27536 Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation

Name of the Procedure:

Open Treatment of Tibial Fracture, Proximal (Plateau); Bicondylar, With or Without Internal Fixation
Common Names: Open reduction and internal fixation (ORIF) for tibial plateau fracture, Bicondylar tibial plateau surgery

Summary

This surgical procedure is designed to treat fractures located at the upper part of the tibia near the knee. The surgery involves realigning the bone fragments and securing them using plates or screws to ensure proper healing.

Purpose

This procedure addresses fractures at the upper part of the tibia bone, near the knee, where the bone surface that forms the knee joint is involved. The goal is to restore the normal anatomy of the knee joint, ensure proper alignment for optimal function, and promote healing to avoid long-term complications like arthritis.

Indications

• Severe fractures involving both condyles of the tibial plateau
• Unstable fractures that cannot be treated with casting or bracing
• Fractures with displaced bone fragments
• Fractures in patients with high physical activity demands

Preparation

• Fasting for a specified period before surgery, typically from midnight prior to the day of the procedure
• Adjustment or cessation of certain medications as advised by the doctor
• Preoperative diagnostic tests like X-rays, CT scans, or MRIs to assess the fracture
• Blood tests and physical examination to ensure overall health status

Procedure Description

1. The patient is placed under general anesthesia or spinal anesthesia to ensure they are pain-free during the surgery.
2. An incision is made over the knee to access the fractured tibial plateau.
3. The bone fragments are carefully realigned (reduced) to their normal positions.
4. Metal plates and screws are then used to secure the bone fragments in place.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.
6. In some cases, a temporary drain may be placed to prevent fluid buildup.

Duration

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

Setting

This procedure is generally performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to surrounding blood vessels or nerves
• Compartment syndrome
• Risks associated with anesthesia
• Delayed healing or nonunion of the fracture
• Postoperative stiffness or decreased range of motion
• Arthritis in the knee joint

Benefits

• Proper alignment and stabilization of the fracture
• Reduced risk of future knee problems
• Improved knee function and strength
• Faster recovery compared to non-surgical treatments for complex fractures

Recovery

• Initial recovery in the hospital for 2-3 days
• Pain management with prescribed medications
• Limited weight-bearing on the affected leg, often with the use of crutches or a walker
• Physical therapy to regain strength and mobility, starting a few weeks post-surgery
• Full recovery can take several months, with regular follow-up appointments to monitor healing

Alternatives

• Non-surgical treatment with casting or bracing for less severe fractures
• External fixation, where pins are inserted into the bone and connected to an external frame
• Each alternative has varying levels of invasiveness, recovery time, and potential effectiveness based on the specific nature of the fracture

Patient Experience

• During the procedure: The patient will be under anesthesia and will not feel pain.
• Immediately after the procedure: Some pain and swelling are expected, managed with medications.
• In the following days and weeks: Gradual improvement in pain and mobility with adherence to post-operative care guidelines, including rest, physical therapy, and follow-up visits to the doctor for progress evaluation.