Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)
CPT4 code
Name of the Procedure:
Open Treatment of Calcaneal Fracture with Internal Fixation and Primary Iliac or Other Autogenous Bone Graft
Summary
This surgical procedure involves realigning and stabilizing a broken heel bone (calcaneus) using internal fixation devices like screws or plates, and adding bone graft material from the patient's own body to aid healing.
Purpose
This procedure addresses fractures in the calcaneus that require surgical intervention for proper healing. The goal is to restore normal anatomy, promote bone healing, reduce pain, and improve function.
Indications
- Displaced calcaneal fractures
- Severe pain and swelling
- Instability of the foot and ankle joint
- Non-healing fractures
- Patients with good general health and bone quality suitable for grafting
Preparation
- Fasting for at least 8 hours before surgery
- Review of current medications; some may need to be paused
- Preoperative imaging studies like X-rays or CT scans
- Blood tests and a thorough medical evaluation
Procedure Description
- Anesthesia is administered (general or regional).
- An incision is made in the heel area to access the fractured bone.
- The fracture is realigned and fixed in place using screws and plates.
- Bone graft is harvested, often from the iliac crest (hip bone).
- The grafted bone is placed at the fracture site to aid in healing.
- The incision is closed with sutures or staples.
- A splint or cast may be applied to immobilize the area.
Duration
The procedure typically takes 2 to 3 hours.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Scrub techs and clinical support staff
Risks and Complications
- Infection
- Blood clots
- Nerve damage
- Non-union or malunion of the bone
- Pain at the graft site
- Potential for additional surgeries
Benefits
- Proper alignment and stabilization of the fracture
- Enhanced bone healing through the graft
- Reduced pain and improved function
- Potential to return to normal activities
Recovery
- Pain management with prescribed medications
- Instructions to keep the foot elevated and limit weight-bearing activities
- Follow-up appointments for X-rays and to monitor healing
- Physical therapy may be needed
- Full recovery may take several months
Alternatives
- Non-surgical management with casting or bracing
- External fixation devices
- Pros of alternatives include less invasiveness
- Cons include potentially less effective stabilization and longer healing time
Patient Experience
Patients can expect discomfort and swelling postoperatively, with pain managed through medications. Physical therapy and gradual return to activities are anticipated. Focusing on following all recovery guidelines will aid in optimal healing.