Name of the Procedure:

Closed Treatment of Medial Malleolus Fracture with Manipulation (with or without Skin or Skeletal Traction)

Summary

This procedure involves the non-surgical, manual realignment of a fractured medial malleolus (the inner part of the ankle). It may involve the use of traction to aid in proper alignment, and is typically done without making any incisions.

Purpose

This procedure addresses fractures of the medial malleolus, which is a common ankle injury. The goal is to ensure that the bones heal in the correct position to prevent future complications and restore normal function and strength to the ankle.

Indications

• Pain, swelling, and bruising around the inner ankle
• Inability to bear weight on the affected ankle
• Visible deformity or misalignment of the ankle
• X-ray confirmation of a medial malleolus fracture

Preparation

• Patient may need to fast for a certain period if sedation or anesthesia will be used.
• Pre-procedure imaging such as X-rays to assess the extent of the fracture.
• Adjustments to certain medications as advised by the healthcare provider.

Procedure Description

1. The patient is positioned to allow easy access to the injured ankle.
2. Sedation or local anesthesia may be administered to minimize discomfort.
3. The healthcare provider will manually manipulate the fractured bone segments to realign them into the proper position.
4. Traction devices may be applied temporarily to aid in maintaining the correct bone position.
5. Once aligned, the ankle is immobilized using a cast, splint, or brace to maintain stability during healing.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital emergency room or outpatient clinic.

Personnel

• Orthopedic surgeon or a specialized physician
• Nurses
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)

Risks and Complications

• Pain and discomfort during manipulation
• Risk of improper alignment leading to the need for surgical intervention
• Infection, though rare (typically more of a concern with surgical interventions)
• Compartment syndrome (increased pressure within muscles)
• Possible damage to surrounding nerves or blood vessels

Benefits

• Non-surgical treatment with a potentially quicker recovery time
• Correct alignment promotes proper healing
• Relief from pain and restoration of ankle function

Recovery

• The patient may need to rest and keep the ankle elevated for the first few days
• Use of crutches or a walker to avoid weight-bearing on the affected ankle
• Follow-up appointments for X-rays to monitor healing
• Physical therapy may be recommended after initial bone healing
• Total recovery time can range from 4 to 8 weeks, depending on the severity of the fracture

Alternatives

• Open reduction and internal fixation (surgical intervention)

  • Pros: Direct visualization for accurate alignment, often used for severe fractures
  • Cons: Surgical risks, longer recovery time

• Immobilization without manipulation

  • Pros: Lower immediate risk
  • Cons: May not be suitable for all fractures, could result in improper healing

Patient Experience

During the procedure, the patient may experience some discomfort despite sedation or anesthesia. Post-procedure, pain can be managed with prescribed medications. The initial period may involve significant swelling and bruising, but these should gradually subside. Mobility will be limited, and adhering to recovery instructions is crucial for optimal healing.