Name of the Procedure:

Closed Treatment of Bimalleolar Ankle Fracture (e.g., lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli) without manipulation

Summary

In this procedure, a bimalleolar ankle fracture, which involves two of the three malleoli (bones) in the ankle, is treated without the need for physically realigning the bones. This is achieved through external methods like casting or splinting to ensure the bones heal correctly.

Purpose

This procedure addresses fractures of the ankle involving two different malleoli, aiming to immobilize the ankle so that the fractured bones can heal properly. The goal is to restore the normal anatomy of the ankle and to ensure proper function and stability.

Indications

• Diagnosis of a bimalleolar ankle fracture.
• Visible swelling, bruising, and pain in the ankle area.
• X-ray confirmation of the fracture without significant bone displacement.
• Patients who are medically fit for non-surgical treatment options.

Preparation

• Patients may be advised to refrain from eating or drinking for a few hours before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Diagnostic imaging such as X-rays will be required to assess the fracture.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. The healthcare provider will apply a splint or a cast to the ankle to immobilize it.
3. Strict instructions will be given to refrain from putting weight on the ankle.
4. No anesthesia or sedation is typically required since there's no manipulation of the bones.

Duration

The procedure itself is relatively quick, generally taking about 30 minutes to 1 hour.

Setting

This procedure is often performed in an emergency room, outpatient clinic, or hospital.

Personnel

• Emergency room physicians or orthopedic doctors.
• Nurses or medical assistants for support.
• Radiologic technologists for X-ray imaging.

Risks and Complications

• Risks include improper healing of the bones (malunion) or bone misalignment if not correctly immobilized.
• Rare risks include skin irritation or pressure sores from the cast or splint.
• Complications may involve prolonged pain, stiffness, or reduced mobility if the fracture is not healed correctly.

Benefits

• Stabilization of the fracture without the need for invasive surgery.
• Reduced risk of surgical complications.
• The potential for a quicker recovery compared to surgical options.

Recovery

• Patients will need to keep the cast or splint dry and clean.
• Follow-up appointments are necessary to monitor healing progress through X-rays.
• Gradual return to weight-bearing on the affected ankle as advised by the healthcare provider.
• Physical therapy may be recommended to restore full function.

Alternatives

• Surgical treatment involving internal fixation with plates and screws.
• Open Reduction and Internal Fixation (ORIF) for more complex or severe fractures.
• Pros of surgery include potentially quicker recovery times and lower risk of malunion.
• Cons of surgery include higher risk of infection and surgical complications.

Patient Experience

Patients might feel some initial discomfort or pain when the cast or splint is applied. Pain is usually managed with over-the-counter pain medications. During recovery, patients should expect some restrictions in daily activities and will need to avoid putting weight on the affected ankle until advised. Regular follow-ups will be essential to ensure proper healing and rehabilitation.