Name of the Procedure:

Repair, nonunion or malunion; tarsal bones
Common name(s): Tarsal bone repair, Tarsal nonunion/malunion surgery

Summary

Tarsal bone repair surgery involves correcting bone abnormalities in the tarsal bones of the foot. This procedure addresses improper healing either not achieved union (nonunion) or healed improperly (malunion) after a fracture or injury.

Purpose

This procedure specifically targets problems with the tarsal bones of the foot that are not healing correctly after a fracture. The goals are to alleviate pain, restore proper bone alignment and function, and improve mobility.

Indications

• Persistent pain or discomfort in the foot
• Visible deformity or change in shape of the foot
• Difficulty walking or bearing weight
• Failure of the tarsal bones to heal properly after a previous injury or surgery
• Diagnosis of nonunion or malunion through imaging studies

Preparation

• Pre-procedure fasting for at least 8 hours if general anesthesia will be used
• Discontinuation of certain medications as advised by the doctor
• Blood tests, imaging studies (X-rays, CT scans, MRI) to assess the condition of the tarsal bones
• Physical examination and medical history review

Procedure Description

1. Anesthesia: The patient is administered either general or regional anesthesia.
2. Incision: A surgical cut is made over the affected area of the foot.
3. Bone Realignment: The surgeon realigns the tarsal bones to their proper positions using surgical tools.
4. Fixation: Metal plates, screws, or pins may be used to hold the bones in place.
5. Bone Grafting: In some cases, a bone graft may be placed to facilitate healing.
6. Closure: The incision is closed using sutures or staples, and the area is bandaged.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Injury to surrounding nerves or blood vessels
• Nonunion or malunion recurrence
• Post-surgical pain or stiffness
• Adverse reaction to anesthesia

Benefits

• Relief from pain and discomfort
• Improved foot function and mobility
• Correction of bone deformity
• Enhanced quality of life, with benefits typically realized within several months post-surgery

Recovery

• Initial recovery in a hospital setting, followed by ambulatory care
• Use of crutches or a walker to avoid putting weight on the affected foot
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility in the foot
• Follow-up appointments to monitor healing and remove any surgical hardware if necessary
• Full recovery may take several months

Alternatives

• Non-surgical management with physical therapy and orthotic devices
• Pain management strategies such as medications and injections
• Pros: Non-invasive, lower risk
• Cons: May not correct the bone deformity or fully alleviate symptoms

Patient Experience

The patient will be under anesthesia during the procedure, so no pain will be felt. Post-operatively, they can expect pain and swelling, managed with medications. There will be limited mobility, and they will need to follow specific care instructions to ensure proper healing. Physical therapy will be critical for a successful recovery.