Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Distal Tibiofibular Joint (Syndesmosis) Disruption with Internal Fixation
Summary
In layman's terms, this procedure involves surgically opening the area around the ankle joint to repair and stabilize the ligaments between the tibia and fibula bones (syndesmosis). Metal screws or plates are often used to hold the bones in the correct position.
Purpose
This procedure addresses a disruption in the syndesmosis, the fibrous joint between the tibia and fibula near the ankle. The goal is to restore the normal alignment, stability, and function of the ankle joint to prevent chronic pain, instability, and arthritis.
Indications
- Severe ankle sprains where there is a complete disruption of the syndesmosis.
- Fractures involving the distal tibia and fibula with syndesmotic disruption.
- Persistent ankle instability and pain following previous treatments.
Preparation
- Fasting for at least 6-8 hours before surgery.
- Adjustments or cessation of certain medications as directed by your doctor.
- Pre-operative imaging studies like X-rays, CT scans, or MRIs.
- Blood tests and a physical examination to ensure fitness for surgery.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the ankle.
- Exposure: The surgeon exposes the syndesmosis and evaluates the damage.
- Alignment: The tibia and fibula are realigned to their proper positions.
- Fixation: Internal fixation using screws and/or plates is applied to hold the bones in place.
- Closure: The incision is closed with sutures or staples, and a bandage is applied.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or a surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site
- Nerve or blood vessel damage
- Blood clots (deep vein thrombosis)
- Hardware complications (screws or plates causing irritation)
- Malalignment or failure to heal properly, requiring additional surgery
Benefits
Restoration of ankle stability and function. Reduction in pain and avoidance of long-term complications such as arthritis. Most patients can expect significant improvement within a few months, with full benefits realized once the bone and joint have healed completely.
Recovery
- Follow-up appointments to monitor healing.
- Period of non-weight bearing on the affected leg, followed by gradual weight-bearing as guided by your doctor.
- Physical therapy to restore movement and strength.
- Recovery time varies but typically ranges from 2 to 4 months.
Alternatives
- Non-surgical management with casting or bracing (less effective for severe disruptions).
- Minimally invasive procedures, if appropriate.
- Pros and cons should be discussed with your doctor to determine the best treatment plan.
Patient Experience
During the procedure, you will be under anesthesia and should not feel pain. Post-surgery, expect some pain and swelling, managed with medications. Follow-up care will include wound management, activity restrictions, and physical therapy to support your recovery.