Open Reduction and Internal Fixation of Fractures o the tibial shaft

DiscussionAn open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe bone fracture, or break. Open reduction means surgery is needed to realign the bone fracture into the normal position. Internal fixation refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection.

The surgical procedure is performed by a doctor who specializes in orthopedics, which is a branch of medicine concerning the musculoskeletal structure of the body. Under general anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when healing takes place.Once the open reduction internal fixation is performed, a cast is usually applied. In the case of an ankle fracture, for instance, the first cast is a non-weight bearing cast, and crutches can be used to help keep weight off the healing bones. Later, when the healing has progressed, this cast will be replaced with one that can bear weight. Eventually, after a period of some weeks, the cast will be removed entirely. The type of fixation device is determined by the anatomic considerations of the fracture (e.g, comminuted, spiral , or open. Severely comminuted fractures may have to be treated with prolonged traction rather than fixation.

Procedure The fracture is exposed in which transverse bone screws or plates (including compression plates) may be applied to reduce fracture fragments. In addition, after the fragments have been reduced, an intramedullary nail or rod may be employed to fix a fractured tibia and provide rotational stability. An ender nail is slightly curved and semi elastic. An incision about the tibia tuberosity is made. A drill reamer penetrates the medullary canal. The measured nail is inserted and aligned to avoid malrotation or shattering the shaft of the tibia. Loose fragments and debris may be pulse ravaged or irrigated with saline or antibiotic solution. The ender nail is then driven past the fracture site into the distal portion until the threaded end remains exposed. A counter incision over the fracture site may be needed to effect reduction. Again, care is taken during the driving of the nail to avoid injury to the shaft. Use of multiple ender nails can improve rotational stability fanning of the proximal end helps control rotation. Small bones or fractures at the insertion site may complicate use of Ender nails. X rays are taken to visualize and document the repair

Preparation of the PatientAn antiembolitc shocking may be placed on the unaffected extremity, as requested. General anesthesia or regional block anesthetic may be employed. The patient is supine; arms may be extended on padded arm boards. The safety straps is secured over the blanket-covered unaffected extremity.Skin Preparation. Care is taken to support the extremity to avoid further injury. Begin at the fracture site; prep the entire extremity, Include the leg, thigh and foot

DrapingThe supported leg is abducted and elevated the foot is grasped and covered by tube stockinet, A large sheet is draped over the end of the table. The stockinet is brought up (unrolled to the level of the tourniquet. A folded towel is wrapped around the top of the stockinet and secreted. A split sheet is draped under the leg, or the leg may be passed through a sheet with a rubberized fenestration.

ASSESSMENTEXPLANTION OF PROBLEMObjectivesNursing InterventionsRationaleEvaluation

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