28495 Closed treatment of fracture great toe, phalanx or phalanges; with manipulation

Name of the Procedure:

Closed treatment of fracture great toe, phalanx or phalanges; with manipulation

Summary

The closed treatment of a fractured great toe involves realigning the broken bone(s) without surgery. This is accomplished through manual manipulation, followed by immobilization to ensure proper healing.

Purpose

The procedure addresses fractures of the great toe's bone(s). The goal is to realign and stabilize the fractured bone(s) to promote proper healing, alleviate pain, and restore function to the toe.

Indications

• Severe pain and swelling in the great toe
• Visible deformity of the toe
• Difficulty or inability to walk due to the injury
• X-ray confirmation of a great toe fracture

Preparation

• The patient may need to fast if sedation or anesthesia is planned.
• Disclose all medications to the healthcare provider; some may need to be adjusted.
• An X-ray or other imaging tests to assess the extent of the fracture.

Procedure Description

1. Anesthesia/Sedation: The patient may receive local anesthesia to numb the area, or sedation if necessary.
2. Manual Manipulation: The healthcare provider will manually realign the fractured bone(s) of the great toe.
3. Immobilization: The toe will be stabilized using a splint, cast, or special boot to keep the bone(s) in place during healing.
4. Post-Procedure Imaging: An X-ray may be taken to confirm the correct alignment of the fracture after manipulation.

Duration

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

Setting

The procedure is usually performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Orthopedic surgeon or physician
• Nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Pain or discomfort during manipulation
• Numbness or tingling due to anesthesia
• Risk of improper bone alignment (malunion)
• Delay in healing or non-union of the bone
• Infection, though rare

Benefits

• Proper realignment and stabilization of the great toe
• Pain relief and improved function
• Reduced risk of long-term complications such as arthritis or deformity

Recovery

• Patients should keep the toe elevated and apply ice to reduce swelling.
• Pain medications may be prescribed as needed.
• Avoid weight-bearing activities as advised.
• Follow-up appointments for monitoring and X-rays to ensure proper healing.
• Full recovery typically occurs within 6 to 8 weeks.

Alternatives

• Non-Operative Approach: Rest, ice, compression, and elevation (RICE) without manipulation.
  • Pros: Less invasive
  • Cons: Longer healing time, potential for improper healing
• Surgical Treatment: Open reduction and internal fixation (ORIF).
  • Pros: Direct visualization and alignment of bones, more stable fixation
  • Cons: Surgical risks, longer recovery

Patient Experience

During the procedure, the patient might feel pressure or brief discomfort during manipulation, especially if only local anesthesia is used. Post-procedure, there might be some soreness, which can be managed with prescribed pain medications. Patients should be prepared to limit activities and follow the healthcare provider's guidance for a smooth recovery.