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The stabilization of the reduced fracture by the use of metal screws, pins, wire, plates,
and nails.


Fracture may be transverse, oblique, spiral, or comminuted

- NVS of the affected area
- Perfusion of the Lower Extremity by use of Doppler Sound to assess blood flow
- Check for Knee Effusion

Management by Internal Fixation

- Usually carried out a few days after injury

- Intramedullary nailing or screw plate fixation are used depending on the fracture
pattern. Internal Fixation permits early mobilization
- A thigh cuff orthosis may be used for external support
- Patient is instructed to exercise the hip and the lower leg, foot, and toes on a
regular basis to preserve muscle strength. Active muscle movements
enhances healing by incresing blood supply and electrical potentials at the
fracture site
- Physical Therapy includes ROM and strenghtening exercises. Functional
Ambulation stimulates fracture healing (Healing time is 4-6 months)
- Compression plates and intramedullary nails may need to be removed after 12-
18 months due to loosening.
- After the plates are removes, a thigh cuff orthosis is used to provide support for
bone remodeling.
- Skeletal traction may be used due to patient having risks of anesthesia and
surgery. 2-4 weeks after injury, when pain and swelling have subsided, traction is
removed and patient is placed in a cast brace, which holds the reduced fracture.
Stabilization/Immobilization helps in alignment of the bone during the
healing process.

- Nerve function is assessed to evaluate extent of impairment

- NVS, skin temp., skin color, capillary refill

- Watch for signs and symptoms of Hemiarthrosis and Anterior Acute

Compartment Syndrome

Management by Internal Fixation

- CRIF and initial immobilization in a long-leg walking cast or a patellar-bearing


- Reduction must be relatively accurate in relation to angulation and rotation for

proper alignment of the bone

- Leg is elevated to control edema

- Partial weight bearing is prescribed 7-10 days after. Activity increases

circulation and decreases edema

- 3-4 weeks after, cast is changed to short-leg cast to allow knee motion.
Fracture healing takes 6-10 weeks

- Comminuted fractures may be treated with internal fixation with intramedullary

nails, plates, and screws which may need an external support (cuff orthosis) to
facilitate bone healing and proper alignment of the bones

- Hip, foot, knee exercises are encouraged within limits of immobilitzation to

increase circulation and preserve muscle strength.

Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. Brunner and Suddarth’s Textbook of
Medical-Surgical Nursing 11th Edition (Vol. 2, pp. 2371, 2449-2450, 2459) Lippincott
Williams & Wilkins; Eleventh Edition edition (December 1, 2006)