Tibial Fracture, Ankle, Adult, Displaced, ORIF

You have a fracture (break) of your tibia in the lower part of the bone that makes up part of your ankle. The tibia is the large "shin" bone in your lower leg. This is the large bump you feel at your ankle on the inside of your leg. Your fracture is displaced. This means the bones are not in their normal position and will not give a good result if they heal in that position. Because of this, surgery is required. This is called an open reduction and internal fixation (ORIF). Even with the best of care and perfect results this ankle may be more prone to be arthritis later due to damage of the cartilage lining the ankle joint which is not visible on X-ray. These fractures are easily diagnosed with X-rays.

TREATMENT

You have a fracture that would probably heal with disability, without surgery. Open reduction means that the area of the fracture is opened up to the vision of the surgeon and internal fixation means that a screw or fixation device is used to hold the boney fragment (piece) in place. Following surgery a short-leg cast or removable fracture boot is then applied from below your knee to your toes. This is generally left in place for about 5 to 6 weeks, during which time it is followed by your caregiver and X-rays may be taken to make sure the bones stay in place.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medications taken including herbs, eye drops, over the counter medications, and creams.

  • Use of steroids (by mouth or creams).

  • History of bleeding or blood problems.

  • Previous problems with anesthetics or novocaine, including a family history of these problems.

  • Possibility of pregnancy, if this applies.

  • History of blood clots (thrombophlebitis).

  • Previous surgery.

  • Other health problems.

RISKS AND COMPLICATIONS

All surgery is associated with risks. Some of these risks are:

  • Excessive bleeding.

  • Infection.

  • Failure to heal properly resulting in an unstable or arthritic ankle.

  • Stiffness of ankle following repair.

BEFORE AND AFTER YOUR SURGERY

Prior to surgery an IV (intravenous line connected to your vein for giving fluids) may be started and you will be given an anesthetic (medications and gas to make you sleep). After surgery, you will be taken to the recovery area where a nurse will monitor your progress. You may have a catheter (a long, narrow, hollow tube) in your bladder following surgery that helps you pass your water. When you are awake, are stable, taking fluids well and without complications, you will be returned to your room. You will receive physical therapy and other care until you are doing well and your caregiver feels it is safe for you to be transferred either to home or to an extended care facility.

HOME CARE INSTRUCTIONS

  • You may resume normal diet and activities as directed or allowed.

  • Keep ice packs (a bag of ice wrapped in a towel) on the surgical area for 15 to 20 minutes, 3 to 4 times per day, for the first two days following surgery. Use the ice only if OK with your surgeon or caregiver.

  • Elevate your ankle above your heart as much as possible for the first 24-48 hrs post-operatively.

  • Change dressings if necessary or as directed.

  • If you have a plaster or fiberglass cast :

  • Do not try to scratch the skin under the cast using sharp or pointed objects.

  • Check the skin around the cast every day. You may put lotion on any red or sore areas.

  • Keep your cast dry and clean.

  • Do not put pressure on any part of your cast or splint until it is fully hardened.

  • Your cast or splint can be protected during bathing with a plastic bag. Do not lower the cast or splint into water.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Use crutches as directed and do not exercise leg unless instructed.

  • These are not fractures to be taken lightly! If these bones become displaced and get out of position, it may eventually lead to arthritis and disability for the rest of your life. Problems often follow even the best of care. Follow the directions of your caregiver.

  • Keep appointments as directed.

SEEK IMMEDIATE MEDICAL CARE IF:

  • There is redness, swelling, or increasing pain in the wound.

  • There is pus coming from wound.

  • You have an unexplained oral temperature above 102° F (38.9° C) develops.

  • There is a bad smell coming from the wound or dressing.

  • You have increasing pain coming from the area of the wound. Especially when someone else moves your toes.

  • The wound breaks open (edges not staying together) after sutures or staples have been removed.

If you do not have a window in your cast for observing the wound, a discharge or minor bleeding may show up as a stain on the outside of your cast. Report these findings to your caregiver.