29856 Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)

Name of the Procedure:

Arthroscopically Aided Treatment of Tibial Fracture, Proximal (Plateau); Bicondylar Also known as Bicondylar Tibial Plateau Fracture Fixation

Summary

This surgical procedure involves using an arthroscope (a type of endoscope) to assist in the repair of a bicondylar tibial plateau fracture. Internal fixation devices, such as plates and screws, are used to stabilize the fracture. The arthroscopy allows for a less invasive approach and provides a visual aid for precise repair.

Purpose

This procedure addresses fractures of the upper part of the tibia (shinbone), specifically involving both condyles (the rounded protuberances). The goal is to realign the bone fragments, stabilize them with internal fixation, and promote proper healing while maintaining knee function.

Indications

• Severe pain and inability to bear weight on the affected leg
• Visible deformity or abnormal alignment of the knee
• Swelling and bruising around the knee area
• Radiographic evidence of a bicondylar tibial plateau fracture

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuation or adjustment of certain medications as advised by the physician
• Pre-operative imaging studies, such as X-rays and CT scans, to assess the fracture
• Pre-surgical physical assessment and anesthetic evaluation

Procedure Description

1. Anesthesia is administered to the patient (general or regional anesthesia).
2. Small incisions are made near the knee to insert the arthroscope and surgical instruments.
3. The arthroscope provides a visual of the fracture site on a monitor.
4. The surgeon realigns the bone fragments and secures them with plates and screws.
5. The incisions are closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes between 2 to 3 hours, depending on the complexity of the fracture.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection at the incision sites
• Bleeding or blood clots
• Damage to surrounding nerves or blood vessels
• Nonunion or malunion of the fracture
• Stiffness or reduced range of motion in the knee
• Arthritis development in the knee joint

Benefits

• Stabilization of the fracture allowing for proper healing
• Restoration of knee alignment and function
• Reduced pain and increased mobility
• Prevention of further complications associated with untreated fractures

Recovery

• Initial immobilization of the leg with a brace or cast
• Pain management with medications
• Physical therapy to regain strength and flexibility
• Gradual increase in weight-bearing activities as healing progresses
• Follow-up appointments for monitoring progress and removing any hardware, if necessary

Alternatives

• Non-surgical treatment with bracing and physical therapy (applicable for less severe fractures)
• External fixation (placement of rods outside the leg to stabilize the bone)
• Pros: Less invasive, lower immediate risk
• Cons: Less precise, longer recovery, and potentially less effective for complex fractures

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Postoperatively, the patient may experience pain and swelling, which can be managed with medications. A period of limited mobility and physical therapy will be necessary for recovery, with gradual improvement in activity levels. Pain management and comfort measures, such as icing and elevation, will help in the early stages of recovery.