Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Tibial Fracture, Proximal (Plateau); Unicondylar, Includes Internal Fixation, When Performed Common name: Open Reduction and Internal Fixation (ORIF) of proximal tibial plateau fracture
Summary
This surgical procedure involves realigning and stabilizing a broken bone at the upper part of the tibia, specifically the unicondylar section of the tibial plateau. It includes the use of internal fixation devices like plates and screws to hold the bone fragments in place as they heal.
Purpose
The procedure addresses fractures in the proximal (upper) part of the tibia, often seen in high-impact injuries such as falls or car accidents. The main goals are to realign the bone, ensure proper joint function, promote healing, and prevent long-term complications such as arthritis.
Indications
- Acute pain, swelling, and instability in the knee or upper leg
- X-ray or CT scan showing a fracture in the proximal tibial plateau
- Inability to bear weight on the affected leg
- Displaced fracture fragments requiring surgical stabilization
Preparation
- Preoperative fasting typically required (usually nothing by mouth after midnight before the surgery)
- Adjustments in certain medications as directed by the surgical team
- Preoperative imaging (X-rays, CT scans) to assess the fracture
- Blood tests and physical examination to evaluate overall health
Procedure Description
- Anesthesia: General anesthesia is typically administered to put the patient to sleep.
- Incision: A surgical incision is made on the skin over the proximal tibia.
- Bone Realignment: The fractured bone fragments are carefully realigned to their normal position.
- Internal Fixation: Metal plates and screws are used to stabilize and hold the bone fragments in place.
- Closure: The surgical wound is sutured, and dressings are applied.
- Immobilization: The leg is often placed in a splint or cast to protect the repair during early healing.
Duration
The procedure typically takes between 2 to 3 hours, depending on the complexity of the fracture.
Setting
This surgery is usually performed in a hospital's operating room.
Personnel
- Orthopedic Surgeon
- Anesthesiologist
- Surgical Nurses and Technicians
Risks and Complications
- Infection
- Blood clots
- Nerve or blood vessel damage
- Nonunion or delayed healing
- Post-traumatic arthritis
- Compartment syndrome
- Hardware failure or irritation
Benefits
- Proper alignment and stabilization of the fracture
- Improved joint function and mobility
- Decreased risk of long-term complications
- Enhanced healing process
Recovery
- Pain management with prescribed medications
- Physical therapy to regain strength and mobility
- Limited weight-bearing on the affected leg for several weeks
- Follow-up appointments to monitor healing and possibly remove hardware
Alternatives
- Non-surgical management with cast immobilization (appropriate for non-displaced fractures)
- Minimally invasive techniques like percutaneous fixation
- Pros: Avoids surgery risks
- Cons: May not be adequate for all types of fractures, may result in poor alignment
Patient Experience
- Under general anesthesia, the patient will be asleep during the procedure
- Postoperative pain and swelling are common but managed with medications
- Initial discomfort in mobility and weight-bearing activities
- Gradual improvement in leg function with physical therapy and rehabilitation