Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Bimalleolar Ankle Fracture
Common Names: ORIF of bimalleolar fracture, Surgical repair of bimalleolar fracture
Technical Terms: Open Reduction and Internal Fixation (ORIF) for bimalleolar fracture
Summary
Open treatment of a bimalleolar ankle fracture involves surgically exposing the broken bones of the ankle and fixing them with hardware like screws, plates, or rods. This method ensures proper alignment and stabilization of the bones to facilitate healing.
Purpose
The procedure addresses fractures of both sides of the ankle (bimalleolar fractures), which often result from high-impact trauma. The goal is to restore the normal anatomy of the ankle, stabilize the joint, and allow for optimal healing, reducing the risk of long-term complications such as arthritis or chronic pain.
Indications
- Severe ankle pain and swelling due to a bimalleolar fracture.
- X-rays or other imaging showing misalignment of ankle bones.
- Inability to bear weight on the affected ankle.
- Open fractures where the bone pierces the skin.
- Failed conservative treatment methods, such as casting.
Preparation
- Fasting for 8-12 hours before the procedure.
- Discontinuation of certain medications (e.g., blood thinners) as advised by the doctor.
- Lab tests (blood work) and imaging (X-rays, MRI).
- Preoperative clearance from a primary care physician or specialist.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the fracture site(s).
- Exposure and Alignment: The fractured bone fragments are exposed and realigned.
- Internal Fixation: Metal screws, plates, or rods are used to secure the bones in the correct position.
- Closure: The surgical site is closed with sutures or staples and dressed with sterile bandages.
- Post-operative Care: A splint or cast may be applied, and the leg is usually kept elevated.
Duration
The procedure typically takes between 1 to 2 hours, depending on the complexity of the fracture.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurse
- Surgical technologist
- Recovery room nurse
Risks and Complications
- Infection at the surgical site
- Blood clots
- Nerve or blood vessel damage
- Anesthesia-related complications
- Delayed bone healing or nonunion
- Need for additional surgery
Benefits
- Proper alignment and stabilization of the ankle bones.
- Reduced pain and faster recovery compared to non-surgical methods.
- Lower risk of chronic complications like arthritis.
- Improved ankle function and mobility.
Recovery
- Pain management through medications.
- Instructions for wound care and keeping the incision site clean.
- Non-weight bearing on the affected leg for several weeks.
- Physical therapy may be recommended after initial healing.
- Follow-up appointments to monitor the bone healing process.
- Possible return to normal activities within 3-6 months.
Alternatives
- Conservative treatment with casting or bracing without surgery.
- Closed reduction and casting. Pros of Alternatives: Non-invasive, lower immediate risk. Cons of Alternatives: Higher risk of improper bone healing and long-term complications.
Patient Experience
During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, patients may experience pain and swelling, which can be managed with medications. Elevation of the leg and ice application can help reduce swelling. Physical therapy may be required to regain strength and mobility in the ankle. Pain should gradually decrease as healing progresses.