27781 Closed treatment of proximal fibula or shaft fracture; with manipulation

Name of the Procedure:

Closed Treatment of Proximal Fibula or Shaft Fracture with Manipulation

Summary

The closed treatment of a proximal fibula or shaft fracture with manipulation involves realigning the broken bone without the need for invasive surgery. This procedure is typically carried out by manually adjusting the bone fragments back into place.

Purpose

This procedure addresses fractures of the proximal fibula or the shaft. The main goals are to ensure the bones align properly, facilitate healing, prevent complications like improper bone union, and restore normal function to the affected leg.

Indications

• Acute fracture of the proximal fibula or shaft.
• Visible deformity or misalignment of the leg.
• Pain, swelling, and inability to bear weight on the affected leg.

Preparation

• Patients may be asked to fast if sedation or anesthesia will be used.
• Pre-procedure imaging tests like X-rays or CT scans to assess the fracture.
• Consultation on current medications and possible adjustments.

Procedure Description

1. The patient is positioned properly, often lying down.
2. Sedation or local anesthesia is administered to minimize pain and discomfort.
3. The healthcare provider manipulates the leg to move the bone fragments into proper alignment.
4. Imaging is used to confirm the proper alignment of the bones.
5. The leg is immobilized using a splint or cast to maintain alignment during healing.

Duration

The procedure itself typically takes about 30 minutes to an hour, depending on the complexity of the fracture and the ease of manipulation.

Setting

This procedure is typically performed in an emergency room, outpatient clinic, or surgical center.

Personnel

• Orthopedic Surgeon or Emergency Physician
• Nurse or Medical Assistant
• Radiology Technician
• Anesthesiologist (if sedation is required)

Risks and Complications

• Pain during and after the procedure
• Incomplete fracture alignment
• Nerve or blood vessel damage
• Infection
• Compartment syndrome
• Potential need for surgical intervention if closed treatment fails

Benefits

• Non-invasive treatment
• Faster recovery time compared to surgery
• Restoration of normal bone alignment
• Reduced risk of postoperative complications

Recovery

• Immobilization with a cast or splint for several weeks.
• Instructions on weight-bearing restrictions.
• Pain management with prescribed medication.
• Follow-up appointments for imaging and progress check.
• Physical therapy may be recommended after initial healing.

Alternatives

• Surgical treatment, such as open reduction and internal fixation (ORIF).
  • Pros: Direct visualization and more precise alignment
  • Cons: Invasive, longer recovery time, higher risk of infection
• Functional bracing or no manipulation in cases of non-displaced fractures.

Patient Experience

During the procedure, patients may feel pressure and discomfort despite anesthesia or sedation. After the procedure, they might experience soreness and swelling, managed with pain medication and elevation of the leg. Full recovery and return to normal activities typically take several weeks to a few months, depending on the severity of the fracture.