Name of the Procedure:

Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation.

Summary

This procedure involves the use of pins or screws to stabilize a fractured tarsal bone in the foot (excluding the talus and calcaneus), allowing the bone to heal properly. The procedure is minimally invasive, with the instruments inserted through small skin punctures.

Purpose

• Medical Condition: Fracture of a tarsal bone other than the talus and calcaneus.
• Goals: The main goal is to realign and stabilize the fractured bone to ensure proper healing and restore normal function to the foot.

Indications

• Severe pain, swelling, and inability to bear weight due to a tarsal bone fracture.
• Displaced fractures that cannot heal properly without surgical intervention.
• Fractures that have failed to heal with conservative treatment (e.g., casting or splinting).

Preparation

• Pre-Procedure Instructions: Patients may need to fast for several hours before the procedure. They might also need to stop taking certain medications (such as blood thinners) as advised by their doctor.
• Diagnostic Tests: Imaging studies such as X-rays, CT scans, or MRI scans to assess the fracture and plan the procedure.

Procedure Description

1. The patient is given regional or general anesthesia to ensure comfort.
2. Small incisions or punctures are made near the fracture site.
3. Using imaging guidance, pins or screws are inserted through the skin and into the bone to stabilize the fracture.
4. The bones are manipulated into the correct alignment.
5. The incision sites are closed, and a sterile bandage is applied.
   • Tools Used: Imaging devices (X-ray, fluoroscopy), pins, and screws.
   • Anesthesia: Usually regional anesthesia or general anesthesia.

Duration

The procedure typically takes about 1-2 hours, depending on the complexity of the fracture.

Setting

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

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (for imaging)

Risks and Complications

• Common: Infection, bleeding, pain at the surgical site.
• Rare: Nerve or blood vessel damage, non-union or malunion of the bone, hardware failure.

Benefits

• Proper alignment and stabilization of the bone, leading to improved healing.
• Reduced pain and quicker recovery compared to non-surgical treatments.
• Restoration of normal function and mobility of the foot.

Recovery

• Post-Procedure Care: Patients may need to keep weight off the foot for several weeks, use crutches, or wear a splint or boot.
• Recovery Time: Generally, 6-8 weeks for initial healing, with physical therapy often required.
• Restrictions: Limited weight-bearing activities and follow-up appointments with the surgeon for monitoring.

Alternatives

• Conservative Management: Casting or splinting without surgery.
• Pros and Cons: Non-surgical options may be less invasive but might result in improper healing if the fracture is severe or displaced.

Patient Experience

• During Procedure: The patient will be under anesthesia and should not feel pain.
• Post-Procedure: Mild to moderate pain that can be managed with medication. Swelling and discomfort expected, with gradual improvement over several weeks.
• Pain Management: Pain medications, ice packs, and elevating the foot can help manage pain and swelling.