From the Guidelines
For a 32-year-old man with no past medical history undergoing surgical repair of a tibial plateau fracture, the required preoperative labs typically include a complete blood count (CBC), basic metabolic panel (BMP), coagulation studies (PT/INR, PTT), and type and screen for potential blood transfusion, but an EKG is not routinely needed for this healthy young patient with no cardiac history, as stated in the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1. The CBC evaluates for anemia and infection, the BMP assesses kidney function and electrolyte balance, and coagulation studies identify bleeding risks.
- A urinalysis may be ordered to rule out urinary tract infection.
- Additional considerations include ensuring the patient is NPO (nothing by mouth) for at least 8 hours before surgery,
- stopping certain medications like NSAIDs 5-7 days prior to reduce bleeding risk,
- and arranging for post-operative pain management and physical therapy. The surgical team should also discuss the expected recovery timeline, weight-bearing restrictions, and rehabilitation protocol with the patient before proceeding with surgery, as the guideline suggests that routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures, which is the case for this patient 1.
From the Research
Preoperative Labs for Surgical Repair of Tibial Plateau Fracture
- The required preoperative labs for a 32-year-old man with no past medical history undergoing surgical repair of a tibial plateau fracture are not explicitly stated in the provided studies 2, 3, 4, 5.
- However, general preoperative care principles can be applied, which include physical and psychosocial care to prepare the patient for surgery safely 6.
- The preoperative period may involve various tests and clinical assessments, which can be undertaken during a preoperative outpatient appointment 6.
Need for EKG
- There is no specific mention of the need for an EKG (electrocardiogram) in the provided studies for a 32-year-old man with no past medical history undergoing surgical repair of a tibial plateau fracture 2, 3, 4, 5.
- However, EKG may be considered as part of the preoperative assessment for patients undergoing surgery, especially if they have any cardiovascular risk factors or concerns 6.
Additional Considerations
- The management of tibial plateau fractures depends on the severity of the fracture, and surgical management is often required to restore articular congruity, mechanical alignment, and ligamentous stability 2, 3, 4.
- The patient's overall health and medical history should be taken into account when determining the necessary preoperative labs and assessments 6.