28436 Percutaneous skeletal fixation of talus fracture, with manipulation

Name of the Procedure:

Percutaneous Skeletal Fixation of Talus Fracture, with Manipulation
Common name(s): Talus Fracture Fixation, Percutaneous Talus Pinning

Summary

Percutaneous skeletal fixation of a talus fracture is a minimally invasive surgical procedure where the talus bone of the ankle is realigned and stabilized using small pins or screws inserted through the skin. This procedure helps heal the bone and restore ankle function.

Purpose

This procedure addresses fractures of the talus bone, which is crucial for ankle movement and stability. The goal is to properly align the fractured bone to ensure it heals correctly, restore normal ankle function, and prevent long-term complications like arthritis or improper bone healing.

Indications

• Severe pain and swelling in the ankle.
• Inability to bear weight on the affected foot.
• X-ray or CT scan confirming a fracture of the talus.
• Displaced or unstable talus fracture.
• Inadequate response to conservative treatments like rest, ice, and immobilization.

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Discontinue certain medications, like blood thinners, as advised by the doctor.
• Pre-operative imaging (X-rays, CT scans) to assess the fracture.
• Blood tests and routine preoperative evaluation.

Procedure Description

1. The patient is positioned appropriately, and the ankle area is cleaned and sterilized.
2. Anesthesia is administered, typically general or regional anesthesia.
3. Using X-ray or fluoroscopy guidance, small incisions are made through the skin to align the fractured talus bone.
4. Pins or screws are inserted through the incisions to hold the bone fragments in place.
5. The incisions are closed with sutures or adhesive strips, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Radiology technician (for imaging guidance)

Risks and Complications

• Infection at the incision site.
• Nerve or blood vessel damage.
• Incorrect bone healing (malunion or nonunion).
• Deep vein thrombosis (blood clot).
• Hardware-related problems (migration or breakage of pins/screws).
• Postoperative pain or stiffness.

Benefits

• Proper alignment and stabilization of the fractured bone.
• Enhanced healing and faster recovery.
• Improved ankle function and mobility.
• Reduced risk of long-term complications like arthritis.

Recovery

• Immobilization of the ankle with a cast or boot for several weeks.
• Instructions on weight-bearing limitations.
• Follow-up appointments for X-rays and to monitor healing.
• Physical therapy to restore range of motion, strength, and function.
• Full recovery typically takes 3 to 6 months, depending on the fracture severity and patient health.

Alternatives

• Conservative management (rest, ice, immobilization) for less severe fractures.
• Open reduction and internal fixation (ORIF) if the fracture is complex or multiple fragments are involved.
• Each alternative comes with its own risks and benefits; conservative management may be less invasive but slower to heal, while ORIF may provide more stability for complex fractures but involves a larger incision.

Patient Experience

During the procedure, the patient won't feel pain due to anesthesia. Postoperatively, pain and swelling are common but manageable with prescribed pain medication. Discomfort from the immobilization and limited activity should be expected, but physical therapy will help in regaining strength and mobility.