27823 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip

Name of the Procedure:

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip.

Summary

This is a surgical procedure to repair a trimalleolar ankle fracture, which involves breaks in the medial, lateral, and posterior malleoli (the bony prominences on either side of the ankle) using internal fixation methods like plates and screws to stabilize the bones.

Purpose

• Medical Condition: Trimalleolar ankle fracture.
• Goals: To realign and stabilize the broken bones to allow for proper healing, restore function, and prevent long-term complications.

Indications

• Severe ankle pain and swelling.
• Inability to bear weight on the affected ankle.
• Visible deformity or significant misalignment of the ankle.
• Diagnostic imaging (X-rays, CT scans) showing a trimalleolar fracture.
• Failed non-surgical treatments or poorly healing fractures.

Preparation

• Pre-procedure Instructions:
  • Fasting (typically no food or drink) for 8 hours before surgery.
  • Medication adjustments may be needed; stopping blood thinners or diabetes medications as advised by the doctor.
• Diagnostic Tests:
  • Preoperative imaging studies (X-rays, CT scans).
  • Blood tests and possibly a preoperative physical exam.

Procedure Description

1. Administration of anesthesia (general or regional).
2. Cleaning and sterilizing the surgical area.
3. Making an incision over the fractured area.
4. Realigning the fractured bones (reduction).
5. Fixing the bones in place with metal plates and screws for stability (internal fixation).
6. Closing the incision with sutures or staples.
7. Applying a sterile dressing and possibly a cast or splint.

Duration

Approximately 2 to 3 hours.

Setting

Usually performed in a hospital or a surgical center.

Personnel

• Orthopedic surgeon.
• Anesthesiologist.
• Surgical nurses.
• Surgical technicians.

Risks and Complications

• Infection.
• Bleeding.
• Nerve damage.
• Blood clots.
• Hardware complications (e.g., screws or plates becoming loose).
• Delayed or improper bone healing (nonunion or malunion).

Benefits

• Proper alignment and stabilization of the ankle bones.
• Reduced pain and swelling.
• Faster and more reliable recovery.
• Restored function and mobility of the ankle.
• Prevention of long-term complications like arthritis or chronic instability.

Recovery

• Post-procedure Care: Pain management with medications, ice to reduce swelling, keeping the ankle elevated.
• Instructions:
  • Follow-up appointments for wound checks and X-rays.
  • Physical therapy to restore strength and mobility.
  • Possible restrictions on weight-bearing activities for several weeks to months.
• Expected Recovery Time: Several weeks to months, depending on the severity of the fracture and individual healing rates.

Alternatives

• Nonsurgical Treatments: Casting or splinting without internal fixation, which may not be sufficient for severe fractures.
• Pros and Cons:
  • Nonsurgical options have fewer immediate risks but may result in improper healing or long-term issues.
  • Surgery offers better stability and faster recovery but comes with surgical risks.

Patient Experience

• During the procedure: The patient will be under anesthesia and should not feel pain.
• After the procedure: Expect some pain and swelling, manageable with prescribed medications. Initial discomfort will lessen as healing progresses. Regular follow-up visits are necessary to monitor healing and remove any surgical hardware if needed later.