29855 Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)

Name of the Procedure:

Arthroscopically Aided Treatment of Tibial Fracture, Proximal (Plateau); Unicondylar

• Common Name: Unicondylar Tibial Plateau Fracture Repair
• Medical Term: Arthroscopic Internal Fixation of Unicondylar Tibial Plateau Fracture

Summary

This procedure involves repairing a fracture on one side of the upper part of the shinbone (tibia) near the knee using both arthroscopy (a minimally invasive camera technique) and internal fixation (plates and screws). It aims to stabilize and heal the broken bone while minimizing surgical impact.

Purpose

The procedure addresses fractures of the tibial plateau, which can compromise knee joint stability and function if left untreated. The goal is to realign and fix the broken bone, ensuring proper healing and maintaining knee function.

Indications

• Fractures of the tibial plateau with displacement or misalignment.
• Unicondylar fractures, affecting one of the two bony surfaces of the knee joint.
• Patients experiencing knee pain, instability, or difficulty bearing weight due to the fracture.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjusting or temporarily stopping certain medications as advised by the doctor.
• Pre-surgical imaging tests such as X-rays or CT scans to assess the fracture.
• Discussion with the anesthesiologist regarding anesthesia options.

Procedure Description

1. The patient is administered anesthesia, typically general or regional.
2. Small incisions are made around the knee for the insertion of the arthroscope and surgical instruments.
3. The surgeon uses the arthroscope to visualize the fracture.
4. The fracture is realigned, and plates and screws are placed to stabilize the bone.
5. The incisions are closed with sutures or surgical staples.
6. A sterile dressing is applied to the surgical site.

Duration

The procedure typically lasts 1 to 3 hours, depending on the complexity of the fracture.

Setting

The procedure is usually performed in a hospital surgical unit or an outpatient surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurse
• Surgical Technologist

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Nerve or blood vessel injury
• Hardware irritation or failure
• Delayed or impaired bone healing
• Persistent pain or stiffness

Benefits

• Stabilization and alignment of the fracture.
• Improved knee function and mobility.
• Reduced pain and quicker recovery compared to open surgery.
• Minimally invasive approach with smaller incisions and less tissue damage.

Recovery

• Initial rest and limited movement, with the leg elevated.
• Pain management with prescribed medications.
• Physical therapy usually starts 1-2 weeks post-surgery to regain strength and mobility.
• Regular follow-up appointments to monitor healing.
• Full recovery and return to normal activities typically take 3 to 6 months.

Alternatives

• Non-surgical management with casting or bracing (only for non-displaced fractures).
• Open reduction and internal fixation (ORIF), involving larger incisions and direct bone manipulation.
• Pros: Alternative methods may be suitable for less severe fractures or patients unsuitable for surgery.
• Cons: May result in longer recovery times, increased risk of misalignment, or incomplete healing.

Patient Experience

• Patients may experience mild to moderate pain post-surgery, managed with medication.
• Initial use of crutches or a walker to avoid weight-bearing on the repaired leg.
• Discomfort from swelling and stiffness is usual but improves with physical therapy.
• Most patients return to normal activities gradually over several months.