27724 Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)

Name of the Procedure:

Repair of Nonunion or Malunion, Tibia; with Iliac or Other Autograft (includes obtaining graft)

Summary

This surgical procedure involves fixing a tibia that has not healed properly after a fracture. Surgeons use a piece of bone (autograft) taken from another part of the patient's body, usually the iliac crest (part of the pelvis), to aid in the repair.

Purpose

Medical Condition:

• Nonunion: A broken bone that fails to heal.
• Malunion: A bone that heals in an improper position.

Goals:

• Restore proper alignment and function of the tibia.
• Promote bone healing and stability.

Indications

Symptoms/Conditions:

• Persistent pain at the fracture site.
• Inadequate bone healing seen on X-rays.
• Deformity in the leg.

Patient Criteria:

• Patients with a confirmed diagnosis of nonunion or malunion of the tibia.
• Suitable general health for undergoing surgery.

Preparation

Pre-procedure Instructions:

• Fasting for at least 8 hours before surgery.
• Adjusting medications as per doctor's advice.
• Arrange for transportation and post-surgery care at home.

Tests/Assessments:

• Blood tests and imaging studies (X-rays, CT scans).
• Pre-operative medical evaluation.

Procedure Description

Steps:

1. Administer anesthesia to the patient.
2. Make an incision over the fracture site on the tibia.
3. Clean the fracture ends to stimulate healing.
4. Obtain an autograft from the patient’s iliac crest or another suitable site.
5. Place the graft into the fracture site to promote bone healing.
6. Secure the graft with plates, screws, or rods as necessary.
7. Close the incision with sutures or staples.

Tools/Equipment:

• Surgical instruments for bone cutting and grafting.
• Imaging tools for guidance.
• Fixation devices like plates, screws, or rods.

Anesthesia:

• General anesthesia.

Duration

• Typically takes 2 to 4 hours.

Setting

• Hospital or specialized surgical center.

Personnel

• Orthopedic surgeon.
• Anesthesiologist.
• Surgical nurses.
• Surgical technician.

Risks and Complications

Common Risks:

• Infection.
• Bleeding.
• Blood clots.

Rare Risks:

• Nonunion of the graft.
• Damage to nearby nerves or blood vessels.
• Chronic pain.

Benefits

• Proper bone healing and restored function.
• Pain relief and improved mobility.
• Correction of the bone deformity.

Recovery

Post-procedure Care:

• Pain management with medications.
• Keeping the leg elevated to reduce swelling.
• Use of crutches or a walker.

Recovery Time:

• Initial healing takes 6 to 8 weeks.
• Full recovery may take several months.

Restrictions:

• Avoid weight-bearing activities until cleared by the doctor.
• Follow-up appointments for X-rays and wound check.

Alternatives

Other Options:

• External fixation.
• Bone stimulators.
• Conservative management with physical therapy.

Pros and Cons:

• Non-surgical options may take longer to heal and might not fully correct the malunion or nonunion.
• Surgical options provide quicker and more definitive results but come with surgical risks.

Patient Experience

During Procedure:

• Under general anesthesia, so the patient will be asleep and pain-free.

After Procedure:

• Initial pain and discomfort managed with pain relief medications.
• Gradual improvement in leg function and reduction in pain.
• Physical therapy may be required to regain strength and mobility.