Name of the Procedure:

Closed Treatment of Tibial Fracture, Proximal (Plateau); Without Manipulation

Summary

In this procedure, a proximal tibial fracture (often involving the tibial plateau) is treated without the need for surgical manipulation of the bone fragments. The treatment typically involves immobilization to allow natural healing.

Purpose

The procedure addresses fractures in the proximal region of the tibia, particularly the tibial plateau. The goal is to stabilize the bone so that it can heal properly, minimizing pain and preventing further damage or deformity.

Indications

• Acute proximal tibial fractures.
• Patients with stable fractures without significant bone displacement.
• Individuals who might not be candidates for more invasive surgical procedures due to other medical conditions.

Preparation

• The patient may need to undergo imaging tests such as X-rays or CT scans to assess the fracture.
• Pre-procedure instructions could include fasting and adjusting current medications, as directed by the physician.
• A medical evaluation to determine the patient’s overall health and anesthetic risk.

Procedure Description

1. The patient is positioned comfortably, often in a supine position (lying on the back).
2. Local or regional anesthesia might be administered to minimize discomfort.
3. Immobilization tools such as casts or braces are applied to the affected leg. No surgical incisions are made, and there’s no physical manipulation of the fracture needed.
4. The immobilization device maintains the bone in proper alignment, ensuring stability during the healing process.

Duration

The immobilization process usually takes about 30-60 minutes.

Setting

The procedure is typically performed in an outpatient setting, such as a hospital or a specialized orthopedic clinic.

Personnel

• Orthopedic surgeons or physicians
• Nurses
• Radiologic technologists (for imaging studies)
• Anesthesiologist or nurse anesthetist (if anesthesia is used)

Risks and Complications

• Minor risks include skin irritation or pressure sores from the cast or brace.
• Rare complications may include malunion or nonunion of the fracture, and potential issues with joint movement or stability.

Benefits

• Reduced pain and discomfort from the fracture.
• Stabilization of the bone to facilitate proper healing.
• Minimally invasive with a relatively quick and simple application.

Recovery

• The patient may need to keep weight off the affected leg and use crutches or a walker.
• Follow-up appointments are crucial to monitor healing progress and potentially adjust the immobilization device.
• Full recovery could take several weeks to months, depending on the individual's healing rate and fracture severity.

Alternatives

• Open reduction and internal fixation (surgical intervention with plates and screws).
• Functional bracing with immediate weight-bearing.
• Non-invasive treatments like physical therapy alone, for less severe cases.
  • Pros of alternatives: Surgical options may provide more immediate and robust stabilization; physical therapy focuses on strengthening without immobilization.
  • Cons of alternatives: Surgery involves higher risks and a longer recovery; functional bracing might delay healing if not appropriately managed.

Patient Experience

• During the procedure, the patient will feel minimal discomfort, especially if anesthesia is used.
• Post-procedure, the patient might experience mild discomfort or itching under the cast or brace.
• Pain management will typically involve over-the-counter pain relievers.
• Patients are generally advised to elevate the affected limb and apply ice packs to reduce swelling in the initial days following the procedure.