take a bath or a shower.
• Keep the dressing dry until your health care provider says it can be removed.

Managing pain, stiffness, and swelling

• If directed, put ice on the affected area.
  • If you have a removable brace, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your brace and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured leg above the level of your heart while you are sitting or lying down. To do this, try putting a few pillows under your knee and lower leg.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a brace on your leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider or physical therapist.
• Do not use your injured limb to support (bear) your body weight until your health care provider says that you can. Follow weight-bearing restrictions as told. Use crutches or a walker as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have a fever.
• Have pain that is not helped with medicine.
• Have redness around your incision.
• Have more swelling or pain around your incision.
• Have blood or more fluid coming from your incision or leaking through your dressing.
• Notice that your incision feels warm to the touch.
• Have pus or a bad smell coming from your incision area.

Get help right away if you:

• Notice that the edges of your incision have come apart after the sutures or staples have been removed.
• Have pain, warmth, or tenderness in the back of your lower leg (calf).
• Have trouble breathing.
• Have chest pain.

Summary

• After the procedure, it is common to have some pain, swelling, tingling, or numbness.
• If you have a brace, wear it as told by your health care provider. Remove it only as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Contact your health care provider if you have blood or more fluid leaking through your dressing.