Tibial Shaft Fracture Fixation — KEVIN PARVARESH, MD

Pain Medications

In most cases local or regional nerve blocks will provide 8-12 hours of numbness.
As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.
If you still have pain after Tylenol and Aleve/Naproxen, take one Norco or Percocet tablet..
If you still have pain after all of the above, take a second Norco or Percocet tab.
Keep in mind Norco and Percocet have Tylenol in them (325mg). If you take an extra tab, then skip a dose of Tylenol. DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take pain medications once you no longer have pain.
You should stop the narcotic first (usually 3-5 days), then wean off the others over the next few weeks.

Other Medications

Take your prescribed blood thinner (Lovenox, Xarelto, etc.) for 4 weeks to prevent blood clots.
Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

Use crutches, a cane, or a walker to assist with ambulation.
You may progressively increase weight on your operative extremity while ambulating with assistance.
Elevate your operative extremity above the heart as much as possible to decrease swelling.
Avoid prolonged periods standing to prevent excessive pain and swelling.

Cold Therapy

We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

You may perform quad sets, heel slides, and ankle exercises as instructed in your preoperative packet.
Your motion goal should be to have 0-90 degrees of knee and ankle motion at your 6 week visit.
Begin physical therapy immediately after surgery.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Therapy Plan: Daily in hospital, 2-3 times per week for 0-3 months, then 1-2 times per week for 3-6 months

ROM Progression

Progress ROM as tolerated with the goal of symmetric full motion at 10-12 weeks.

Weight Bearing Progression

Progress weight bearing as tolerated with assistance and assistive devices (walker, cane)

Ideally patients will be able to return to their prior ambulation status between 3-6 months after surgery
Gait must be pain free and non-compensatory to transition to a cane or independence
Fall precautions should be observed until the patient demonstrates independence

Phase 1 Physical Therapy (0-6 weeks): fracture healing

Phase 2 Physical Therapy (6-12 weeks): progressive strengthening

Wean out of walker/crutches if strength and balance are appropriate
Continue stretching, Soft tissue mobilization, isometric exercises, core strengthening
Gradually progress strengthening as tolerated
Tactile and verbal cueing to enable non-compensatory gait patterning

Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level and sport