Name of the Procedure:

Closed treatment of tibial fracture, proximal (plateau) with or without manipulation, with skeletal traction

Summary

This procedure involves the non-surgical realignment and stabilization of a fracture at the upper end of the tibia, also known as the tibial plateau. Skeletal traction, which uses weights and pulleys, is employed to maintain the proper alignment of the bone during healing.

Purpose

The procedure aims to address fractures of the proximal tibia, particularly the tibial plateau, usually resulting from trauma. The goals are to properly align the bone fragments to facilitate natural healing, prevent complications like joint instability, and restore normal knee function.

Indications

• Fracture of the proximal tibia or tibial plateau.
• Symptoms include severe pain, swelling, and inability to bear weight on the affected leg.
• Patients typically include those who have sustained significant trauma, such as in car accidents or falls.

Preparation

• Patients may need to fast for several hours if anesthesia is involved.
• Medication adjustments may be necessary, particularly blood thinners.
• Diagnostic tests such as X-rays or CT scans will be performed to assess the fracture.

Procedure Description

1. The patient is typically sedated or given regional anesthesia.
2. The affected leg is positioned, and skeletal traction is applied using a system of weights and pulleys anchored to a pin inserted through the bone.
3. The bone fragments are manipulated externally to achieve proper alignment without making an incision.
4. Once alignment is confirmed, the traction is maintained to keep the bones in place during healing.

Duration

The initial procedure to apply traction and achieve alignment usually takes about 1 to 2 hours. However, the traction may need to be maintained for several weeks to ensure proper healing.

Setting

This procedure is typically performed in a hospital setting, either in the emergency room or an operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Nurses and radiologic technologists

Risks and Complications

• Infection at the pin site.
• Non-union or malunion of the fracture.
• Compartment syndrome (increased pressure in the leg that can damage tissues).
• Risks associated with anesthesia.

Benefits

• Non-invasive method to stabilize and heal the bone.
• Avoids the risks and longer recovery time associated with open surgery.
• Helps in maintaining joint function and reducing pain.

Recovery

• Regular follow-up appointments to monitor healing progress.
• Pain management with medications.
• Limited weight-bearing on the affected leg, using crutches or a walker.
• Physical therapy may be recommended to restore mobility and strength.
• Recovery time varies but typically ranges from several weeks to a few months.

Alternatives

• Open reduction and internal fixation (surgical method with plates and screws).
• Cast immobilization without traction (more suitable for less complex fractures).
• Pros of alternatives include a potentially shorter recovery time for surgery and less equipment for basic casting.
• Cons include the invasiveness and risks of surgery and less precise alignment with basic casting.

Patient Experience

• During the procedure, patients will experience sedation or anesthesia, so they should feel minimal discomfort.
• Post-procedure, discomfort or pain at the pin site is common, but management is provided with medications.
• Mobility will be limited, and adherence to weight-bearing restrictions is crucial.
• There may be follow-up X-rays and appointments to ensure proper healing.