Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)
CPT4 code
Name of the Procedure:
Repair of nonunion or malunion, tibia; without graft, using compression technique
Summary
This procedure is undertaken to correct a tibia (shinbone) that has not healed properly after a fracture. Using a method known as compression technique, the surgeon brings the bone fragments together without the use of a bone graft.
Purpose
The procedure addresses issues with bones that have either failed to heal (nonunion) or healed incorrectly (malunion) after a fracture. The goal is to promote proper bone healing, restore functionality, and alleviate pain or discomfort associated with the improperly healed bone.
Indications
- Chronic pain or instability in the tibia after a fracture
- Visible deformity or shortening of the leg
- Difficulty walking or bearing weight on the affected leg
- Lack of bone healing observed in imaging studies
Preparation
- Fasting for at least 8 hours before surgery
- Adjustment or cessation of certain medications as directed by the surgeon
- Pre-operative imaging tests such as X-rays or CT scans
- Blood tests to evaluate overall health status
Procedure Description
- Anesthesia administration: General or spinal anesthesia will be given.
- Incision: The surgeon makes an incision over the affected area of the tibia.
- Preparation of Bone Ends: The bone ends are prepared by cleaning and freshening them to promote healing.
- Compression Technique: Special devices, such as plates and screws, are used to bring the bone fragments together under compression to enhance bone healing.
- Closure: The wound is cleaned, and the incision is closed with sutures or staples.
- Immobilization: A cast or brace may be applied to protect the repaired bone.
Duration
The procedure typically takes about 1-2 hours.
Setting
This surgery is generally performed in a hospital operating room.
Personnel
- Orthopedic surgeon
- Surgical nurse
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site
- Blood clots
- Nerve or blood vessel damage
- Failure of the bone to heal (persistent nonunion)
- Hardware irritation or failure
- Pain and discomfort during recovery
Benefits
- Proper bone healing and alignment
- Relief from pain or discomfort
- Improved leg function and stability
- Enhanced ability to walk and bear weight
Recovery
- Post-operative pain management with medications
- Instructions for wound care and keeping the incision clean
- Limited weight-bearing activities; use of crutches or walker as directed
- Physical therapy to regain strength and mobility
- Follow-up visits to monitor healing, remove sutures or staples, and assess recovery progress
- Recovery time can range from several weeks to a few months, depending on the individual's healing rate
Alternatives
- Non-surgical options like bracing and physical therapy for minor cases
- Surgery with bone grafting if additional support is required
- Use of external fixation devices
- Each alternative has its own risks and benefits, and the choice depends on the specific case's severity and patient preferences
Patient Experience
- Mild to moderate pain during and after the procedure managed with pain medications
- Swelling and bruising around the surgical site
- Discomfort from immobilization devices like casts or braces
- Potential physical limitations during the initial recovery phase, improving with time and rehabilitation efforts