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Need for surgery
|
Only way to treat this type of fracture with least complications |
|
Nature of Operation
|
Supra major surgery involving attempt to put the bones together so that it
heals in near anatomical position and early movement can be started |
|
Alternative of Surgery
|
Traction & bed rest for 6 to 8 weeks with possibility of Nonunion &
Malunion & complications of recumbency |
|
Alternative of Implant
|
External fixator / Ring fixator |
|
Need for special measures (ICU, DVT Prophylaxis) |
May be necessary considering risk / age / recumbency |
Watch for compartment syndrome and vascular complication |
|
Infection & measures to
prevent & tackle if it occurs |
(As per situation) |
|
Need for blood transfusion & estimated units |
(As per situation) mostly the surgery will be performed under a pneumatic tourniquet |
|
Compartment Syndrome |
**See Note at end of this protocol |
|
Need for Bone graft / Substitutes |
To assist in hastening the union / fill up a void in the bone caused by the
injury/ substitute for loss of bone due to injury. Autograft is better than
bone substitutes but had additional incision on the pelvis & few patients
may have residual pain |
|
Possible Surgical Sequelae |
Although I will take utmost care to prevent it there is a possibility of some
difference in limb length, possibility of injury to popliteal artery and nerve. |
|
Possibility of Knee joint stiffness |
You have a badly comminuted
fracture which involves the knee
joint. There is associated damage
to the cartilage & the ligaments
which have happened at the time
of the injury itself. There is a
possibility that these injuries will
ultimately result in stiffness of the
knee joint movements.
The stiffness may be due to muscle
adhesion or due to joint damage &
arthritis The knee may not be fully
mobile or in some cases
completely stiff |
The surgeon has no control on the damage at the time of the injury. I will put back the pieces as best as I possibly can. Knee stiffness may require further surgery after the fracture heals. In some cases, especially in the elderly a total knee replacement may need to be done |
|
Possibility of Knee Ligament Injury |
You have a fracture which is close to the knee joint. There may be associated damage to the knee ligaments which have happened at the time of
the injury itself. There is a
possibility that these injuries will
ultimately result in stiffness of
the knee joint movements.
The stiffness may be due to muscle
adhesion or due to joint damage &
arthritis. The knee may not be fully
mobile or may be loose & unstable |
You may require reconstruction of your knee ligaments at a later date depending on your symptoms |
|
Implant cut out |
Possible if the bones are too weak to support the implant |
The fracture is too comminuted & bone grafting is necessary |
|
Implant Breakage |
This happens if the Fracture fails to unite. However strong the implant is, if the fracture fails to heal, the implant will
eventually break |
The Implant was chosen after due consideration to your requirements & choice. |
|
Duration taken for natural healing of fracture |
Doctor puts the bones together & holds them in proper position using
implants. It is patient’s body which heals the fracture naturally. Surgery is
to put bones in appropriate position and encourage healing. Surgery puts
the broken bone back in position. Nature heals the broken bone. The
estimated time for healing in your case in 8 to 12 weeks. Of these the first
4 weeks you will walk with a walker without putting weight on the operated
leg (as per the surgeons discretion). After that based on the clinical &
X ray findings you will be advised further
|
|
Possibility of alternative outcomes (Nonunion) |
You have a fracture which is otherwise known to heal without major problems. However You have a history of Smoking / Diabetes /
Hypertension / Osteoporosis / Anaemia / Low protein / General debility /
advanced age. These delay healing & may lead to an unexpected
outcome.
|
|
Need for second surgery to tackle adverse events |
If in a rare case your fracture does not heal, you may require resurgery in the form of refixation & bone grafting OR a knee replacement as per the
circumstances then
|
|
Special consent for ICU, Transfusion, Transfer to higher center |
|
Need for Pre-op / Intraop Urinary Catheter (Consent) |
|
Need for Bone Graft (Consent) |
|
Need for Blood Transfusion (Consent) |
|
Mark & Initial Side of surgery with permanent marker pen |
