27769 Open treatment of posterior malleolus fracture, includes internal fixation, when performed

Name of the Procedure:

Open treatment of posterior malleolus fracture with internal fixation

• Common terms: Posterior malleolus fracture surgery, Ankle fracture repair

Summary

This surgical procedure involves the open treatment and stabilization of a fracture in the posterior part of the ankle (posterior malleolus) using internal fixation devices such as screws or plates.

Purpose

The procedure addresses fractures of the posterior malleolus, aiming to realign and stabilize the bone, promoting proper healing, restoring ankle function, and preventing complications like arthritis or instability.

Indications

• Fracture of the posterior malleolus with displacement
• Instability or incongruity of the ankle joint
• Severe pain and difficulty bearing weight on the affected ankle
• High-risk patients where non-surgical treatments are unsuitable

Preparation

• Pre-surgery fasting (usually at least 6-8 hours prior)
• Adjustment or discontinuation of certain medications as advised by the doctor
• Pre-operative imaging studies such as X-rays or CT scans to assess the fracture
• Blood tests and possibly an electrocardiogram (EKG) to evaluate overall health

Procedure Description

1. The patient is administered anesthesia (general or regional).
2. An incision is made over the affected area of the ankle.
3. The fracture is visualized, and bone fragments are realigned.
4. Internal fixation devices (screws, plates) are placed to stabilize the bone.
5. The surgical site is closed with sutures or staples.
6. A sterile dressing is applied, and the ankle is often placed in a splint or cast.

Duration

The procedure typically takes 1-2 hours, depending on the complexity of the fracture.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Hardware irritation or failure
• Delayed bone healing or non-union
• Ankle stiffness or reduced range of motion

Benefits

• Stabilization of the fracture
• Improved alignment and healing of the bone
• Restoration of ankle function
• Reduced pain
• Lower risk of long-term complications

Recovery

• Initial immobilization in a cast or splint
• Pain management with prescribed medications
• Instructions on weight-bearing status, often starting with no weight and gradually increasing
• Physical therapy to restore mobility and strength
• Follow-up appointments for X-rays and assessment of healing
• Full recovery and return to normal activities may take several months

Alternatives

• Non-surgical treatment (casting or bracing without surgery) for less severe fractures
• External fixation if internal fixation is not suitable
• Conservative management with rest and physical therapy

Patient Experience

Patients will likely experience some pain and swelling immediately after the surgery, managed with medications. Postoperative discomfort generally decreases over time. Physical therapy plays a crucial role in recovery, helping regain strength and mobility. Initial weight-bearing may be restricted, followed by gradual reintroduction based on the healing progress assessed by the healthcare team.