Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage
CPT4 code
Name of the Procedure:
Treatment of Tibial Shaft Fracture by Intramedullary Implant
Common Name(s): Tibial Nailing, IM Nailing of the Tibia, Intramedullary Tibial Fixation
Summary
The treatment involves inserting a metal rod (intramedullary implant) into the hollow center of the tibia to stabilize the bone. It aims to properly align and secure the tibial shaft fracture so it can heal correctly. This procedure can sometimes involve the use of screws (interlocking screws) or wire loops (cerclage) to enhance stability.
Purpose
This procedure addresses fractures of the tibial shaft, which is the long, middle part of the shinbone. It aims to stabilize the fracture, reduce pain, and facilitate proper healing. The expected outcome is to restore function and allow the patient to bear weight on the leg again.
Indications
- A tibial shaft fracture with or without accompanying fibular fracture.
- Fractures that are unstable or displaced.
- Open fractures where the skin is broken.
- Failure of other conservative treatments such as cast immobilization.
Preparation
Before the procedure, patients may be asked to:
- Fast for a specific period (usually 6–8 hours) if general anesthesia is planned.
- Adjust or stop certain medications, especially anticoagulants.
- Undergo diagnostic tests such as X-rays or a CT scan to assess the fracture.
- Have a physical examination and pre-operative clearance.
Procedure Description
- Anesthesia: General anesthesia is typically administered.
- Incision: A small incision is made near the knee.
- Reaming: A special tool is used to create space in the center of the tibia.
- Insertion: The intramedullary rod is inserted through the hollow center of the tibia.
- Stabilization: Interlocking screws may be used at both ends to secure the rod. Cerclage wires may also be applied if necessary.
- Closure: The incision is closed with sutures or staples.
Tools and equipment include:
- Intramedullary rod (nail).
- Surgical drill and reamers.
- Interlocking screws and insertion systems.
- Cerclage wiring systems.
Duration
The procedure typically takes about 1 to 2 hours, depending on the complexity of the fracture.
Setting
The procedure is usually performed in a hospital's operating room or a specialized surgical center.
Personnel
- Orthopedic Surgeon(s)
- Anesthesiologist
- Surgical Nurses
- Surgical Technicians
Risks and Complications
- Infection at the surgical site.
- Blood clots.
- Knee or ankle pain.
- Damage to nerves or blood vessels.
- Complications related to anesthesia.
- Nonunion or delayed healing of the fracture.
Benefits
- Stable fixation and proper alignment of the fracture.
- Faster return to mobility and weight-bearing.
- Reduced pain and improved function.
- Shorter hospital stay and recovery time compared to other treatments.
Recovery
- Patients will often begin physical therapy within a few days.
- Pain management may include medications and ice application.
- Weight-bearing may be limited initially, progressing as healing occurs.
- Follow-up appointments are necessary to monitor healing, with X-rays to check alignment.
- Full recovery can take several months, depending on the patient's overall health and fracture severity.
Alternatives
- Cast immobilization: Non-surgical option but may not be suitable for all fractures.
- External fixation: Pins and wires outside the skin but involves more follow-up care.
- Open reduction and internal fixation (ORIF): Involves plates and screws directly on the bone, but is more invasive.
Patient Experience
During the procedure, patients will be under general anesthesia and should not feel any pain. Postoperatively, they may experience pain and swelling, managed with medications. Initial discomfort while moving is likely, but pain should gradually decrease with proper pain management and rehabilitation exercises.