The time arrangement for re-examination after bone plate fixation

The reexamination after bone plate fixation is a key link to ensure the surgical effect, monitor the fracture healing process and prevent complications. The follow-up time needs to be dynamically adjusted based on factors such as fracture type, surgical site, patient age and underlying diseases. The following are the regular follow-up time nodes and key points to focus on, for the reference of patients and their families.

First, early postoperative follow-up (0-6 weeks after the operation)

1-2 weeks after the operation (first follow-up)

Objective: To evaluate the wound healing condition, the stability of the internal fixator and early complications.

Inspection contents:

Wound examination: Observe whether there are signs of redness, swelling, exudation or infection at the incision. If necessary, perform secretion culture.

Imaging examination: Usually, X-ray films are taken to confirm the position of the bone plate and whether the screws are loose or broken.

Functional assessment: Examine joint range of motion and muscle strength, and guide patients to undergo early rehabilitation training (such as isometric muscle contractions).

Special circumstances:

If the wound heals poorly or gets infected, the follow-up interval should be shortened (such as 3 to 5 days).

High-risk areas (such as the spine and pelvis) may require CT examination to further evaluate the stability of internal fixation.

4 to 6 weeks after the operation (second follow-up)

Objective: To evaluate the initial healing of the fracture end and adjust the rehabilitation plan.

Inspection contents:

Imaging examination: Recheck the X-ray films to observe whether the fracture line is blurred and whether callus has formed.

Functional assessment: Gradually increase the range of joint motion and guide the patient to perform weight-bearing training (such as partial weight-bearing).

Notes:

Avoid premature full weight-bearing to prevent fatigue fracture or fracture displacement of the internal fixator.

If there are no obvious signs of healing at the fracture end (such as a clear fracture line), be alert to delayed healing. It may be necessary to extend the fixation time or adjust the treatment plan.

Second, mid-term postoperative review (6-12 weeks after the operation)

8 to 10 weeks after the operation

Objective: To confirm the progress of fracture healing and determine whether to bear full weight or remove the external fixation.

Inspection contents:

Imaging examination: Recheck the X-ray films to assess the healing degree of the fracture ends (such as the amount of callus and the disappearance of the fracture line).

Functional assessment: Develop personalized rehabilitation plans based on the fracture site (such as knee flexion degree and ankle dorsiflexion Angle).

Special circumstances:

If the fracture heals well, it can be gradually transitioned to full weight-bearing.

If the healing is delayed, the non-weight-bearing time needs to be prolonged. If necessary, MRI examination should be performed to evaluate osteonecrosis or blood circulation disorders.

12 weeks after the operation (mid-term review)

Objective: To comprehensively evaluate fracture healing, joint function and the status of internal fixators.

Inspection contents:

Imaging examination: Recheck the X-ray films to confirm the clinical healing of the fracture (such as no local tenderness and negative longitudinal percussion pain).

Functional assessment: Measurement of joint range of motion, muscle strength (such as manual muscle strength tests), and gait analysis.

Rehabilitation guidance: Develop a long-term rehabilitation plan, including strength training, balance training and daily living activity training.

Third, postoperative follow-up (12 weeks -2 years after the operation)

Six months after the operation

Objective: To evaluate the quality of fracture healing, the recovery of joint function and the long-term stability of internal fixators.

Inspection contents:

Imaging examination: Recheck the X-ray films to observe the shaping of the fracture end and whether the internal fixation device is loose.

Functional assessment: The degree of joint function recovery is quantified through scale scores (such as DASH score, Lysholm score).

Special circumstances:

If pain or functional impairment related to the internal fixator occurs, it is necessary to assess whether the internal fixator needs to be removed in advance.

For adolescent patients, it is necessary to monitor the growth of the epiphyses to prevent the internal fixator from affecting bone development.

One year after the operation

Objective: To confirm the complete healing of fractures and the maximum recovery of joint function, and to evaluate whether the internal fixator needs to be removed.

Inspection contents:

Imaging examination: Recheck X-ray films or CT scans to confirm complete healing of the fracture ends and continuous cortical bone.

Functional assessment: Compare the functions before and after the operation to evaluate the rehabilitation effect.

Discussion on internal fixation: Communicate with the patient whether the internal fixation needs to be removed (for example, titanium alloy bone plates usually do not need to be removed, but stainless steel bone plates need to be removed when foreign body reactions occur).

Two years after the operation (final review)

Objective: Long-term follow-up and evaluation of complications after fracture healing (such as traumatic arthritis and nonunion of bones).

Inspection contents:

Imaging examination: Recheck the X-ray films to observe the joint space and the formation of osteophytes.

Functional assessment: Confirm whether the patient has returned to the preoperative activity level and whether there is long-term pain or functional impairment.

Fourth, re-examination arrangements for special circumstances

High-risk fractures (such as comminuted fractures and open fractures)

The re-examination intervals need to be shortened (such as 2 weeks, 4 weeks, 6 weeks, and 8 weeks after the operation), and the healing process should be closely monitored.

Early CT three-dimensional reconstruction may be required to evaluate the quality of fracture reduction.

Elderly patients (such as those with osteoporosis)

During the re-examination, changes in bone mineral density should be evaluated, and the anti-osteoporosis treatment plan should be adjusted if necessary.

Pay attention to the stability of the internal fixator to prevent screw loosening caused by osteoporosis.

Child patients

During the re-examination, the growth of the epiphysis needs to be monitored to prevent the internal fixator from crossing the epiphyseal line and affecting bone development.

The rehabilitation plan should take into account the needs of growth and development to avoid joint stiffness caused by excessive immobilization.

Complications related to internal fixators (such as infection and loosening)

When there is redness, swelling, exudation, fever or increased local pain at the wound site, an immediate re-examination is required.

Blood tests (such as C-reactive protein and erythrocyte sedimentation rate), secretion culture or radionuclide scanning may be required to confirm the infection.

Fifth, self-management by patients and their families

Record the review results

Patients can use notebooks or mobile phones to record the imaging results of each re-examination, the doctor’s suggestions and rehabilitation goals, which is convenient for long-term follow-up.

Communicate abnormal situations in a timely manner

If any abnormalities such as the internal fixation protruding from the skin, severe pain, or sudden restricted joint movement occur, contact a doctor immediately to avoid delaying treatment.

Follow the rehabilitation plan

Strictly follow the doctor’s instructions for rehabilitation training to avoid premature weight-bearing or excessive activity that may cause the internal fixation device to fail.

Sixth, common misunderstandings in re-examination

Misconception 1: The more frequent the follow-up, the better

Analysis: Excessive re-examination may increase radiation exposure (such as frequent X-ray examinations) or medical costs, and the changes in early fracture healing are not obvious.

Suggestion: Follow the follow-up plan formulated by the doctor and avoid increasing the number of follow-ups on your own.

Misconception 2: Rehabilitation can be stopped as long as the imaging examinations are normal

Analysis: Imaging healing (such as the disappearance of the fracture line) does not mean complete functional recovery. Rehabilitation training still needs to be adhered to.

Suggestion: The rehabilitation plan should continue until the maximum recovery of joint function is achieved, usually 6 to 12 months after the operation.

Misconception 3: Internal fixation devices must be removed

Analysis: Most titanium alloy bone plates can remain in the body for life and only need to be removed when there is a foreign body reaction, infection or when joint movement is affected.

Suggestion: Communicate fully with the doctor and weigh the risks and benefits of removing the internal fixation device.