27720 Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)

Name of the Procedure:

Repair of nonunion or malunion, tibia; without graft, using compression technique

Summary

This procedure is undertaken to correct a tibia (shinbone) that has not healed properly after a fracture. Using a method known as compression technique, the surgeon brings the bone fragments together without the use of a bone graft.

Purpose

The procedure addresses issues with bones that have either failed to heal (nonunion) or healed incorrectly (malunion) after a fracture. The goal is to promote proper bone healing, restore functionality, and alleviate pain or discomfort associated with the improperly healed bone.

Indications

• Chronic pain or instability in the tibia after a fracture
• Visible deformity or shortening of the leg
• Difficulty walking or bearing weight on the affected leg
• Lack of bone healing observed in imaging studies

Preparation

• Fasting for at least 8 hours before surgery
• Adjustment or cessation of certain medications as directed by the surgeon
• Pre-operative imaging tests such as X-rays or CT scans
• Blood tests to evaluate overall health status

Procedure Description

1. Anesthesia administration: General or spinal anesthesia will be given.
2. Incision: The surgeon makes an incision over the affected area of the tibia.
3. Preparation of Bone Ends: The bone ends are prepared by cleaning and freshening them to promote healing.
4. Compression Technique: Special devices, such as plates and screws, are used to bring the bone fragments together under compression to enhance bone healing.
5. Closure: The wound is cleaned, and the incision is closed with sutures or staples.
6. Immobilization: A cast or brace may be applied to protect the repaired bone.

Duration

The procedure typically takes about 1-2 hours.

Setting

This surgery is generally performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Failure of the bone to heal (persistent nonunion)
• Hardware irritation or failure
• Pain and discomfort during recovery

Benefits

• Proper bone healing and alignment
• Relief from pain or discomfort
• Improved leg function and stability
• Enhanced ability to walk and bear weight

Recovery

• Post-operative pain management with medications
• Instructions for wound care and keeping the incision clean
• Limited weight-bearing activities; use of crutches or walker as directed
• Physical therapy to regain strength and mobility
• Follow-up visits to monitor healing, remove sutures or staples, and assess recovery progress
• Recovery time can range from several weeks to a few months, depending on the individual's healing rate

Alternatives

• Non-surgical options like bracing and physical therapy for minor cases
• Surgery with bone grafting if additional support is required
• Use of external fixation devices
• Each alternative has its own risks and benefits, and the choice depends on the specific case's severity and patient preferences

Patient Experience

• Mild to moderate pain during and after the procedure managed with pain medications
• Swelling and bruising around the surgical site
• Discomfort from immobilization devices like casts or braces
• Potential physical limitations during the initial recovery phase, improving with time and rehabilitation efforts