Name of the Procedure:

Open Treatment of Trimalleolar Ankle Fracture, Includes Internal Fixation, When Performed, Medial and/or Lateral Malleolus; Without Fixation of Posterior Lip

Summary

This is a surgical procedure to repair a type of severe ankle fracture involving three key areas of the ankle: the medial malleolus (inner part of the ankle), the lateral malleolus (outer part of the ankle), and the posterior lip. The procedure involves making an open surgical incision and fixing the bones with hardware like plates and screws, but without repairing the posterior lip of the bone.

Purpose

Medical Condition Addressed

• Trimalleolar ankle fracture, which is a severe form of ankle break involving three different parts of the ankle bones.

Goals and Expected Outcomes

• Stabilize and align fractured bones to promote proper healing.
• Restore functionality and mobility of the ankle.
• Reduce pain and prevent long-term complications such as arthritis.

Indications

Symptoms and Conditions

• Severe pain and swelling in the ankle.
• Inability to bear weight on the affected leg.
• Visible deformity of the ankle.
• Confirmed trimalleolar fracture on imaging tests.

Patient Criteria

• Patients with a confirmed trimalleolar fracture.
• Patients with displaced or unstable fractures.
• Patients in good overall health for surgery.

Preparation

• Fasting for at least 8 hours before the procedure.
• Stopping certain medications like blood thinners, as advised by the physician.
• Preoperative imaging studies like X-rays or CT scans.
• Routine blood tests and physical examination.

Procedure Description

• The patient will be given regional or general anesthesia.
• An incision is made over the ankle to expose the fracture.
• The bones are realigned to their proper position.
• Metal plates and screws are used to fix the medial and/or lateral malleolus in place.
• The posterior lip of the bone is not fixed.
• The incision is closed with stitches or surgical staples.

Duration

The procedure typically takes about 1.5 to 2 hours.

Setting

The procedure is usually performed in a hospital's operating room or at a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks

• Infection
• Blood clots
• Nerve damage
• Bleeding

Rare Risks

• Nonunion or malunion of the bone
• Implant failure
• Chronic pain

Management of Complications

• Antibiotics for infections
• Blood thinners for clot prevention
• Further surgeries if necessary

Benefits

• Proper alignment and stabilization of the ankle.
• Improved chances of full recovery and return to normal activities.
• Pain reduction.
• Lower risk of long-term damage like arthritis.

Recovery

• Rest and elevation of the affected leg.
• Pain management with prescribed medication.
• Physical therapy to regain strength and mobility.
• Avoid weight-bearing on the operated leg for several weeks.
• Follow-up appointments to monitor healing.

Alternatives

Other Treatments

• Closed reduction and casting (less invasive but less stable for severe fractures).
• External fixation.
• Non-surgical management (not typically recommended for severe fractures).

Pros and Cons

• Closed reduction: Less invasive but may not provide adequate stability for severe fractures.
• External fixation: Involves a frame outside the body and might be less comfortable.

Patient Experience

• During the procedure, the patient will be under anesthesia and will not feel pain.
• Post-procedure, there may be pain and discomfort managed by medications.
• Swelling and bruising around the ankle can be expected.
• Physical therapy will be essential for a full recovery.