Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Distal Fibular Fracture (Lateral Malleolus)
- Common Names: Open Reduction and Internal Fixation (ORIF) of Fibular Fracture, Surgical Repair of Lateral Malleolus Fracture.
Summary
The open treatment of a distal fibular fracture, commonly referred to as ORIF, involves surgically exposing the fractured bone in the ankle and using internal fixation devices, such as plates and screws, to hold the bone fragments in place to promote proper healing.
Purpose
This procedure addresses fractures located at the distal end of the fibula, or lateral malleolus, typically caused by trauma or injury. The primary goals are to realign the bone fragments accurately, ensure stable fixation, and allow the bone to heal correctly, restoring the ankle's function and reducing pain.
Indications
- Symptoms: Severe pain, swelling, bruising, and inability to bear weight on the affected ankle.
- Conditions: Displaced or unstable fractures of the distal fibula.
- Patient Criteria: Suitable for individuals who have sustained significant ankle injury where non-surgical treatments (e.g., casting) are insufficient.
Preparation
- Pre-Procedure Instructions: Patients may need to fast for several hours before surgery.
- Medication Adjustments: Certain medications, especially blood thinners, may need to be paused.
- Diagnostic Tests: X-rays, CT scans, or MRI may be required to assess the extent of the fracture.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the lateral aspect of the ankle.
- Bone Exposure: The fractured segments of the fibula are exposed.
- Reduction: The bone fragments are realigned into their normal anatomical positions.
- Fixation: Metal plates and screws are used to secure the bone fragments together.
- Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes about 1 to 2 hours, depending on the complexity of the fracture.
Setting
The procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon: An orthopedic surgeon specializing in trauma or foot and ankle surgery.
- Anesthesiologist: Administers anesthesia and monitors the patient.
- Surgical Nurse: Assists the surgeon and prepares the surgical site.
Risks and Complications
- Common Risks: Infection, blood clots, and bleeding.
- Rare Risks: Nerve or blood vessel damage, implant failure, nonunion or malunion of the bone.
- Complication Management: Immediate medical intervention may be necessary to address any complications.
Benefits
- Alignment: Accurate realignment of the bone fragments.
- Stability: Enhanced stability of the fracture site.
- Healing: Promotes proper bone healing and restores ankle function.
- Pain Relief: Significant reduction in pain is typically experienced as healing progresses.
Recovery
- Post-Procedure Care: Wound care, pain management, and limited weight-bearing on the affected leg.
- Recovery Time: Initial healing can take 6 to 8 weeks, with full recovery potentially lasting several months.
- Restrictions: Avoidance of certain activities and gradual return to full weight-bearing.
- Follow-Up: Regular follow-up visits to monitor healing and remove sutures or staples.
Alternatives
- Non-Surgical: Casting or splinting, suitable for less severe fractures.
- Pros: Non-invasive.
- Cons: May not provide adequate stability for severe fractures.
- Other Surgical Options: Minimally invasive techniques may be viable for specific cases.
- Pros and Cons: Depend on the specific fracture and patient's condition.
Patient Experience
- During Procedure: The patient is asleep or sedated and should not feel pain due to anesthesia.
- After Procedure: Postoperative pain is managed with medications. Discomfort and swelling around the surgical site are common.
- Pain Management: Includes prescribed pain relievers and possibly ice packs to reduce swelling.
Overall, the open treatment of a distal fibular fracture with internal fixation aims to restore joint stability and function, allowing the patient to resume normal activities more effectively post-recovery.