Name of the Procedure:

Closed Treatment of Fracture of Weight Bearing Articular Portion of Distal Tibia (e.g., Pilon or Tibial Plafond), with or without Anesthesia; with Skeletal Traction and/or Requiring Manipulation

Summary

This procedure involves aligning and stabilizing a broken bone in the lower part of the tibia (shinbone) near the ankle, specifically in the region crucial for weight bearing. It does not involve making an incision in the skin and may use techniques such as skeletal traction or manual manipulation to correctly position the bone, with or without the use of anesthesia.

Purpose

The procedure is designed to treat fractures at the lower end of the tibia that affect the ankle joint. The primary goal is to restore proper alignment and function of the ankle, enable healing, and minimize complications such as stiffness, deformity, or arthritis.

Indications

• Severe pain and swelling around the ankle
• Inability to bear weight on the affected limb
• Visible deformity or misalignment of the ankle
• Confirmed fracture of the weight-bearing part of the distal tibia via imaging (e.g., X-rays, CT scans)
• Medical conditions such as osteoporosis that predispose to fractures

Preparation

• Fasting may be required if general anesthesia will be used
• Adjustment or discontinuation of certain medications, as directed by the healthcare provider
• Pre-procedure imaging studies (X-ray, CT scan) to assess the fracture details
• Complete a medical history review and physical examination

Procedure Description

1. The patient is positioned so the healthcare provider can easily access the affected limb.
2. Anesthesia is administered if needed, which could include local, regional, or general anesthesia.
3. Skeletal traction may be applied using pins or wires through the bone to help realign the fracture.
4. Manual manipulation may be employed to correctly align the broken bone fragments.
5. Once aligned, the limb will be immobilized using a cast, brace, or another external fixation device to maintain the bone position during healing.
6. The alignment is verified with imaging studies.

Duration

The procedure typically takes 1-2 hours, depending on the complexity of the fracture and the techniques used.

Setting

The procedure is usually performed in a hospital setting, emergency room, or specialized surgical center.

Personnel

• Orthopedic surgeon
• Nursing staff
• Anesthesiologist (if anesthesia is required)
• Radiology technician (for imaging)

Risks and Complications

• Infection at the site of traction pin or cast
• Nerve or blood vessel injury
• Malalignment or nonunion of the fracture
• Deep vein thrombosis (blood clots)
• Joint stiffness or arthritis

Benefits

• Proper alignment of the fracture facilitates optimal healing
• Restores function and mobility of the ankle
• Reduces pain associated with the fracture
• Minimizes the risk of long-term complications

Recovery

• Follow post-procedure care instructions, such as keeping the cast dry and elevating the limb to reduce swelling
• Pain management with prescribed medications
• Physical therapy may be needed to restore strength and mobility
• Follow-up appointments to monitor healing and remove or adjust immobilization devices
• Recovery typically spans several weeks to months, depending on the severity of the fracture

Alternatives

• Open reduction and internal fixation (surgical procedure involving incisions and hardware placement)
• Non-surgical management with bracing or casting alone
• Each alternative has its own risks and benefits, which should be discussed with the healthcare provider

Patient Experience

• Patients may experience discomfort or pain during and after the procedure, which can be managed with pain medications.
• Some stiffness and limited mobility can be expected during the initial recovery period.
• Physical therapy and rehabilitation exercises will help in regaining full function of the ankle over time.