Learning Plan

How does an ankle ORIF work? how is the patient experience/ response to this surgery?

lEARNING PLAN

Most ORIF's are emergencies, therefore, they will take a quick health history and then perform the surgery. While some might wait longer for swelling to decrease in order to start the surgery. The first step in the surgery is anesthesia/ local anesthesia + analgesics. Then cleaning the area. Moving on they will begin the "reduction", where they realign the bones within the ankle. Following this, they will secure the bones with screws and plates. Finally, they will suture/staple the skin back up for the healing process to begin (John Hopkins, 2020). The patient experience/ respone to this surgery is anxiety as the patients found importance in independence, adequate sleep, and independence of ADL's (McKeown et al., 2020).

REFERENCES

AMY OVALLE

Ankle fracture open reduction and internal fixation. Ankle Fracture Open Reduction and Internal Fixation | Johns Hopkins Medicine. (2020, January 3). Retrieved March 20, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ankle-fracture-open-reduction-and-internal-fixation#:~:text=If%20you%20fracture%20your%20ankle,back%20in%20their%20proper%20alignment.

Hawes, E. (2021, April 10). The most common types of ankle fractures. SIMON MOYES. Retrieved March 20, 2023, from https://simonmoyes.com/magazine/ankle-conditions/common-ankle-fractures/#:~:text=Stable%20vs%20Unstable%20ankle%20fractures&text=Unstable%20ankle%20fracture%3A%20the%20stability,These%20normally%20require%20surgery.

Lynde, M. J., Sautter, T., Hamilton, G. A., & Schuberth, J. M. (2012). Complications after open reduction and internal fixation of ankle fractures in the elderly. Foot and Ankle Surgery, 18(2), 103-107.

McKeown, R., Kearney, R. S., Liew, Z. H., & Ellard, D. R. (2020). Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study. BMJ open, 10(2), e033539.

Rehabilitation protocol for ankle fracture with Orif. (2021, October). Retrieved March 22, 2023, from https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-ankle-fracture-with-orif.pdf

WebMD. (n.d.). Orif surgery: When it's needed and how it's done. WebMD. Retrieved March 20, 2023, from https://www.webmd.com/a-to-z-guides/what-is-orif-surgery#:~:text=it%20can%20heal.-,When%20Do%20You%20Need%20ORIF%20Surgery%3F,or%20plates%20until%20it%20heals.

What are some post op risks to this population?

Who and why would someone with ankle fracture need an ORIF surgery?

Post operation risks:

• Infection
• Bleeding
• Nerve damage
• Wound dehisence
• Blood clots
• Fat embolism
• Bone misalignment
• Irritation of the overlying tissue from the hardware
• Inproper healing

Patients with co-morbidities are often more at risk. For example, those with diabetes are associated with poor wounding healing (Lynde et al., 2011).

(John Hopkins, 2020)

An Open Reduction Internal Fixation (ORIF) is a surgery for patients who suffered a severe fracture, where the bone shattered into multiple pieces. To break it down, open reduction means that a surgeon repositions the bones in surgery and internal fixation means physically reconnecting the bones with screws, plates, rods, and or wires (John Hopkins, 2020). Common ankle fractures are the lateral malloelus fracture (just the fibula), Bimalleolar ankle fracture (both fibula and tibia), Trimalleolar fracture (2 parts of the tibia and 1 part of the fibula), and Pilon fracture (just tibula) (Hawes, 2020). At risk groups are those with osteoporosis, those in contact sports and those in motor vechile accidents. All in all, an ORIF would mostly likely be needed when the bones are not aligned, the bones punctured the skin, bone is broken in severe pieces, and when the ankle is unstable (John Hopkins, 2020).

ORIF- ANKLE

How does post op care look for this population?

As a nurse what patient education do we need to present/explain to the patient?

Patients within this population will receive pain/swelling management, physiotherapy, and vitamin/ supplements to promote healing. Pain is often a main product of many surgeries therefore, administration of analgesics along side anti-emetics is given to help treat pain and treat side effects of analgesics (nausea/ vomiting). Calcium and Vitamin D are also prescribed to promote healing of the bones. Other interventions for post op patients is wrapping ankle in a brace, x-ray, monitoring for any infections/ swelling. Patients may even be administered blood thinners to prevent the blood clots. Moreover, physiotherapy is encourage soon after surgery to restore strength and mobilization, excercise improves chances of a full recovery (John Hopkins, 2020). Post op goals are safe ambulation with prescribed weight bearing precautions, manage swelling, perform ADLs in a modified independent manner or with minimal assistance, and increase range of motion of ankle (General Brigham, 2021).

Patient education on:

• Safe ambulation/mobility
• Adequate nutrition
• Importance of taking vitamins and supplements/ other prescribed mediacations
• Possible complications that can arise (so they can be aware and let us know of any signs/symptoms)
• Physiotherapy and approval of discharge (make sure they are able to safely ambulate at home)
• Importance of follow up with doctor after surgery