Name of the Procedure:

Closed Treatment of Posterior Malleolus Fracture; with Manipulation

• Common Names: Closed reduction of posterior ankle fracture, Non-surgical management of posterior malleolus fracture

Summary

This procedure involves realigning and stabilizing a fractured posterior malleolus (a part of the ankle) without surgical incisions. The bone fragments are manipulated back into place from outside the skin.

Purpose

The procedure addresses fractures of the posterior malleolus, which is crucial for ankle stability and function. The goal is to realign the bone to ensure proper healing, restore joint function, and prevent long-term complications such as arthritis.

Indications

• Fracture of the posterior malleolus as confirmed by imaging (X-ray, MRI)
• Displaced bone fragments causing joint instability
• No contraindications for non-surgical intervention
• Patient preference for non-surgical treatment

Preparation

• Fasting may not be necessary, but follow specific instructions given by the medical team.
• Discontinue certain medications like blood thinners if advised by your healthcare provider.
• Diagnostic imaging tests like X-rays or CT scans to assess the fracture.

Procedure Description

1. Patient is positioned comfortably, often with pillows to support the leg.
2. A local anesthetic or sedation may be administered to minimize pain.
3. The healthcare provider manipulates the ankle and foot to realign the bone fragments.
4. Once aligned, the ankle is immobilized using a cast or splint to maintain bone position.
5. Post-procedure imaging may be done to confirm correct alignment.

Duration

Approximately 30 minutes to 1 hour, depending on the complexity of the fracture.

Setting

Typically performed in an outpatient clinic, emergency department, or a hospital setting.

Personnel

• Orthopedic surgeon or a trained healthcare provider
• Nurses or medical assistants
• Anesthesiologist (if sedation is used)

Risks and Complications

• Mild to moderate pain or discomfort
• Swelling or bruising
• Potential improper alignment requiring further intervention
• Rare risks include nerve damage or infection at the site of manipulation

Benefits

• Non-surgical realignment of the bone, reducing risks associated with surgery
• Faster initial recovery time compared to surgical options
• Improved ankle function and stability when properly aligned

Recovery

• Keep the ankle elevated and apply ice to reduce swelling.
• Avoid weight-bearing activities as advised until cleared by your healthcare provider.
• Follow-up appointments for monitoring healing and cast adjustments.
• Full recovery can take several weeks to months, depending on the severity of the fracture and patient adherence to recovery protocols.

Alternatives

• Surgical open reduction and internal fixation (ORIF)
  • Pros: More precise alignment, reduced risk of re-displacement.
  • Cons: Involves surgical risks such as infection, longer recovery time.
• Conservative treatment without manipulation
  • Pros: No anesthesia risks, non-invasive.
  • Cons: May result in improper healing or long-term complications.

Patient Experience

• During the procedure, you might feel pressure and slight discomfort.
• Post-procedure, pain and swelling can be managed with prescribed medications and rest.
• Your healthcare provider will ensure your comfort through proper pain management and instructions for home care.