Name of the Procedure:

Closed treatment of trimalleolar ankle fracture; without manipulation

Summary

This procedure involves treating a trimalleolar ankle fracture (a break involving three ankle bones) without the need to manually realign or manipulate the bones. The bones are left in place, and immobilization techniques, such as casting or splinting, are used to allow the fracture to heal naturally.

Purpose

The procedure addresses a trimalleolar ankle fracture, which involves breaks in three bones of the ankle (the medial malleolus, lateral malleolus, and posterior malleolus). The goal is to stabilize the ankle to allow it to heal correctly, alleviate pain, and restore function and mobility.

Indications

• Severe pain, swelling, and bruising around the ankle
• Inability to bear weight on the affected leg
• Deformity or instability of the ankle
• Radiographic evidence (X-rays) confirming a trimalleolar fracture

Preparation

• Follow any specific instructions provided by your healthcare provider.
• Inform your doctor about any medications you are taking; adjustments may be necessary.
• Undergo pre-procedure X-rays or other imaging studies to confirm the diagnosis and plan treatment.

Procedure Description

1. The patient is positioned comfortably, typically lying down.
2. An appropriate cast or splint is selected.
3. The cast or splint is carefully applied to the ankle, ensuring proper immobilization.
4. No anesthesia or sedation is required as there is no manipulation of the bones.

Duration

The procedure typically takes around 30 to 60 minutes, including the application of the cast or splint and the initial assessment.

Setting

The procedure is usually performed in an outpatient clinic or an emergency department of a hospital.

Personnel

• Orthopedic physician or surgeon
• Nurses or medical assistants

Risks and Complications

• Limited risks compared to surgical options
• Possibility of inadequate healing (malunion or nonunion)
• Potential for prolonged immobilization leading to stiffness or muscle atrophy

Benefits

• Non-invasive with no surgical risks
• Promotes natural healing
• Shorter recovery time compared to surgical alternatives

Recovery

• Follow-up appointments for X-rays and assessments
• Keep the cast or splint dry and clean; follow provider instructions
• Avoid bearing weight on the affected leg initially; use crutches if needed
• Perform prescribed physical therapy exercises to restore mobility once cleared by a doctor
• Recovery time can vary but generally ranges from 6 to 12 weeks

Alternatives

• Closed treatment with manipulation (if bone alignment is necessary)
• Surgical intervention (internal fixation with screws and plates)
• Pros of alternatives: better alignment and quicker stabilization
• Cons of alternatives: higher risk, longer recovery time, potential surgical complications

Patient Experience

During the procedure, the patient will feel the pressure as the splint or cast is applied but should not experience significant pain. Afterward, some discomfort may persist but can be managed with pain relief medications. Regular follow-up visits will be necessary to monitor the healing process and adjust the cast or splint if required.