Perioperative Management of Proximal Tibial Fractures

Pain Control and Infection Prevention

• Administer regular paracetamol throughout the perioperative period, as recommended by Praxis Medical Insights 1
• Use opioids cautiously in patients with renal dysfunction, reducing both dose and frequency, as suggested by Anaesthesia 2
• Avoid NSAIDs in patients with renal dysfunction, according to Praxis Medical Insights 3
• Consider peripheral nerve blocks for additional analgesia, though these don't reliably block all three nerves, as noted by Anaesthesia 4
• Administer prophylactic antibiotics within one hour of skin incision per hospital protocols, as recommended by Anaesthesia 2

Thromboprophylaxis and Temperature Management

• Prescribe fondaparinux or low molecular weight heparin, administered between 18:00-20:00 to minimize bleeding risk with neuraxial anesthesia, as suggested by Anaesthesia 2
• Use thromboembolism stockings or intermittent compression devices intraoperatively, as recommended by Anaesthesia 2
• Early mobilization is the most effective DVT prevention, according to Praxis Medical Insights 1
• Implement active warming strategies during and after surgery to prevent hypothermia, particularly in elderly patients, as recommended by Praxis Medical Insights 1
• Maintain theatre temperature at 20-23°C, as suggested by Anaesthesia 5

Monitoring and Pitfalls

• Perform regular radiographic assessment to ensure proper bone healing, as recommended by Praxis Medical Insights 3
• Monitor for signs of infection throughout recovery, according to Praxis Medical Insights 1
• Avoid positioning errors, such as excessive flexion and internal rotation of the non-operative hip during surgery, to prevent complications, as recommended by Praxis Medical Insights 1 and 3