Post Operative Instructions

ORIF Patella Fracture

You have undergone Open Reduction and Internal Fixation (ORIF) of your patella fracture.

BRACE/SPLINT/CRUTCHES

Your knee has been immobilized with a compressive dressing reinforced by an immobilizer. The immobilizer provides initial comfort by minimizing any motion at the surgical site. You are to remain non-weight bearing on the surgical leg until told otherwise.

SWELLING

Some degree of swelling of your foot and toes is normal. Swelling can be minimized by elevating your leg. Try to keep your leg up elevated upon a few pillows consistently for the first 48 hours, and intermittently thereafter. The goal is for the leg to be above the level of your heart. Swelling can be further controlled by use of ice or cold therapy directly over the site of surgery. Place a bag of ice or package of frozen vegetables (which nicely conforms to the surgical site), usually 20 minutes on, and 20 minutes off. If you have a Cold Therapy® pad and cooler (arranged pre-operatively for this use), keep the sleeve directly over the dressings. Use it continuously for the first week.

BRUISING

Because bleeding from the surgical site cannot escape, it typically travels under the skin to the most "dependent" part of the extremity. An evolving bruising of the foot and/or toes, which can increase over the first few weeks, is normal, and will ultimately resolve.

DRESSING/ /BATHING

Keep your dressing dry and in place until your post-op visit. A cast is usually applied at your post-operative visit. You may shower, but keep the dressing dry, through use of a plastic bag (such as a clean garbage bag) as a cover. Secure it with tape above the dressing/splint to prevent getting it wet. When taking a shower, you should use a plastic chair or some other means of sitting, both for balance and to avoid placing any weight on your leg. As an alternative you may want to try a bath and keep your leg hanging over the side of the tub (so as to keep the incision dry).

FEVER

A low grade fever (less than 101°) is fairly common within the first 3-5 days following surgery. If the fever is higher or lasts longer, this could reflect infection and warrants contacting our office.

ACTIVITY

For the first week try to minimize how much you're up and about. The more your leg is "dependent" the greater degree of discomfort. Do not weight bear (put weight on your leg).

PAIN MEDICATION

Vicodin® (Hydrocodone) or Percocet ® (oxycodone) narcotic pain killers, have been prescribed for pain. Take one to two every six hours as needed for pain, which is typically needed for the first week or so after surgery. All narcotic pain medications can cause side effects, the most common of which is nausea. We have prescribed Phenergan to help with the nausea – take it as you need every 6 hours. If you have known side effects to any of these medications please let us know and we will call in a substitute. Tylenol can be used in place of a narcotic, but NOT in addition to the narcotic. Use Tylenol when pain is less severe.

Pain Medication Tips:

  • Do not drive while taking pain medications.
  • Do not drink alcoholic beverages while taking pain medications.
  • Pain medication should be taken with food as this will help prevent any stomach upset.
  • Often pain medications will cause constipation. Eat high fiber foods and increase your fluid intake if possible.
  • To alleviate constipation, purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.

DVT (BLOOD CLOT) PRECAUTIONS

Deep Venous Thrombosis (DVT, aka blood clot) is an uncommon complication that can occur following lower extremity surgery. Starting the day after your surgery, take an enteric coated 325mg aspirin (which acts as a blood thinner) once a day for three weeks. Because aspirin can cause stomach upset, you may want to take it with food. If you have an allergy to Aspirin, please inform us so we can consider alternative precautions. Remember that Tylenol®, Motrin®, Alleve®, and other Non-steroidal Anti-Inflammatory (NSAID) medications do not protect against DVT, and should not be used for this purpose.

FOLLOW-UP

You should be scheduled for a post-op appointment 10 - 14 days following surgery, at which time we will review your post-operative program and answer any of your questions. Your post-operative appointment is schedule on: _______________________________________________________________.

If you need to verify or change your post-op appointment, please call 703-277-BONE (2663).

PHYSICAL THERAPY

Physical therapy is usually started within the first week of your surgery. We will help you in identifying an appropriate therapist if you need assistance.

IN CASE OF EMERGENCY

You may reach me 24 hours/day through either office (703) 810-5215 Option 3 (Arlington) or (703) 810-5213 Option 3 (Tysons). You should contact me for any of the following symptoms:

  • Fever greater then 101.5 degrees F
  • Numbness, loss of color or coolness in hand
  • Severe pain unresponsive to narcotic medication
  • Excessive bleeding or vomiting
  • Difficulty breathing or shortness of breath – Call 911