27726 Repair of fibula nonunion and/or malunion with internal fixation

Name of the Procedure:

Repair of Fibula Nonunion and/or Malunion with Internal Fixation

Summary

This procedure involves the surgical correction of a fibula bone that has improperly healed (malunion) or not healed at all (nonunion). An internal fixation device, such as screws, plates, or rods, is used to stabilize and align the bone to promote healing.

Purpose

• Medical Condition: Treats nonunion (failure of bone to heal) and malunion (improper healing alignment) of the fibula.
• Goals: Restore the proper alignment of the fibula, promote bone healing, alleviate pain, and improve functionality.

Indications

• Chronic pain due to fibula nonunion or malunion
• Difficulty in bearing weight or walking
• Visible deformity or misalignment of the leg
• Failure of the fibula to heal after a fracture
• Previous treatments (e.g., casting, bracing) have not succeeded

Preparation

• Fasting: Typically required before anesthesia.
• Medication Adjustments: May need to stop certain medications like blood thinners.
• Pre-Procedure Tests: X-rays, CT scans, or MRI to assess bone condition; blood tests may be required.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical cut is made over the affected area of the fibula.
3. Bone Preparation: Any necrotic or scar tissue is removed, and the bone edges are freshened.
4. Realignment: The fibula is realigned to its proper position.
5. Internal Fixation: Metal plates, screws, or rods are implanted to hold the bone in place.
6. Closure: The incision is closed with sutures or staples.

Duration

Approximately 2-4 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Radiologic technologist (if X-ray guidance is used)

Risks and Complications

• Common Risks: Infection, blood clots, bleeding, and adverse reactions to anesthesia.
• Rare Risks: Damage to adjacent nerves or blood vessels, hardware complications (loosening or breakage), nonunion or malunion recurrence.

Benefits

• Improved bone alignment and healing
• Reduction or elimination of chronic pain
• Enhanced leg function and mobility
• Stability of the fibula allowing for weight-bearing activities

Recovery

• Post-Procedure Care: Pain management with medications, wearing a cast or brace, and keeping the leg elevated.
• Recovery Time: Typically 6-12 weeks for initial healing; full recovery may take several months.
• Restrictions: Limited weight-bearing on the affected leg, physical therapy for rehabilitation.
• Follow-Up: Regular follow-up appointments to monitor healing through X-rays.

Alternatives

• Non-Surgical: Prolonged casting or bracing, bone stimulators, physical therapy.
• Surgical Alternatives: Bone grafting, external fixation devices.
• Pros and Cons: Non-surgical options may take longer to heal and might not be effective; alternative surgeries could have different risks and benefits.

Patient Experience

• During Procedure: Patient will be under anesthesia and won't feel pain.
• After Procedure: Patients may experience pain and swelling which can be managed with medications. Discomfort from the incision and limited mobility initially.
• Pain Management: Postoperative pain is managed through prescribed medications, and gradual weight-bearing is encouraged as healing progresses.