Name of the Procedure:

Open Treatment of Fracture of Weight Bearing Articular Surface/Portion of Distal Tibia, with Internal Fixation; of Fibula Only

• Common name(s): Open reduction and internal fixation (ORIF) of distal tibia fracture with fibula fixation

Summary

This surgical procedure involves realigning and stabilizing a fracture at the lower end of the fibula and the weight-bearing part of the distal tibia. The bones are set back in their proper position and held together with plates, screws, or rods.

Purpose

This procedure addresses fractures in the weight-bearing part of the tibia, specifically around the ankle region (pilon or tibial plafond fractures). The goal is to restore joint alignment, ensure stability for proper healing, reduce pain, and return the patient to normal function.

Indications

• Severe fractures of the distal tibia involving the articular surface
• Malalignment of the bones due to a fracture
• Failure of non-surgical treatment like casting or bracing
• Young, healthy patients or those with active lifestyles

Preparation

• Patients may need to fast for several hours before the surgery.
• Medications may need to be adjusted or stopped; this is determined by the healthcare provider.
• Pre-operative imaging (X-rays, CT scan, MRI) to assess the fracture.
• Blood tests and a full medical assessment to ensure fitness for surgery.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made over the affected area.
3. Exposure: The fractured ends of the tibia and fibula are exposed.
4. Reduction: The bones are realigned into their normal position.
5. Internal Fixation: Plates, screws, or rods are used to secure the bones.
6. Closure: The incision is closed with sutures or staples.
7. Imaging: Post-fixation imaging to verify proper placement and alignment.

Duration

The procedure typically takes about 2 to 3 hours, depending on the complexity of the fracture.

Setting

Conducted in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (for imaging during surgery)

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Non-union or delayed union of the fracture
• Hardware irritation or need for removal
• Chronic pain or arthritis in the joint

Benefits

• Proper alignment and stabilization of the fracture
• Reduced pain and discomfort
• Improved function and mobility
• Decreased risk of long-term complications like arthritis

Recovery

• Pain management with medications
• Immobilization with a cast or brace initially
• Physical therapy to regain strength and motion
• Avoiding weight-bearing on the affected limb as advised
• Follow-up appointments to monitor healing
• Recovery time varies but generally takes several months

Alternatives

• Non-surgical management with casting or bracing
• Minimally invasive surgery if applicable
• Pros: Non-surgical options have fewer risks; minimally invasive surgery may involve shorter recovery.
• Cons: May not properly align complex fractures; potential for incomplete healing or future complications.

Patient Experience

• During: The patient will be under anesthesia and not feel pain.
• After: Pain and swelling managed with medications; discomfort as healing begins.
• Pain management: Regular pain-checks and medication to manage discomfort during inpatient recovery and outpatient follow-up.

This markdown document provides detailed information about the open treatment of fractures involving the weight-bearing portion of the distal tibia, including fixing the fibula. It covers all necessary aspects, from terminology to recovery and patient experience.