Wound Care

• Remove dressing in 2 days keep covered with ace bandage.
• You will have dermabond (glue) covering your incisions. Leave this in place.
• You may shower 3 days after surgery; be sure to pat the incision dry afterwards.
• Do not scrub the area; just allow water/soap to wash over you.
• Do not bath or swim until approved by surgeon.
• Continue to wear your TEDS compression stockings for one week after surgery to help decrease the swelling. You may remove for showering, etc.

Ice

• You will be provided with ice packs on the day of your surgery. We recommend that you use ice on a consistent basis for the first 24–48 hours. This will help reduce post-operative swelling. After that, use as necessary.
• Use a cloth between the ice and your skin. DO NOT place ice directly on skin as this may cause frostbite. Do not leave ice wrap or cold therapy on for more than 20 minutes without checking your skin.
• You may consider purchasing other commercially available ice and compression devices available online (e.g. amazon.com). Some options include a NICE Machine, Game Ready machine or Cryocuff. These devices are not always covered by insurance; we advise you contact your insurance company for cost details. If desired we can write you a prescription for these devices. If you are interested in pursuing this option, please let our office know

Brace

• With fixation of tibial avulsion fracture, you will wear your Bledsoe Brace in the locked position at all times (your leg will be fully straight) until you see Dr. Pettit in the office.
• You may remove your brace for showering, dressing, etc.

Crutches & Weight bearing status

• Following fixation of tibial spine fracture, you will not put weight on the extremity for 4 weeks.
• After 4 weeks you begin progressive weight bearing and walking normally without the crutches.

Physical Therapy

• Formal physical therapy will be ordered by your orthopedic surgeon in the form of a written prescription upon discharge from surgery. You will also receive a therapy protocol form. Following Tibial Spine Avulsion Fracture Repair.
• The prescription and protocol should be given to a physical therapist of your choice so you can begin your program as directed under close supervision of your surgeon.
• Once you schedule surgery, you should contact your physical therapy facility to schedule your first PT appointments within 2-5 days.
• Until you begin working with a therapist, you can do some exercises at home, such as: quad sets, leg raises, flexion and extension, and calf pumps (see pictures below). You may begin these exercises the day following surgery.

Pain Control and Medications

Day of Surgery

• You have been given a regional anesthetic block prior to your operation. This will wear off in the evening following your surgery.
• Some swelling and bruising can occur after surgery. Make sure to apply ice to the affected area. Please perform frequent calf pumps to help reduce your swelling. If you are concerned about the amount of swelling or bruising, please contact our office.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Driving

• You may drive once you have full control of your arms and legs. Do NOT drive if you are taking narcotics! If you have had surgery on your RIGHT knee, please wait 2-4 weeks after your surgery and are able to unlock your brace. If you drive a manual transmission vehicle and have had surgery on your LEFT knee, please also wait 2-4 weeks to prevent irritation from operating the clutch. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2 – 4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work/School

• You may return to work/school as soon as you are comfortable and able to safely mobilize using crutches. This typically occurs 1–4 weeks post-op. Return to work/school notes can be obtained at your first post-op appointment.

Follow-up Appointment

Your first post-operative appointment will be scheduled 10 – 14 days following your surgical procedure. Typically dissolvable sutures are used during surgery, and do not need to be removed. If you do have sutures that need to be removed, this will occur at your first post-operative visit. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-354-3700 to make the appointment or 513-441-5639 (Direct Line to Sandy Evans)

****Signs & Symptoms to Immediately Report****

• Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.