27818 Closed treatment of trimalleolar ankle fracture; with manipulation

Name of the Procedure:

Closed Treatment of Trimalleolar Ankle Fracture with Manipulation

Summary

In simple terms, this procedure involves realigning and stabilizing a triple ankle fracture (involving three bones) without making any surgical incisions, using external manipulation techniques.

Purpose

This procedure addresses a trimalleolar ankle fracture, which includes breaks in the lateral, medial, and posterior malleoli. The goal is to properly align the bones to ensure proper healing, restore ankle function, and reduce pain and swelling.

Indications

• Severe ankle pain and swelling following an injury
• Inability to bear weight on the affected ankle
• Visible deformity or misalignment of the ankle
• X-ray or imaging confirming trimalleolar fractures

Preparation

• Fasting might be required if sedation is used.
• Discussion about current medications, especially anticoagulants, to manage bleeding risks.
• Pre-procedure imaging (X-rays, MRI) to assess fracture extent.
• Anesthesia consultation if sedation or regional anesthesia is anticipated.

Procedure Description

1. Preparation: The patient is positioned comfortably, usually lying down.
2. Anesthesia: Local anesthesia, sedation, or a nerve block is administered to manage pain.
3. Manipulation: The healthcare provider manually adjusts the fractured bones back into their proper positions.
4. Immobilization: Once aligned, a cast or splint is applied to maintain the position and promote healing.
5. Imaging: Post-manipulation X-rays might be taken to ensure bones are correctly aligned.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

This procedure is commonly performed in an emergency room, outpatient clinic, or hospital setting.

Personnel

• Orthopedic surgeon or qualified physician
• Nurses or medical assistants
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Potential for improper alignment leading to poor healing
• Risk of infection, especially if skin was broken during injury
• Possibility of blood clots in the leg
• Swelling and continued pain
• Limited ankle mobility if not properly managed

Benefits

• Immediate pain relief from correctly aligned bones
• Faster recovery compared to open surgical methods
• Lower risk of infection since no incision is made
• Improved chances of regaining full ankle function

Recovery

• Keep the ankle immobilized in a cast or splint for several weeks.
• Elevate the leg to reduce swelling.
• Pain management with prescribed medications.
• Follow-up appointments for monitoring and potential cast adjustments.
• Gradual physical therapy exercises after immobilization to restore strength and mobility.

Alternatives

• Open Reduction and Internal Fixation (ORIF): Surgical method that might be necessary for severe fractures.
• Non-operative treatment: Involves prolonged casting without manipulation; suitable for minor or less displaced fractures.
• External Fixation: External devices to stabilize the fracture if soft-tissue injury precludes casting.

Patient Experience

• Mild to moderate discomfort during manipulation, largely addressed with appropriate anesthesia.
• Initial swelling and soreness managed with pain medication and rest.
• Cast-related restrictions like avoiding getting the cast wet.
• Gradual return to weight-bearing and normal activities following physician guidance.

By adhering to post-procedure instructions and follow-up care, patients can expect a steady recovery and regain function of their ankle.