Name of the Procedure:

Open Treatment of Fracture of Weight Bearing Articular Surface/Portion of Distal Tibia with Internal Fixation (Commonly referred to as Open Reduction and Internal Fixation (ORIF) of Tibial Pilon Fracture)

Summary

This surgical procedure involves realigning and stabilizing a fractured distal tibia (the lower part of the shinbone that forms part of the ankle joint) using medical hardware like screws and plates. It's specifically used for fractures affecting the weight-bearing surface of the bone.

Purpose

The procedure addresses fractures of the distal tibia, particularly those involving the tibial plafond, a crucial weight-bearing part of the bone. Its goals are to restore the normal alignment of the bone, ensure proper joint function, and minimize the risk of arthritis associated with the fracture.

Indications

• Severe fractures of the distal tibia affecting the articular surface.
• Fractures that are not aligned properly (displaced fractures).
• High-energy trauma cases such as car accidents.
• Inability to bear weight or severe pain in the ankle.

Preparation

• Patients may need to fast for 8-12 hours before the surgery.
• Adjustments or cessation of certain medications, particularly blood thinners.
• Preoperative imaging studies like X-rays or CT scans to assess the extent of the fracture.
• Blood tests and a complete medical evaluation to ensure fitness for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made near the ankle to access the fracture site.
3. The broken bone pieces are realigned to their correct anatomical positions.
4. Internal fixation devices (screws, plates) are used to secure the bone fragments in place.
5. The incision is closed with sutures or staples.
6. A sterile dressing is applied to the wound site.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the fracture.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Orthopedic Surgeon
• Operating Room Nurses
• Anesthesiologist
• Surgical Technicians and Assistants

Risks and Complications

• Infection at the surgical site
• Blood clots (deep vein thrombosis)
• Nerve or blood vessel damage
• Nonunion or malunion of the fracture
• Postoperative stiffness or decreased range of motion
• Hardware irritation or failure

Benefits

• Restored alignment and function of the tibial pilon.
• Decreased pain and improved mobility.
• Lower risk of post-traumatic arthritis if the joint surface is properly aligned.
• Most patients can expect to bear weight on the affected leg within a few months post-surgery.

Recovery

• The patient will likely need to stay in the hospital for 1-2 days.
• Postoperative care includes pain management, wound care, and physical therapy.
• Non-weight bearing on the operated leg for 6-12 weeks, followed by gradual weight-bearing as advised by the surgeon.
• Follow-up appointments for X-rays to monitor healing, and removal of stitches or staples.
• Full recovery can take several months, with a gradual return to normal activities.

Alternatives

• Closed reduction and external fixation (less invasive but with limitations).
• Casting or splinting (mainly for minor or non-displaced fractures).
• Pros: Non-surgical options are less invasive and carry fewer immediate risks.
• Cons: Non-surgical options may not provide adequate alignment for proper healing, particularly in complex fractures.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Postoperatively, there may be significant pain and swelling, managed with medications. The patient will need to follow strict instructions to avoid weight-bearing and participate in physical therapy. Gradual improvement in pain and function is expected over weeks to months.