Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage
CPT4 code
Name of the Procedure:
Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage.
Common name(s): Open reduction and internal fixation (ORIF) of the tibial shaft.
Summary
This procedure involves surgically opening the skin and tissues to access and align the fractured bones of the lower leg (tibia, and sometimes fibula). Metal plates and screws are then used to hold the bones in the correct position to ensure proper healing. Sometimes, cerclage wires (wire loops) are also used to provide additional stabilization.
Purpose
The procedure is performed to treat a tibial shaft fracture, which is a break along the length of the tibia. The goal is to realign and stabilize the bones to promote proper healing, restore normal leg function, and reduce the risk of complications such as improper healing (malunion), nonunion, or infection.
Indications
- Severe or displaced tibial shaft fractures
- Fractures involving multiple breaks
- Open fractures where the bone has pierced the skin
- Failure of non-operative treatments like casting or bracing
- Associated fibular fractures requiring stabilization
Preparation
- Patients may need to fast for several hours before the procedure.
- Avoid certain medications, particularly blood thinners.
- Diagnostic tests such as X-rays, CT scans, or MRIs to assess the extent of the fracture.
- Preoperative assessment by an anesthesiologist.
Procedure Description
- The patient is given general or regional anesthesia.
- An incision is made over the fracture site.
- The fractured bone ends are exposed and realigned.
- Metal plates are shaped and fixed to the bone with screws to hold the fracture in position.
- If necessary, cerclage wires are placed around the bone to provide additional support.
- The incision is closed with sutures or staples, and a sterile dressing is applied.
- The leg may be placed in a brace or cast to protect it during initial healing.
Duration
Approximately 1.5 to 3 hours, depending on the complexity of the fracture.
Setting
Performed in a hospital or surgical center operating room.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Infection
- Blood clots
- Nerve or blood vessel damage
- Hardware irritation or failure
- Nonunion or delayed union of the fracture
- Compartment syndrome
Benefits
- Stabilizes the fracture for proper alignment and healing.
- Restores the structural integrity and function of the leg.
- Reduces pain and facilitates earlier mobilization.
Recovery
- Post-procedure, patients will receive pain management medications.
- Physical therapy may begin within days to weeks.
- Typically, weight-bearing is restricted initially, with gradual increase based on healing.
- Follow-up appointments for X-rays to monitor healing.
- Full recovery may take several months.
Alternatives
- Closed reduction and casting: Non-surgical, but less effective for severe fractures.
- External fixation: Metal pins and a frame outside the leg, used temporarily.
- Intramedullary nailing: Less invasive but may not be suitable for all fracture types.
Patient Experience
- During: The patient will be under anesthesia and should not feel pain during the procedure.
- After: There may be discomfort and swelling, managed with pain relief medications. Gradual improvement in function and reduction in pain can be expected over time with appropriate post-operative care.