Name of the Procedure:

Open Treatment of Tarsal Bone Fracture (Except Talus and Calcaneus)

• Common name(s): Open reduction and internal fixation (ORIF) of a tarsal fracture.
• Technical terms: Tarsal bone fracture fixation, open surgical repair of tarsal bones.

Summary

An open treatment of a tarsal bone fracture involves surgically exposing the broken bone (except the talus and calcaneus) and aligning it correctly. The bone is then stabilized using internal fixation devices such as plates, screws, or wires to ensure proper healing.

Purpose

The procedure is performed to properly realign and stabilize fractures of the tarsal bones (excluding the talus and calcaneus). It aims to restore the normal function of the foot, prevent complications, and minimize pain and long-term disability.

Indications

• Fractures that are displaced or unstable.
• Inability to bear weight on the affected foot.
• Severe pain, swelling, and bruising in the midfoot area.
• Failure of non-surgical treatments (e.g., immobilization, casting).
• Health status allowing for surgical intervention.

Preparation

• Fasting typically required for at least 8 hours before surgery.
• Medication adjustments may be needed, especially for blood thinners.
• Pre-operative imaging (X-rays, CT scans) to assess the fracture.
• Blood tests and a general health assessment.
• Consultation with the surgical team and anesthesiologist.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made over the site of the fracture.
3. Exposure: The fractured bone is exposed by carefully moving the surrounding tissues.
4. Realignment: The broken bone fragments are aligned to their proper anatomical positions.
5. Fixation: Internal fixation devices such as screws, plates, or wires are used to stabilize the fracture.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

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

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Non-union or improper healing of the fracture
• Hardware complications (e.g., loosening or breakage)
• Pain or discomfort at the site of fixation

Benefits

• Proper alignment and stabilization of the fracture.
• Reduction in pain and restoration of foot function.
• Prevention of long-term complications such as arthritis or chronic pain.
• Typically, the benefits are realized within a few weeks post-surgery as healing progresses.

Recovery

• Initial immobilization with a cast or brace.
• Pain management with prescribed medications.
• Physical therapy to regain strength and mobility.
• Weight-bearing restrictions usually for 6-8 weeks, as advised by the surgeon.
• Follow-up appointments to monitor healing and adjust treatment as necessary.

Alternatives

• Non-surgical treatments like casting or splinting.
• External fixation (pins connected to an external support frame).
• Each alternative has its pros and cons, such as longer immobilization times or lower likelihood of perfect bone alignment as compared to ORIF.

Patient Experience

• During the procedure: Patient will be under general anesthesia and should not experience pain or discomfort.
• After the procedure: Some pain and swelling are normal, managed with medications and ice application.
• Mobility aids (crutches or walker) might be needed during the initial recovery period.
• Gradual return to normal activities with physical therapy guidance.

Note: Always consult with your healthcare provider for personalized medical advice.