28405 Closed treatment of calcaneal fracture; with manipulation

Name of the Procedure:

Closed Treatment of Calcaneal Fracture with Manipulation
Common Names: Non-surgical treatment of heel bone fracture, Closed calcaneal fracture reduction

Summary

This procedure involves treating a fracture of the heel bone (calcaneus) without making any surgical incisions. Manipulation is performed to realign the broken bone pieces back to their normal position.

Purpose

Condition Addressed: Calcaneal (heel bone) fractures
Goals/Outcomes: To realign the fractured bone, restore foot functionality, and promote effective healing while minimizing pain.

Indications

Symptoms/Conditions: Severe heel pain, swelling, bruising, inability to bear weight on the affected foot, and noticeable deformity post-injury.
Patient Criteria: Suitable for patients with non-displaced or minimally displaced fractures, those with contraindications to surgery, or those preferring a non-surgical treatment.

Preparation

Pre-procedure Instructions:

• Avoid eating or drinking if sedation is planned.
• Stop certain medications as advised by the doctor.
• Wear loose, comfortable clothing to access the injured foot easily.

Diagnostic Tests/Assessments:

• X-rays or CT scans to determine the extent and location of the fracture.
• Medical history review and physical examination.

Procedure Description

1. Initial Assessment: The healthcare provider reviews diagnostic images and assesses the injury.
2. Anesthesia/Sedation: Local anesthesia or conscious sedation may be administered to minimize discomfort.
3. Manipulation: The physician carefully manipulates the foot to realign the bone fragments.

4. Immobilization: Once aligned, the foot is immobilized using a cast, splint, or brace to maintain the position.

   Tools/Equipment: X-ray machine, cast materials, splints, or braces.

Duration

Typically takes about 30 minutes to 1 hour.

Setting

Performed in a hospital emergency room, outpatient clinic, or orthopedic surgical center.

Personnel

Healthcare Professionals Involved: Orthopedic surgeon or specialist, nurses, radiology technician, anesthesiologist (if sedation is used).

Risks and Complications

Common Risks: Pain, swelling, bruising, and discomfort during manipulation.
Rare Risks: Improper bone alignment necessitating surgical intervention, nerve or blood vessel damage, and delayed healing.

Benefits

Expected Benefits: Effective realignment of the fracture, reduced pain, and restored foot function.
Timeline: Immediate alleviation of severe symptoms, with gradual healing over weeks to months.

Recovery

Post-procedure Care:

• Elevate the foot and apply ice to reduce swelling.
• Keep the immobilization device dry and clean.
• Follow weight-bearing restrictions as instructed.
• Attend follow-up appointments for X-rays and progress checks.

Expected Recovery Time: 6 to 12 weeks, depending on the fracture severity.
Restrictions: Limited weight-bearing activities; avoid strenuous activities until cleared by the doctor.

Alternatives

Other Treatment Options:

• Surgical Treatment: Open reduction and internal fixation (ORIF) for severe cases.
• Pros: Potentially better alignment and quicker recovery for complex fractures.
• Cons: Increased surgical risk, longer initial recovery, and potential for complications.

Patient Experience

During the Procedure: Patients may feel pressure and brief discomfort during manipulation. Sedation will minimize pain and anxiety.
After the Procedure: Pain and swelling can be managed with medications and rest. Comfort measures include elevation and ice application.