Name of the Procedure:

Closed Treatment of Tibial Shaft Fracture (with or without Fibular Fracture); with Manipulation, with or without Skeletal Traction

Summary

This procedure involves the non-surgical alignment and stabilization of a broken tibia (shinbone), which may also involve a fractured fibula (the smaller bone in the lower leg). The process includes moving the fractured bones back into their proper position without making any incisions and using traction if necessary to maintain alignment.

Purpose

This procedure addresses tibial shaft fractures, which are breaks in the main part of the tibia. The goal is to realign the bones to promote proper healing, alleviate pain, and restore normal function to the leg.

Indications

• Severe pain and swelling in the lower leg suggestive of a fracture
• Deformity or visible bend in the lower leg
• Inability to bear weight on the affected leg
• Confirmed tibial or combined tibia-fibula fractures via X-ray or other imaging

Preparation

• Inform the patient to fast if general anesthesia will be used.
• Adjust any medications as advised by the doctor.
• Conduct diagnostic imaging such as X-rays or CT scans to locate and evaluate the fracture.
• Obtain a full medical history and perform a physical examination.

Procedure Description

1. Administer anesthesia or sedation as needed.
2. The healthcare provider aligns the fractured bone(s) by applying specific maneuvers known as manipulation.
3. Skeletal traction might be applied using weights or pins to keep the bones in place.
4. Casts or braces are often used post-manipulation to maintain proper alignment during healing.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or emergency physician
• Nurses
• Anesthesiologist (if anesthesia is required)

Risks and Complications

• Infection, especially if pins are used for skeletal traction
• Improper bone healing (malunion or nonunion)
• Nerve or blood vessel damage
• Compartment syndrome (increased pressure in the leg that can damage muscles and nerves)
• Blood clots

Benefits

• Proper alignment of the bone to ensure it heals correctly
• Reduction of pain and avoidance of long-term complications
• Restoration of leg function and mobility

Recovery

• Follow-up imaging to monitor bone healing
• Physical therapy to restore strength and flexibility
• Partial or non-weight-bearing on the affected leg until fully healed, as advised by the doctor
• The recovery time varies but typically ranges from several weeks to a few months

Alternatives

• Open Reduction and Internal Fixation (ORIF): Surgically aligning the bones and using metal hardware
• External Fixation: Using an external frame to stabilize the bones
• Pros: Surgical options might provide more immediate and rigid stabilization.
• Cons: Surgical options might carry higher risks of infection and require a longer recovery period.

Patient Experience

• During the procedure, the patient might feel discomfort or pain depending on the type of anesthesia used.
• Post-procedure, expect some pain and swelling, managed with medications.

• Physical therapy may be recommended to aid recovery and restore full function.

  Pain management and comfort measures include prescribed pain relievers, elevation of the leg, and application of ice packs to reduce swelling.