Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation
CPT4 code
Name of the Procedure:
Closed treatment of bimalleolar ankle fracture with manipulation
Common Name: Non-surgical treatment of a bimalleolar ankle fracture
Summary
Closed treatment of a bimalleolar ankle fracture involves realigning the broken bones of the ankle without surgical intervention. The procedure focuses on adjusting the lateral and medial malleoli (the bony prominences on both sides of the ankle) to ensure proper healing.
Purpose
Medical Condition: Bimalleolar ankle fracture, where both the medial (inner) and lateral (outer) malleoli are broken.
Goals: To realign the broken bones for optimal healing, reduce pain, and restore the function and alignment of the ankle.
Indications
Symptoms/Conditions: Severe ankle pain, swelling, bruising, inability to bear weight, and visible deformity.
Patient Criteria: Suitable for individuals whose fractures can be aligned without surgery, typically determined through clinical assessment and imaging results.
Preparation
Pre-Procedure Instructions: Patients may need to fast for a few hours if sedation or anesthesia is required. Medication adjustments, especially anticoagulants, may be necessary.
Diagnostic Tests: X-rays or CT scans to assess the extent of the fracture and plan the manipulation.
Procedure Description
- Sedation/Anesthesia: Local anesthesia or mild sedation might be administered to ensure patient comfort.
- Positioning: The patient is positioned in a way that allows easy access to the ankle.
- Manipulation: The physician will manually manipulate the ankle to realign the bones. This may involve traction and gentle movements to reposition the fragments correctly.
- Verification: Correct alignment is verified through imaging, usually an X-ray.
- Immobilization: Once aligned, the ankle is immobilized with a cast or splint to maintain the position during healing.
Tools Used: Cast or splint materials, X-ray machine, and possibly traction devices.
Duration
Typically 30 minutes to 1 hour, depending on the complexity of the fracture and the ease of manipulation.
Setting
Usually performed in an outpatient clinic or hospital setting equipped with imaging facilities, sometimes in an emergency room.
Personnel
Healthcare Professionals: Orthopedic surgeon or an emergency physician with expertise in fracture management, radiology technicians, nurses, and possibly an anesthesiologist.
Risks and Complications
Common Risks: Pain during manipulation, swelling, mild discomfort.
Rare Risks: Improper bone alignment, nonunion (failure of the bones to heal together), infection if there are open wounds, decreased range of motion.
Benefits
Expected Benefits: Proper alignment of the bones will reduce pain, facilitate healing, and restore function. Pain relief and reduced swelling are typically noticed within a few days post-procedure.
Recovery
Post-Procedure Care: Elevate the ankle, apply ice, and take prescribed pain medications.
Recovery Time: Generally, 6 to 8 weeks for the bones to heal. Physical therapy may be needed for full recovery of function.
Restrictions: Avoid bearing weight on the affected ankle until advised by your doctor. Follow-up appointments for X-rays to monitor healing.
Alternatives
Other Treatment Options:
- Surgical intervention: Involves open reduction and internal fixation (ORIF) with screws and plates.
- Pros and Cons:
- Surgery typically offers quicker stabilization but involves higher risk and a longer initial recovery period.
- The non-surgical approach avoids surgical risks but may not be suitable for severely displaced fractures.
Patient Experience
During the Procedure: Patients might feel pressure or discomfort during manipulation but sedation or anesthesia will minimize pain.
After the Procedure: Some pain and swelling are expected but can be managed with medications, ice, and rest. Patients should expect to use crutches or a walker to avoid weight-bearing on the affected ankle.