Tibial Nailing for Tibial Shaft Fracture Patient Information Trauma and Orthopaedics Department Author ID: KC Leaflet Number: Musc 015 Name of Leaflet: Tibial Nailing for Nail Shaft Fracture Version: 4 Date Produced: February 2018 Review Date: February 2020 Tibial Nailing for Nail Shaft Fracture Page 1 of 6
What is a Tibial Shaft Fracture? The tibia is the larger of two bones situated in the lower leg. The tibial bone (shin-bone) is situated in close proximity to the skin surface and in some cases if fractured (broken) can pierce the skin; this is called a compound fracture. Fractures of the tibia occur more often following a sports injury or a road traffic accident. Benefits of surgery If you are advised to have an operation to fix the fracture site, the main benefits for you would be a return to normal activities sooner than if other types of treatment is used. Alternative treatment Treatment options depend on the extent of the fracture and the damage of any other structures near the fracture site, such as skin and muscle. If the fracture is in good alignment (position) and there are no complications a long leg plaster cast (above the knee to below the ankle) can be applied to keep the fracture in alignment until healing has occurred, this can take approximately three months. The use of crutches to prevent weight being put on the fracture area is necessary to promote healing. You will be shown how to use crutches before you go home Information about looking after your plaster cast and who to contact if you have any concerns will also be given. Regular checks will be required of your plaster cast to ensure that it is not too tight/loose, and to ensure the fracture is healing. Attending appointments for the out patient clinic is an important part of your treatment. If the fracture is not in alignment a manipulation under anaesthetic (MUA) may be necessary, before the plaster cast is applied. This involves a general anaesthetic which will send you to sleep for the procedure. The fracture is pulled back into position by the surgeon and a plaster cast applied. An x-ray is then taken to check the bone is in a satisfactory position. In some cases a tibial fracture cannot be held in a good position with a plaster cast alone therefore an admission to hospital for an operation is required. The doctor will discuss with you the best treatment for your fracture. If you are unsure or worried about the operation or any part of the treatment, please discuss with a member of the health care team. Tibial Nailing for Nail Shaft Fracture Page 2 of 6
Tibial shaft operation An operation will need a general anaesthetic; this will send you to sleep for the duration of the operation. Other types of anaesthetic can be used; the doctor will discuss the options with you prior to the operation. Depending on the type of fracture either metal screws and/or a metal plate to bridge the fracture are used. In some cases a metal rod is inserted down the inside of the tibia to hold the fracture in place, this is called a Tibial Nail. In either tibial nailing or insertion of screws or plates, an incision (cut) will be necessary over the fracture area. The surgeon will close the skin using stitches or clips and a dressing applied. If the fracture is extensive it may be necessary to apply an external fixator frame. This looks like scaffolding attached to the outside of the leg, an operation is performed to insert metal pins through the damaged bone, the metal pins are attached to the external frame which holds them and also the fracture in position. After the operation Following an operation you will spend a short time in the recovery area of the operating theatre where you will wake up from the anaesthetic.you will then be transferred back to the ward. Your leg which has been operated on can cause you some discomfort initially so painkillers will be given to you to ease the pain. The surgeon will advise you how much weight can be put on the operated leg after the operation. The physiotherapist will visit you and show you how to do exercises to prevent your leg from becoming stiff. The physiotherapist will also help you to walk as appropriate to your surgeon s directions using crutches or a walking frame. You will be able to go home 3 to 5 days after the operation, unless the doctor has advised you to stay longer. The district nurse, GP or practise nurse will remove any stitches or clips approximately 14 days following the operation. An appointment to attend fracture clinic will be made for you so that a check can be kept on the healing of your fracture and you will be advised when to return to normal activities In the case of an elderly person a period of rehabilitation may be recommended following the initial hospital stay. The need for rehabilitation will be discussed with the patient and their family/carer s early on in the hospital stay, in conjunction with a social worker and the health care team. Tibial Nailing for Nail Shaft Fracture Page 3 of 6
More detailed information will be given prior to going home. Complications of the operation As with all operations complications may occur some are minor, others in rare cases are serious and may be life threatening. Complications include:- Anaesthetic problems. Bleeding during the operation or after the operation. Infection in the surgical wound. Blood clots (In the leg-dvt or the lung -Pulmonary Embolism). Specific complications include;- Infection in the bone. Tibial nail/screw breaking. Delayed union (healing) of the fracture. Malunion (Fracture heals out of position it was set in). Severe pain and/or stiffness in the affected leg. The doctor will discuss the risks involved with you before the operation. If you are unsure or worried about any part of your treatment or care please discuss this with a member of the health care team. Contact information Contact number: 01942 822026, Aspull Ward, Royal Albert Edward Infirmary. Tibial Nailing for Nail Shaft Fracture Page 4 of 6
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Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: 01942 822376 (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me? How We Use Your Personal Information For details on how we collect, use and store the information we hold about you, please take a look at our how we use your personal information leaflet which can be found on the Trust website: www.wwl.nhs.uk/patient_information/leaflets/default.aspx This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call 01942 773105. Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Tibial Nailing for Nail Shaft Fracture Page 6 of 6