Pre-operative Assessment
Initial Evaluation
- Obtain comprehensive trauma history
- Assess neurovascular status
- Document soft tissue condition
- Review imaging studies (X-rays, CT, MRI as indicated)
Pre-operative Planning
- Determine fracture pattern and classification
- Select appropriate fixation method
- Review implant options and sizes
- Consider patient factors:
- Age and bone quality
- Comorbidities
- Activity level
- Compliance potential
Operative Protocol
Patient Positioning
- Position based on fracture location and approach
- Ensure access for fluoroscopy
- Properly pad pressure points
Surgical Approach
- Make appropriate surgical incision
- Protect neurovascular structures
- Access fracture site with minimal soft tissue disruption
Fracture Reduction
- Achieve anatomic reduction
- Confirm alignment under fluoroscopy
- Apply temporary fixation as needed
Fixation Method
Internal Fixation Options:
- Plates and screws
- Intramedullary nails
- Tension band wiring
- External fixation devices
Closure
- Irrigate wound thoroughly
- Layer-wise closure
- Apply sterile dressing
Post-operative Protocol
Immediate Post-op Care
- Monitor neurovascular status
- Pain management
- Early mobilization as appropriate
- Wound care instructions
Follow-up Schedule
- First visit: 2 weeks
- Subsequent visits: 6 weeks, 12 weeks
- Final review at 6 months
Rehabilitation Protocol
- Phase 1: Protection (0-6 weeks)
- Phase 2: Motion (6-12 weeks)
- Phase 3: Strengthening (3-6 months)
- Phase 4: Return to activity (6+ months)
Complications Management
Early Complications
- Infection
- Compartment syndrome
- Vascular compromise
Late Complications
- Nonunion
- Malunion
- Hardware failure
Documentation Requirements
- Operative notes
- Post-operative orders
- Rehabilitation protocol
- Follow-up visit documentation