What questions should I ask at a two‑week postoperative follow‑up after open reduction and internal fixation of a femoral condyle fracture?

Two-Week Post-ORIF Femoral Condyle Follow-Up Assessment

At two weeks post-ORIF for femoral condyle fracture, your primary focus should be identifying early fracture-related infection (FRI), assessing wound healing, optimizing pain control to enable mobilization, and evaluating early rehabilitation progress.

Infection Surveillance: Your Top Priority

Screen aggressively for fracture-related infection, as this is the most critical complication at the two-week mark. 1

Confirmatory Signs (Infection Definitively Present)

• Ask directly: "Is there any drainage from the incision?" Purulent drainage confirms infection 1
• Examine for: Wound breakdown or dehiscence—this definitively indicates the implant communicates with skin microbiome 1
• Look for: Any sinus tract formation 1

Suggestive Signs (Raise Suspicion)

• Pain assessment: "Is your pain getting worse instead of better?" New-onset or increasing pain suggests infection 1
• Local inflammation: Document presence of redness, swelling, heat, or new-onset joint effusion 1
• Wound drainage: "Has there been any new drainage or persistent oozing?" This is suggestive even if not frankly purulent 1
• Systemic symptoms: Fever or constitutional symptoms 1

Laboratory Monitoring

• Order inflammatory markers: CRP, ESR, and WBC count 1
• Critical interpretation: A secondary rise after initial decrease, or unexplained persistent elevation over time, strongly suggests FRI 1
• Caution: These markers should be interpreted carefully in trauma patients, as they may remain elevated from the initial injury 1

Common pitfall: Biofilm maturation occurs over weeks, making the two-week window critical for early detection before chronic osteomyelitis develops 1

Pain Management Assessment

Inadequate analgesia at two weeks prevents the mobilization necessary to avoid life-threatening thromboembolism. 2

Structured Pain Evaluation

• Document pain scores: At rest AND with movement—these differ substantially during remobilization 2
• Ask specifically: "How is your pain during physical therapy compared to when you're resting?" 2
• Current regimen review: "Are you taking acetaminophen 1000mg every 6 hours regularly?" This should be the foundation 2

Medication Optimization

• Verify acetaminophen compliance: This decreases supplementary analgesic requirements and must be scheduled, not as-needed 2
• NSAID safety check: "Do you have any kidney problems?" NSAIDs are contraindicated with any renal dysfunction 2
• Opioid assessment: These should be rescue therapy only—if still needed regularly at two weeks, investigate why mobilization isn't progressing 2

Red Flags for Cognitive Dysfunction

• Screen for confusion: Postoperative cognitive dysfunction occurs in 25% of hip fracture patients (similar risk profile) 2
• Ask family: "Have you noticed any confusion or memory problems?" 2
• Medication review: Avoid cyclizine and other antimuscarinic agents that worsen delirium 2

Mobilization and Rehabilitation Progress

Early weight-bearing prevents DVT (1-3% clinical prevalence) and PE (0.5-3% prevalence) in lower extremity fracture patients. 3

Functional Assessment

• Direct question: "Are you up and walking? How much weight are you putting on the leg?" 3
• Mobilization barriers: If not mobilizing adequately, determine if pain, fear, or lack of physical therapy is the limiting factor 3
• Weight-bearing status: Confirm they understand their weight-bearing restrictions and are following them 4

Rehabilitation Milestones

• Range of motion: Document active and passive knee flexion/extension 4
• Toe-off exercises: "Are you doing your ankle pumps and toe exercises?" These reduce thromboembolism risk 3
• Physical therapy compliance: Verify they're attending sessions and performing home exercises 4

Critical pitfall: Delaying mobilization due to pain concerns increases thromboembolism risk more than it protects the surgical site 5

Wound and Surgical Site Examination

Direct Visualization

• Inspect incision: Look for erythema, warmth, induration, or fluctuance 1
• Palpate carefully: Assess for tenderness, crepitus, or fluid collection 1
• Document drainage: Character, amount, and odor if present 1

Suture/Staple Management

• Timing: Most femoral condyle ORIF incisions are ready for suture/staple removal at 2 weeks if healing well 4
• Assess readiness: Edges well-approximated, no drainage, no erythema 4

Nutritional and Hydration Status

Up to 60% of fracture patients are malnourished on admission, impacting healing. 5

• Ask directly: "How is your appetite? Are you eating regular meals?" 5
• Hydration assessment: "Are you drinking enough fluids?" Hypovolemia remains common at two weeks and impacts renal function 2
• Avoid routine IV fluids: Encourage oral intake instead 2

Radiographic Assessment

Standard Imaging

• Order AP and lateral knee radiographs: Assess for maintained reduction, hardware position, and early signs of healing 4, 6
• Compare to immediate post-op films: Look for any loss of reduction or hardware migration 4
• Evaluate joint congruity: Anatomical reduction of the articular surface is critical for outcomes 4

Red Flags on Imaging

• Hardware loosening or migration 6
• Loss of fracture reduction 4
• Periosteal reaction (may suggest early infection) 1

Thromboembolism Prophylaxis Review

• Verify compliance: "Are you taking your blood thinner as prescribed?" 5
• Assess for DVT symptoms: Unilateral leg swelling, calf tenderness, warmth 3
• PE symptoms: New shortness of breath, chest pain, tachycardia 3

Social and Discharge Planning

• Home safety: "Do you have help at home? Any stairs you need to navigate?" 1
• Equipment needs: Walker, crutches, elevated toilet seat, shower chair 1
• Follow-up coordination: Ensure physical therapy is scheduled and accessible 4