Name of the Procedure:

Closed Treatment of Metatarsal Fracture with Manipulation

Summary

A closed treatment of a metatarsal fracture with manipulation involves realigning the broken bones in the foot back into place without making any surgical incisions. The process typically involves manually adjusting the bones through the skin, then immobilizing the foot to ensure proper healing.

Purpose

This procedure addresses fractures of the metatarsal bones in the foot. The primary goal is to realign the broken bones, promote proper healing, and restore normal foot function, while minimizing the risks and complications associated with surgical intervention.

Indications

• Pain, swelling, and bruising localized to the foot area.
• Visible deformity or inability to bear weight on the affected foot.
• X-ray evidence of a metatarsal fracture.

Preparation

• Avoid eating or drinking for several hours before the procedure if general anesthesia or heavy sedation is planned.
• Inform the healthcare provider of all current medications and any known allergies.
• Undergo an X-ray or other imaging tests to assess the fracture.

Procedure Description

1. Preparation: Patient is prepped and positioned for the procedure. Local or regional anesthesia is administered to numb the affected area.
2. Manipulation: The healthcare provider manually adjusts the fractured bones to their normal positions through the skin.
3. Imaging Confirmation: X-rays are often taken to confirm the bones are properly aligned.
4. Immobilization: The foot is immobilized using a cast, splint, or boot to maintain the position of the bones and facilitate healing.

Tools include bandages, splints, adhesive tape, and imaging equipment. Local anesthesia is commonly used to minimize discomfort.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the fracture.

Setting

Usually performed in an outpatient clinic, emergency room, or a dedicated surgical center.

Personnel

• Orthopedic surgeon or trained physician.
• Nurse or medical assistant.
• Radiologist or radiologic technologist for imaging.

Risks and Complications

• Pain during or after the manipulation.
• Swelling or bruising.
• Improper bone alignment, possibly necessitating surgical intervention.
• Compartment syndrome (rare but serious condition).
• Delayed healing or non-union of the fracture.

Benefits

• Non-invasive compared to surgical options.
• Stable alignment of the bones without the need for incisions.
• Quicker recovery time with fewer complications associated with surgical wounds.
• Restoration of proper foot function.

Recovery

• Keep the foot elevated and avoid putting weight on it initially.
• Pain management with prescribed medications.
• Follow-up appointments for progress assessment and potential cast adjustments.
• Limited weight-bearing activity for several weeks, typically followed by physical therapy.

Alternatives

• Surgical intervention: Open reduction and internal fixation for severe cases.
  • Pros: More precise alignment, faster stabilization.
  • Cons: Surgical risks, longer recovery time.
• Conservative treatment: Simple casting without manipulation for minor fractures.
  • Pros: Least invasive, minimal risk.
  • Cons: Potential for improper alignment, longer healing time.

Patient Experience

Patients may feel some discomfort during manipulation, with appropriate anesthesia minimizing pain. Post-procedure, pain and swelling can be managed with medications and rest. The initial immobilization may feel restrictive, but it is essential for proper healing. Regular follow-ups ensure the bones are healing correctly.