Open Treatment of Tarsal Bone Dislocation, Includes Internal Fixation, When Performed

Name of the Procedure:

• Common Name: Open Reduction and Internal Fixation (ORIF) of Tarsal Bone Dislocation
• Technical Term: ORIF of Tarsal Dislocation

Summary

The open treatment of tarsal bone dislocation with internal fixation is a surgical procedure to realign and stabilize dislocated bones in the tarsal region (midfoot). In this procedure, the surgeon uses surgical hardware, such as screws or plates, to hold the bones in place during healing.

Purpose

• Medical Condition: This procedure addresses dislocations of the tarsal bones, which can occur due to trauma or injury.
• Goals: The primary objectives are to realign the dislocated bones, stabilize the affected area, alleviate pain, and restore function and mobility to the foot.

Indications

• Severe pain and swelling in the midfoot
• Visible deformity or inability to bear weight on the foot
• Confirmed tarsal bone dislocation through imaging (e.g., X-ray, CT scan)
• Failure of non-surgical treatments to provide relief

Preparation

• Pre-procedure Instructions: Patients may be advised to fast for several hours before surgery. Adjustments to medications, particularly blood thinners, may be necessary.
• Diagnostic Tests: Imaging studies like X-rays, CT scans, or MRIs are typically performed to assess the extent of the dislocation and plan the surgery.

Procedure Description

1. Anesthesia: The patient is given general or regional anesthesia to ensure they are pain-free during the procedure.
2. Incision: The surgeon makes an incision over the affected area to access the dislocated bones.
3. Reduction: The bones are carefully realigned to their proper anatomical positions.
4. Internal Fixation: Surgical hardware (screws, plates) is used to secure the bones in place.
5. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the dislocation and the patient's overall health.

Setting

The surgery is generally performed in a hospital's operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Hardware irritation or failure
• Limited range of motion or stiffness
• Non-union or delayed healing of the bones

Benefits

• Realignment and stabilization of the affected tarsal bones
• Reduction of pain and swelling
• Improved foot function and mobility
• Increased likelihood of a full recovery with a return to pre-injury activities

Recovery

• Post-procedure Care: Keep the surgical site clean and dry. Follow instructions on wound care and medication.
• Recovery Time: Initial recovery may take 6 to 8 weeks. Full recovery, including physical therapy, may take several months.
• Restrictions: Avoid weight-bearing activities initially; follow up with regular appointments to monitor healing.

Alternatives

• Non-surgical Treatments: Closed reduction, casting, or splinting may be options for less severe dislocations but may not be as effective for severe cases.
• Pros and Cons: Non-surgical methods may have fewer immediate risks but could result in improper healing or prolonged symptoms.

Patient Experience

• During Procedure: With proper anesthesia, the patient should not feel pain during surgery.
• After Procedure: Pain and discomfort are expected post-surgery, managed with prescribed pain medications. Swelling and bruising are common. Physical therapy will help in regaining strength and mobility.