Name of the Procedure:

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), with internal fixation, of both tibia and fibula.

Summary

This surgical procedure involves the open treatment of a fracture in the weight-bearing portion of the distal tibia, specifically targeting the pilon or tibial plafond area. The procedure also addresses fractures of the fibula, and involves aligning and stabilizing the bones using internal fixation devices such as screws, plates, or rods.

Purpose

The purpose of this procedure is to repair fractures in the distal tibia and fibula, specifically in the weight-bearing area of the ankle. The goal is to restore proper alignment and function to the ankle joint, promote healing, and prevent long-term complications such as arthritis.

Indications

• Severe fractures of the distal tibia and fibula, particularly in the weight-bearing articular portion.
• Displaced fractures that cannot be aligned through closed reduction.
• Patients experiencing significant pain, swelling, and inability to bear weight on the affected leg.

Preparation

• Patients may be advised to fast for several hours before surgery.
• Medication adjustments may be necessary, particularly for blood thinners.
• Diagnostic tests such as X-rays, CT scans, or MRI may be conducted to assess the extent of the fracture.

Procedure Description

1. Anesthesia and Sedation: General anesthesia is typically administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made over the fractured area to expose the bones.
3. Fracture Reduction: The fractured bones are aligned correctly.
4. Internal Fixation: Metal plates, screws, or rods are used to secure the bones in their proper position.
5. Closure: The incision is closed with sutures or staples.
6. Bandaging and Immobilization: The area is bandaged, and a splint or cast may be applied to immobilize the leg.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Nerve damage
• Blood clots
• Non-union or malunion of the bones
• Compartment syndrome
• Arthritis development in the ankle joint

Benefits

• Proper alignment and stabilization of the bones
• Improved healing and restoration of function
• Reduced pain and improved ability to bear weight on the leg
• Prevention of long-term complications

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Pain management includes medications and possibly ice therapy.
• Physical therapy may be recommended to help regain strength and mobility.
• Full recovery can take several months, with weight-bearing restrictions and follow-up appointments for monitoring progress.

Alternatives

• Closed reduction and external fixation.
• Conservative treatment with immobilization such as casting.
• Pros and cons: Alternatives may be less invasive but might not provide the same level of fracture stability and proper alignment, potentially leading to longer recovery times and higher risk of complications.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel pain.
• Post-surgery pain and swelling are common, managed with medications.
• Patients may need assistance with mobility and daily activities initially.
• Rehabilitation activities will help improve recovery and restore function.