Services A to Z

Alison Potts, Consultant in Public Health

Heather Jarvie, Programme Manager (adult screening)

Uzma Rehman, Programme Manager (adult, pregnancy, newborn and vision screening)

Leanne Carnevale, Administration Team Leader

Emma Kinghorn, Senior Support Officer

Jo Zelazny, Senior Support Officer

Jade Curtis, Senior Support Officer

Liz O’Hora, Senior Support Officer

You can contact us by emailing phsu.admin@ggc.scot.nhs.uk or call 0141 201 4541.

This booklet gives you information about hip arthroscopy. It will explain what will happen when you come into hospital, what to expect before you go home and when you are at home. The success of the operation is a team effort including doctors, nurses, physiotherapists but most importantly you.

Please note that your aftercare and rehabilitation will vary depending on what you have done to your hip during the operation and also on your surgeon’s wishes.

Next: Who may be suitable for a hip arthroscopy?

A hip arthroscopy is a surgical procedure where we look inside the hip joint using a small camera on the end of a flexible tube (an arthroscope). This allows the surgeon to see any problems in the hip joint. The surgeon can then use small instruments to treat some of these problems if appropriate. Hip arthroscopy can help with the following problems:

• Labral tears

• Hip impingement

• Damaged cartilage

• Loose bodies in the joint

Next: What to expect

The Operation:

You will have a general anaesthetic which means you will be asleep. The operation usually takes 1 to 2 hours. We use a special table to access your hip joint. This moves the joint a little further apart and allows space to insert the arthroscope. The surgeon will make 2 to 4 small cuts around your hip area. They will insert the arthroscope and any instruments needed to treat your hip through these cuts.

The Wound:

Sometimes we stitch the cuts but not always. We will cover them with a sterile dressing. Usually the nursing staff change this dressing if you stay in overnight, however if it is dry and intact they may leave it. We will give you dressings to take home with you. The nursing staff will discuss this with you on the ward.

Pain Control:

We will inject some local anaesthetic into the joint and around your cuts to help reduce the pain when you wake up. We will also give you pain killers. It is important to let a member of staff know if you are sore so they can give you something to help.

Discharge (Going Home):

Most patients go home the day after their operation but some people go home the same day. This depends what time you are back on the ward and how you are feeling.

Next: Complications

After a hip arthroscopy it is likely that you will have some muscle bruising and swelling around the hip and thigh. As with any surgical procedure there is a small risk of other complications. These may include:

1.  Difficulty passing urine or having a bowel movement after the operation.
2.  Problems with the anaesthetic or development of an acute medical problem (clarify).
3.  Wound Infections: If you notice a change in the area around your wounds and they become red, very hot and swollen, or if you develop any discharge from your wounds please see your GP as soon as possible?
4. Blood clots in your calf are known as a DVT (deep vein thrombosis):

• You may go home on aspirin to help prevent this however the best way to reduce the risk is to do the exercises in this booklet regularly and by moving around.

• If you experience pain and tenderness in your calf and it becomes hot and swollen please see your GP.

    5. Blood clots in your lung known as a PE (pulmonary embolis):

• If you experience a sudden shortness of breath which is unusual for you please see your GP.

    6. Damage or bruising to a minor nerve leading to numbness or tingling in your thigh, groin or genitalia.

    7. Damage to the major blood vessels or nerves around the joint or the joint itself.

Next: Physiotherapy

You will normally see a physiotherapist before you go home. They will show you some exercises to help keep the muscles around your hip strong and to get the hip moving. These exercises are shown in this booklet.

We will give you elbow crutches to help you walk after the operation. You may be able to take as much weight as you feel able to through your hip (fully weight bearing) but we will often advise you to take some weight off the hip by leaning through the elbow crutches (partial weight bearing). This will depend on what treatment you have done and on your consultant’s wishes. For example if you have a simple labral tidy up you will usually be able to fully weight bear. However if you have a more extensive procedure such as microfracture on your joint surface we will normally advise you to take minimal weight through your hip for 4-6 weeks. The physiotherapist will advise you how much weight to take through your hip and how long you will need to use your elbow crutches.

We will show you how to go up and down stairs before you go home.

Your physiotherapist is likely to refer you to your local physiotherapy department for ongoing rehabilitation and in some places they may refer you for hydrotherapy (rehabilitation in water). This will depend on where you stay and on your consultant’s wishes.

Next: Exercises

1. Ankle pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and helps prevent clots forming.

2. Static Quads: Point your toes to the ceiling. Press the back of our knee against the bed tightening up the muscle at the front of your thigh. Hold for 5 seconds then relax. Repeat 10 times.

3. Static Gluts: Squeeze your bottom muscles together. Hold for 5 seconds then relax. Repeat 10 times.

4. Static Hamstrings. Dig your heel into the bed as if trying to bend your knee. Hold for 5 seconds then relax. Repeat 10 times.

5. Hip Flexion: Bend your hip and knee up and down. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg up. Do 2 sets of 10.

Following some procedures this movement may be restricted for 4-6 weeks. Your physiotherapist will advise you if this is the case.

6. Hip Abduction: Bring your leg out to the side then back in again. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg out to the side and back in. Do 2 sets of 10.

It is important to do these exercises regularly. We advise you to try and do them 4 times a day or even a set of 10 every hour or two.

 Next: Going Up and Down Stairs

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up the stairs as you will need it when you get to the top.

Going up stairs:

1. Place your un-operated leg up onto the step

2. Lift your operated leg onto the same step

3. Bring the crutch up onto the same step

Going down the stairs:

1. Place your crutch down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

 Next: General Advice Following your Hip Arthroscopy

Ice:

This may help with pain and swelling around the hip or thigh area. Wrap an ice pack or a bag of frozen peas in a towel and rest this on your hip or thigh area. Do not leave on for any longer than 20 minutes at a time.

Pain Relief:

We will usually give you a 7 day supply of pain killers to take home with you and can get more from your GP if necessary once these run out. If you experience more pain when you go home and do not feel the pain killers are helping, please see your GP.

Wound Care:

If you have stitches you will need to visit your practice nurse 10-12 days after your operation to have these removed. The nursing staff will discuss your wound care with you before going home.

Rehabilitation:

It is important to do the exercises in this booklet regularly to prevent your hip becoming stiff and weak. Most patients are referred for physiotherapy locally once they are home. The length of time you need to go to physiotherapy will depend on the treatment that you have and also on what activities you plan on getting back to. You are likely to attend physiotherapy for at least 3 months.

Next: Return to Activity

• Driving: You can begin driving when you are allowed to be fully weight bearing, walking without crutches and feel comfortable to do so. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. This will vary depending on what treatment you have and on your consultant’s wishes.
•  Work: This will depend on your job and on what treatment you have done. People in manual jobs or jobs involving a lot of walking are likely to need longer off than those who have jobs involving mainly sitting. Please discuss this with your consultant while in the hospital or in the clinic
•  Sport: Your physiotherapist will advise you about returning to sport. Again this will depend on what treatment you have done and on the sport you wish to return to.

Next: Routine Follow-Up

We will see you back at the clinic 4-6 weeks after your operation. You may then have a further appointment about 12 weeks after the operation. If you need further appointments we will arrange these.

This leaflet will provide you with some information and exercises for you to follow after your shoulder surgery. This leaflet is for rehabilitation following shoulder surgeries that involve immobilisation which means your arm will be in a sling for 4 – 6 weeks.  

Your surgery may be planned weeks in advance (Elective) or done at short notice due to trauma.

• Elective Surgeries – surgeries that are planned in advance and may include repairs of the shoulder joint structures such as rotator cuff or joint replacement.
• Trauma Surgerie – surgeries that are undertaken at short notice due to fall or accident which has caused damage to the shoulder bone or soft tissues.

Your surgery maybe keyhole (arthroscopy); this involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. Some surgeries require larger incisions but your surgeon will inform you prior to your surgery which approach they will take.

They will look for any areas of possible damage and undertake any treatment. Scans and x-rays allow your surgeon to plan surgery but sometimes the treatment required can be more or less than anticipated prior to surgery.

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area. You will have little or no movement of your full arm or hand initially after your surgery. This should return within 24 hours of surgery. The anaesthetist will speak to your before surgery about these.

Most patients go home on the day of their surgery or the day after. Your arm will be in a sling after your surgery.

A physiotherapist and/or Occupational Therapist will see you on the ward after your surgery to provide advice, sling education and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient appointment.

Pain

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief. Ensure your sling is in correct position; your arm should rest in it across your stomach with your elbow at 90 degrees. Your arm should feel fully supported by the sling.

Swelling and bruising

It is normal to have some swelling/ bruising around your shoulder and down your arm or chest. Often this is worse following trauma or more complicated surgeries. Bruising can be more common if you are medication to thin your blood.  You can reduce swelling in your hand and elbow by ensuring you complete the exercises provided and ensuring your sling is applied correctly. If your sling is too loose your arm will hang downwards allowing swelling to gather in your fingers and hand.

If you have swelling around your shoulder you can apply an ice pack to help reduce swelling and ease pain. This should be wrapped in a towel and applied for 15 minutes at a time, monitor your skin to ensure you are not getting ice burns.

Wound

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery.

Sleeping

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain. Your sling will need to remain on during the night.

Washing and dressing

Avoid getting your wound dressing very wet.

If showering you can remove your arm from your sling and let it hang by your side. Do not lift your arm to assist with washing. To clean under your operated arm, lean to that side so there is a gap between your body and arm, do not lift your operated arm.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

The physiotherapist will have shown you how to remove and apply your sling on the ward but below is a link if you need some assistance.

Your sling should only be removed for washing, dressing and completing your exercises. 

Very occasionally, some people are advised to wear their sling under clothes to avoid excess movement. We will advise you if this applies to you.  

 You should not drive will your arm is in a sling. Do not drive until you have regained full control and movement of your arm.

Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

This depends on your occupation, most people can return to work around 6 -12 weeks after their surgery. If your job does not involve use of your operated arm you may be able to return sooner.

Please discuss this with your surgeon, doctor or physiotherapist.

Your physiotherapist will guide your return to heavy activities and sport.

This will depend on your pain, shoulder movement and strength as your rehabilitation progresses. Pain would be a sign that you are not ready to return to a specific activity.

You will be referred for physiotherapy by the ward physiotherapist or from fracture clinic when they are happy for you to start rehabilitation following surgery for trauma. You will need to attend physiotherapy to regain movement and strength of your arm.

Rehabilitation will not start until after your period of immobilisation around 4-6weeks after your surgery. 

While your shoulder is immobilised it is important to maintain the other joints of your arm such as your elbow to stop these from stiffening up. The exercises included in this booklet are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. 

Hand and fingers

• Make a fist (thumb over fingers). Straighten your fingers and bring them apart.
• Repeat 10 times 3 x daily

Wrist movement

• Bend and straighten your wrist keeping your fingers straight throughout the exercise.
• Repeat 10 times 3 x daily

Elbow Rotation

• With your arm in your sling across your stomach , turn your palm up and down rotating your forearm.
• Or with your arm out of sling across your stomach with your elbow bent at 90 degrees, turn your palm up and down rotating your forearm.
• Repeat 10 times 3 x daily

Elbow bend and straighten

• Stand with your arm out of your sling, your elbow bent at 90degrees and forearm across your stomach.
• Bend your elbow and then straighten your elbow.
• Repeat 10 times 3 x daily

Shoulder blades

• Stand, pinch shoulder blades together as shown.

• Repeat 10 times 3 daily

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.

A wrist fracture is a break in the radius bone, close to the wrist joint. In medical terms this is called a “distal radius fracture”. Occasionally a small chip or fracture can occur in the ulna.

Fractures happen when a force is applied to a bone that is greater than the strength of the bone. The angle at which the force is applied and how the strong the force is can affect the type of fracture that happens. Fractures can happen with a fall, while playing sport or exercising, through a work injury or road traffic accident for example.

The aim of surgery is to realign and stabilise the bone while it is healing. This aims to prevent stiffness, weakness and pain. Some wrist fractures can be treated in a plaster if the bone is not displaced, you accept the displacement or surgery would be too risky.

Surgery involves the bone being held with either pins that go through the skin (k-wires) or by a plate and screws that sit under the skin and muscle on the bone. The type of surgery carried out depends on what is needed to safely fix your fracture. It is carried out with either a general anaesthetic (were you are asleep) or a regional anaesthetic (were you are awake but can’t feel your arm). Surgery usually takes 30-60 minutes.

You will be seen back at the fracture clinic 2 weeks after your surgery. This should have been arranged with you before you were discharged from the hospital.

Closed Reduction and K-Wire Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given a new cast. You will then be given a further appointment for 3 weeks later. At this appointment the cast will be removed and you will be given a removable splint to wear for 1 week. The wires will be removed in the clinic. This is safe and is usually not painful.

Open Reduction and Internal Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your dressings or cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given new cast, removable splint or no splint depending on your injury. You will then be given a further appointment for 4 weeks later. At this appointment the splint/cast will be removed.

Before you are discharged from hospital you will be given advice on problems to watch out for and advice on hand and wrist exercises. You will be given this patient information sheet. You should read through this leaflet closely as it will tell you about what you should expect for your recovery and exercises to carry out. It will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your wrist fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Some problems patients can develop after surgery are infection, poor bone healing, arthritis, tendon irritation, complex regional pain syndrome and carpal tunnel syndrome. These problems can cause you to feel unwell, develop pain, stiffness, swelling, pins and needles or weakness.

• Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the wrist. Sometimes the wound can start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.
• Pain – This can be caused by many problems. If your pain is getting worse at any time after surgery, or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.
• Stiffness – If you are having problems with wrist stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.
• Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.
• Tendon Irritation – If you are getting pain or a grating/cracking sensation when you are trying to move one of your fingers or thumb then allow it to rest for 1-2 weeks. If the pain doesn’t go away or gets worse then contact the clinic using the details below.
• Carpal Tunnel Syndrome – If you develop pins and needles, or numbness in any of your fingers that doesn’t go away after an hour, contact the clinic using the details below. If it is severe and the hand becomes numb and it is out-with the clinic hours, attend your local emergency department.

If you have a problem related to your wrist fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic

• Call: 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)

Victoria ACH Fracture Clinic

• Call: 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties should be possible, but you should avoid anything which makes your wrist uncomfortable, such as prolonged typing.

For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending on the extent of your injury.

You should not drive while you are needing to wear a cast or splint. After this you can drive when you are able to control your vehicle without distraction. This is your decision, you can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle.

The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

You should only return to contact sport 12 weeks after your injury. Other sport may be earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Most patients don’t need physiotherapy. If you carry out the hand and wrist exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do 12 weeks or more after surgery, please self refer to your local physiotherapy department or arrange this with your GP.

Below is a rough guide of what most patients will be able to do after wrist fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0 to 2

• You will be in a cast, splint or bulky bandage depending on your injury
• Use the sling for the first few days if the arm is painful.
• Move your fingers often.
• Carry out stage 1 exercises

Weeks 2 to 6

• You can use the arm for simple tasks as pain permits.
• Depending on your injury and if you are comfortable the nurse in clinic may remove your cast, splint or bulky bandage.
• Continue stage 1 exercises
• Return to desk based work if required and comfortable.

Weeks 6 to 12

• The fracture is united (healed)
• You can begin to resume normal activity but be guided by any pain you are experiencing.
• Carry out day to day activities.
• Carry out stage 2 exercises
• Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Weeks 12+

• Return to manual work, sport and heavy activities.
• You are still experiencing significant pain and swelling then please contact the Fracture Care Team for advice.

Finger exercises

• Keep your fingers moving whilst you are in the splint.

Elbow Bend to Straighten and Forearm Rotations

Elbow Bend to Straighten

• Bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch.
• You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Forearm Rotations

• Begin this exercise with your elbow at your side and bent to 90 degrees. Slowly turn your palm up and down as far as you can go without pain.
• You should not feel more than a mild to moderate stretch. You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Finger and wrist flexion and extension

• Open and close your hand as shown 10-15 times. Then move your wrist up and down 10-15 times.
• After a few days, hold a soft ball / ball of socks. Squeeze the ball as hard as possible without pain.
• Hold for 5 seconds and repeat 10 times.

Contact Details

• Queen Elizabeth University Hospital main switchboard – 0141 211 1100
• Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)
• Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)
• Appointments booking office – 0141 347 8347 (Monday – Friday, 8.00am – 8.00pm)
• Physiotherapy – 0141 452 3713 (Monday – Friday 8.30am – 4.00pm)

Other Resources

• MSK Physiotherapy Self Refer
• Further information is available on the NHS UK website.

A fracture is a break or crack in a bone. The Tibia is the ”shin bone” in the lower leg, between the knee and ankle. The top of the tibia is the bottom half of the knee. The bottom of the tibia is the top half of the ankle. The fibula is a smaller bone that sits on the outside of the tibia. A tibial fracture is a break or crack in the tibia. It happens when a force is applied to the bone that is stronger than the bone can withstand.

This sometimes happens after a fall, playing sport, a road traffic accident or a fall from height. Occasionally the skin will be damaged at the same place as the fracture which is then called an ”open fracture”. Sometimes the fracture goes into the knee or ankle joint, which is then called an “intra-articular fracture”.

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some tibial fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

Surgery usually involves the bone being realigned either through pulling the leg straight or with a clamp through small cuts in the skin. The bone is then held together with a metal rod that is put within the bone. This rod goes from just below the knee to just above the ankle. Screws lock the rod in place at the top and bottom. There are other ways that tibial fractures can be fixed surgically but your surgeon will discuss them with you if that is necessary. Usually the other methods are if you have an open or intra-articular fracture.

You will usually have a small cut (wound) at the front of the knee, two small stab wounds just below this and another 2 small stab wounds just above the ankle. If another wound is needed to realign the fracture with a clamp you may have another wound at the level of your fracture.

There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaesthetist. The surgery usually takes between 1-2 hours.

You will usually be discharged from hospital within a day or two after surgery unless you have problems with your mobility. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. You will usually have follow up at 2 weeks and 12 weeks after surgery. These appointments will should be given to you before you leave hospital.

Walking Boot : You will usually go home wearing a walking boot that you can put as much weight through as you are able. You should wear this for 2 weeks after surgery (you can wear this for up to 6 weeks if you find it helpful). You can take it off when you are sitting down, in bed, or doing your exercises.

Physiotherapy : You will also see a physiotherapist before you go home that will show you how to do some knee and ankle exercises. These are also shown in this information sheet. If they think you might need some extra help they will arrange an appointment for you to see them once you have gone home.

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses. They will examine your wounds and leg. They will look at your wound, remove the clips. They will then make sure you have another appointment booked for week 12 with the fracture clinic. If they are concerned they may ask you to come back later that day or the next day to see a surgeon.

At around 12 weeks after your surgery, you will come back to hospital for an X-ray and to see a surgeon. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

If your bone has not healed back together yet, some bloods will be taken at this clinic and you might be referred onto a specialist. They will then phone you at around 6 months after surgery to find out how you are doing and to review your tests. If your bone hasn’t healed you might be offered further surgery at around 1 year following your original operation. This is only required for around 1 in 20 patients.

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, knee pain, nerve damage, irritating or prominent metalwork, , knee or ankle stiffness, walking difficulties or poor balance. If you are suffering from any of the list below, it may mean you have one of these problems from your surgery.

• Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the knee or ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.
• Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain more than 12 weeks after surgery and it hasn’t been discussed with your surgeon, then contact the clinic using the details below.
• Stiffness – If you are having problems with knee or ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.
• Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.
• Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

Irritating or prominent metalwork – If you can feel a prominent lump around one of your scars, it might be that one of the screws has become loose. If this happens you should contact the fracture clinic.

If you have a problem related to your fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic

• Call: 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)

Victoria ACH Fracture Clinic

• Call: 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery.

You will need to wear a walking boot while you are walking for the first 2 weeks after surgery but you can wear it for up to 6 weeks if this is helpful. You can take it off when you are sitting down, sleeping or doing your exercises. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home and sometimes at their clinics.

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking.

For manual work requiring lifting, you will need at between 6-12 weeks off, and this may be longer depending of the extent of your injury. If your job involves driving you will be off work for at least 6 weeks. Once you can do the activities required by your job without significant pain, you can go back to work.

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure.

You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

You should only return to contact sport at least 12 weeks after your injury. Other sport may be possible earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Before you are discharged you will be seen by a physiotherapist and they will go over the exercises in this book with you. If they feel that you might need extra help they may arrange an appointment at their clinic for you.

If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please contact the physiotherapy department below or arrange this with your GP.

Below is a rough guide of what most patients will be able to do after surgery for a tibial fracture. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0 to 2

• You will be in a walking boot for 2 weeks (up to 6 weeks if you find if helpful).
• Keep foot elevated when you are not walking to reduce swelling.
• You can weight bear as your pain allows.
• You can remove this when you are sitting down, in bed or doing your exercises.
• You can begin the knee and ankle exercises.

Weeks 2 to 6

• Continue knee and ankle exercises
• Return to desk based work if required and comfortable.

Weeks 6 to 12

• The fracture is still healing.
• You can begin to resume normal activity but be guided by any pain you are experiencing.
• Carry out day to day activities.
• Continue knee and ankle exercises.
• If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
• Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12+

• The fracture is still healing for most people. It is usually healed by around week 14.
• Return to manual work, sport and heavy activities may be possible.
• If you are still experiencing significant pain or swelling that has come on after your week 12 clinic appointment then please contact the fracture clinic for advice.

Daily exercise programme

Aim to complete this exercise program every day, five times daily. You should spend around 2 minutes per exercise.

Bed Exercise

1. Straight leg raise

• Sit in bed with your legs straight and your back supported
• Point your toes up to the ceiling, tighten your thigh muscles of your operated leg and press the back of your knee down into the bed.
• Keep the knee straight and lift your leg up off the bed (clearing approx 30cm)
• Hold for five seconds and then relax for five seconds.
• Repeat 10 times

2. Ankle Movement

• Sit in bed with your legs straight and your back supported.
• Write out the alphabet with your foot, allowing your ankle to move through the movements of all the letters A to Z. All the movements should come from your ankle joint

3. Active assisted toe up with towel

• Sit in bed with your legs straight and your back supported.
• Loop a long towel/cloth around the front of your foot.
• Hold the two ends with your hands.
• Keeping you knee straight, try to bring your toes up towards your face. Assist the movement by pulling the ends of the towel/cloth.
• Hold this position for 30 seconds and then release and relax.
• Repeat 10 times

Chair Exercises

1.Knee bending

• Sit upright in a chair, with both feet flat on the floor.
• With the operated leg, slide your foot underneath the chair, keeping your toes on the floor, trying to bend your knee as much as possible, within your pain limits.
• Hold this bent position for 10 seconds and then slowly return your leg to a comfortable position.
• Relax between repetitions.
• Complete this exercise 10 times.

2. Knee extension

• Sit in a chair, with your knees at 90 degrees, and with both feet on the floor.
• With the operated leg, tighten the muscles in your thigh, lift your toes and straighten your leg as much as possible.
• Hold this straight position for five seconds and then slowly lower back down to the floor.
• Relax between repetitions.
• Repeat 10 times.

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your tibial fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Contact Details

• Queen Elizabeth University Hospital main switchboard – 0141 211 1100
• Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)
• Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)
• Appointments booking office – 0141 347 8347 (Monday – Friday, 8.00am – 8.00pm)
• Physiotherapy – 0141 452 3713 (Monday – Friday 8.30am – 4.00pm)
• MSK Physiotherapy Self Referral

Other Resources

• Further information is available on the NHS UK website