27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)

Name of the Procedure:

Percutaneous Skeletal Fixation of Tibial Shaft Fracture
Common names: Percutaneous tibial fracture fixation, Tibial shaft pinning

Summary

Percutaneous skeletal fixation is a minimally invasive surgical technique used to stabilize fractures of the tibial shaft. The procedure involves the insertion of pins or screws through small skin incisions directly into the bone fragments to hold them in place as they heal.

Purpose

This procedure addresses tibial shaft fractures, with or without an associated fibular fracture. The goal is to realign and stabilize the fractured bones to ensure proper healing, restore normal function, and minimize complications such as malunion or nonunion.

Indications

• Severe tibial shaft fractures that cannot be managed with conservative treatment.
• Displacement or significant misalignment of bone fragments.
• Cases where quick stabilization is necessary to prevent further injury.
• Patients who are otherwise healthy candidates for surgery.

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Pre-operative imaging studies (e.g., X-rays, CT scans) to assess the fracture.
• Adjustment or discontinuation of certain medications (e.g., blood thinners) as per doctor's advice.

Procedure Description

1. The patient is given regional or general anesthesia to eliminate pain during surgery.
2. Small incisions are made near the fracture site(s).
3. Fluoroscopic imaging guides the surgeon in placing pins or screws through the skin into the bone fragments.
4. The hardware is adjusted to achieve optimal bone alignment and stabilization.
5. Incisions are closed with sutures or adhesive strips and covered with sterile bandages.
6. Application of a splint or cast may follow for additional external support.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the fracture.

Setting

Percutaneous skeletal fixation is usually performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technologist (for intraoperative imaging)

Risks and Complications

• Infection at the incision or pin sites.
• Damage to surrounding nerves or blood vessels.
• Hardware failure or loosening.
• Nonunion or malunion of the fracture.
• Allergic reaction to anesthesia.
• Deep vein thrombosis (DVT).

Benefits

• Minimally invasive with smaller incisions and quicker recovery time compared to open surgery.
• Effective stabilization of fractures, leading to proper healing.
• Reduction of pain and improved limb functionality.

Recovery

• Post-procedure care involves limb elevation and ice application to reduce swelling.
• Pain management with prescribed medications.
• Physical therapy to restore movement and strength.
• Follow-up appointments for X-rays to monitor bone healing.
• Gradual resumption of weight-bearing as advised by the surgeon.
• Overall recovery time ranges from several weeks to a few months, depending on the patient's health and fracture severity.

Alternatives

• Non-operative management with bracing or casting (appropriate only for minor fractures).
• Open reduction and internal fixation (ORIF) involving larger incisions and more extensive hardware.
• External fixation using an external frame to stabilize the fracture (used in certain complex cases).

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, some discomfort and swelling at the incision sites are common, manageable with pain medications. Physical therapy and gradual return to activity will be emphasized to ensure a successful recovery.