Post-operative management of Tibial Shaft Fractures.

[MagicalTrevor]

Hey everybody. I had a question about tibial shaft fractures. One of my friends was hit by a car and got a midshaft tib/fib fracture of his left leg which was managed with an intramedullary nail. He just got out of the hospital today and his surgery was yesterday and the orthopod is telling him to weightbear right away and walk normally. This sounded a bit suspect to me especially after a long series of mishaps during the short course of his admission most notably of which included him not being catheterized and getting a spinal anesthetic. When he finally did get catheterized, he let out over a liter of fluid.... In short, is immediate weightbearing advised post-surgery or is this orthopod's management going against guidelines. Thanks!

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[bedrock]

SDN is not for medical advice, particularly just so you can sound you actually know the medicine instead of just being a know-it-all med student.

 

[skiz knot]

Hey everybody. I had a question about tibial shaft fractures. One of my friends was hit by a car and got a midshaft tib/fib fracture of his left leg which was managed with an intramedullary nail. He just got out of the hospital today and his surgery was yesterday and the orthopod is telling him to weightbear right away and walk normally. This sounded a bit suspect to me especially after a long series of mishaps during the short course of his admission most notably of which included him not being catheterized and getting a spinal anesthetic. When he finally did get catheterized, he let out over a liter of fluid.... In short, is immediate weightbearing advised post-surgery or is this orthopod's management going against guidelines. Thanks!

If you were so magical, you would know the answer. And plus, don't be a douche, saying there have been a long series of mishaps during his hospitalization. Did you know urinary catheterization is not absolutely indicated after spinal anesthesia.

http://www.ncbi.nlm.nih.gov/pubmed/17233363 Conclusion: Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.

Of course you didn't because you are a piss-ant, know-nothing medical student. How much orthopaedic surgery did you learn in college and in medical school so far? None!?! Weird, because you were questioning the judgement of someone who was probably in the top of their medical school class that has ALREADY finished their residency (and likely fellowship with a few years of practice to boot).

I was wondering, since you (think you) are so smart, why didn't you utilize the medical school's library to learn about proper management of tibial shaft fractures? Too busy thinking you were smarter than everybody else and second guessing their decisions?

 

[MagicalTrevor]

Alright sure... whatever. I actually looked up articles on PubMed that give conflicting statements on whether early mobilization is advised or not and was looking for someone to cut through the fog. And that's Intern not medical student. I haven't changed my tag.. As far as acting like a know-it-all, I don't live in the same geographic area as my friend even and I am genuinely concerned for his health. And regarding the catheter incident. Is it standard practice for your nurses to say "keep trying to pee" when the patient hasn't peed for >8 hours post-procedure? Then instead of leaving the catheter in take it out and repeat the same crisis 5-6 hours later? But sure. I'm the douche.

 

[skiz knot]

Alright sure... whatever. I actually looked up articles on PubMed that give conflicting statements on whether early mobilization is advised or not and was looking for someone to cut through the fog.

I'll give you some slack and assume you meant early weight-bearing and not early mobilization. The literature on early mobilization is pretty cut and dry. That's why we don't do balanced skeletal traction anymore. In terms of weight bearing, there is not a standard answer because no two fractures are exactly alike. For a mid-shaft tibia fracture without proximal or distal extension and with minimal comminution, immediate weight bearing as tolerated is pretty standard. The intramedullary device is strong enough to take it, and the micromotion and compressive forces encourage healing of the fracture.

And that's Intern not medical student. I haven't changed my tag.. As far as acting like a know-it-all, I don't live in the same geographic area as my friend even and I am genuinely concerned for his health. And regarding the catheter incident. Is it standard practice for your nurses to say "keep trying to pee" when the patient hasn't peed for >8 hours post-procedure? Then instead of leaving the catheter in take it out and repeat the same crisis 5-6 hours later? But sure. I'm the douche.

If after 11.5 months of internship you haven't realized that there is no limit to dumb things nurses do and say, than you will have a difficult time making it through residency. As to foley management for urinary retention in an alert individual, you should probably be better versed at this by this point in your training. It is MY standard practice to avoid indwelling catheters in my patients when reasonable. I'm not alone in this. This is the preferred method among my peers. It decreases infections. It encourages mobilization. The hospital would rather avoid readmission for UTI or SSI. They don't get paid for those things.

 

[MagicalTrevor]

Well thanks. That's all I was looking for.

 

[KLPM]

 

[Buckeye(OH)]

Alright sure... whatever. I actually looked up articles on PubMed that give conflicting statements on whether early mobilization is advised or not and was looking for someone to cut through the fog. And that's Intern not medical student. I haven't changed my tag.. As far as acting like a know-it-all, I don't live in the same geographic area as my friend even and I am genuinely concerned for his health. And regarding the catheter incident. Is it standard practice for your nurses to say "keep trying to pee" when the patient hasn't peed for >8 hours post-procedure? Then instead of leaving the catheter in take it out and repeat the same crisis 5-6 hours later? But sure. I'm the douche.

You should know the indications for immediate versus delayed weight bearing. BTW, what was the fracture pattern and how big was the nail? I don't really care, just pointing out the details you are clearly unaware of.

Yes, its called "straight cath q6"

 

[MagicalTrevor]

You should know the indications for immediate versus delayed weight bearing. BTW, what was the fracture pattern and how big was the nail? I don't really care, just pointing out the details you are clearly unaware of.

Thanks for showing up late to the party, Dr. *******. I'm well aware of the details I'm missing, but unfortunately I can't call up my friend who has no medical background and is in a completely different geographic area and say "Yo DAWG, Is your fracture comminuted, spiral, transverse, or open?" He hasn't even seen his X-rays. I'm going by what I believe the mechanism of injury was and a vague description of a "the doctor is going to put a nail in me" to surmise a transverse midshaft tibial treated with a intramedullary nail.

What was the point of your little powertrip anyways? This thread is days old and I have the info I needed. Go choke on a dick.

Thanks.

 

[bedrock]

you see the attitude on this little ****?

I called it with my first post. I don't understand why the rest of you bothered to answer him.

This is why you don't respond to queries for medical advice, particularly from pre-meds/med students.

 

[loltopsy]

Reading SDN for the past two years now has made me realize something about people on their way to being doctors and the doctors themselves.

Pre-allo has a hard on for talking down on HSDN. Allo has a hard on for talking down on pre allo. The attendings have a hard on for talking down to everyone else.

Bedrock, if you read the thread, you'd know that the OP is an intern. You'd also know that Buckeye was talking down to him, and he responded in kind.

Yes, OP's question was a bit silly judging by what was posted in response. But can't you all just either ignore the thread or respond without being jerks about it? Can't you remember a time when you were more naive and maybe in med school/college and got talked down to by someone higher up?

You guys are not the physicians I hope to be one day.

 

[KLPM]

Reading SDN for the past two years now has made me realize something about people on their way to being doctors and the doctors themselves.

Pre-allo has a hard on for talking down on HSDN. Allo has a hard on for talking down on pre allo. The attendings have a hard on for talking down to everyone else.

Bedrock, if you read the thread, you'd know that the OP is an intern. You'd also know that Buckeye was talking down to him, and he responded in kind.

Yes, OP's question was a bit silly judging by what was posted in response. But can't you all just either ignore the thread or respond without being jerks about it? Can't you remember a time when you were more naive and maybe in med school/college and got talked down to by someone higher up?

You guys are not the physicians I hope to be one day.

But .... But ...... What about people who get hard on reading flame threads? What will happen to them? Those poor people .......

 

[Winged Scapula]

Given the level of vitriol on both sides, this thread is being closed, as it appears to have served its purpose.

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