Name of the Procedure:

Percutaneous Skeletal Fixation of Fracture Great Toe, Phalanx or Phalanges, with Manipulation

Summary

Percutaneous skeletal fixation of the great toe involves the use of pins or screws to stabilize a fractured bone within the toe. This procedure is minimally invasive and is performed to ensure proper alignment and healing of the broken bone.

Purpose

This procedure addresses fractures in the great toe that have not healed properly with conservative treatments like casting or splinting. The goal is to provide stability to the bone, allowing it to heal correctly and reducing pain and immobility associated with the fracture.

Indications

• Severe pain and swelling in the great toe
• Visible deformity or misalignment of the toe
• Inability to bear weight on the affected foot
• Nonunion or malunion of a previously treated fracture
• Fractures that are unstable or displaced

Preparation

• Patient might be required to fast for 6-8 hours prior to the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Pre-procedure diagnostic tests such as X-rays or CT scans to assess the fracture's location and severity.
• Discussion with the healthcare provider about any allergies or chronic health conditions.

Procedure Description

1. The patient is given local anesthesia or light sedation to minimize discomfort.
2. The affected toe is cleaned and prepped to maintain a sterile environment.
3. The surgeon makes a small incision near the fracture site.
4. Under imaging guidance, pins or screws are inserted percutaneously (through the skin) to fixate the bone fragments.
5. Manipulation is performed to align the bone fragments correctly.
6. Once the bone is stabilized, the incision is closed and a dressing is applied to the site.

Duration

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

Setting

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

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse or technician
• Radiology technician (if imaging is used)

Risks and Complications

• Infection at the incision site
• Bleeding or blood clots
• Damage to surrounding nerves or blood vessels
• Allergic reaction to anesthesia
• Nonunion or delayed healing of the fracture
• Risks associated with anesthesia

Benefits

• Improved alignment and stabilization of the fractured bone
• Faster and more effective healing
• Reduction in pain and discomfort
• Restoration of normal toe function and mobility

Recovery

• Post-procedure, the patient may need to keep the foot elevated and avoid bearing weight on the affected toe.
• Pain management with prescribed medications.
• Instructions on wound care and signs of infection to watch out for.
• Follow-up appointments to monitor healing progress and remove pins if necessary.
• Physical therapy might be recommended to restore full function.

Alternatives

• Conservative treatment such as casting or splinting, though these may be less effective for unstable fractures.
• Open surgical fixation, which is more invasive but may be necessary for complex fractures.
• Pros and cons should be discussed with a healthcare provider to determine the best option.

Patient Experience

During the procedure, the patient will be sedated or under local anesthesia, so they should feel minimal discomfort. Post-procedure, the patient might experience some pain and swelling, which can be managed with medication and ice packs. Full recovery can range from a few weeks to several months, depending on the severity of the fracture and the patient's overall health.