Name of the Procedure:

Open Treatment of Talotarsal Joint Dislocation (includes internal fixation)
Common Name: Surgical repair of talotarsal dislocation

Summary

The open treatment of talotarsal joint dislocation is a surgical procedure to correct the displacement of the bones in the talotarsal joint, usually involving the use of internal fixation devices like screws or plates to hold the bones in their proper position.

Purpose

This procedure is designed to address dislocations of the talotarsal joint, which connects the ankle to the foot. The aim is to alleviate pain, restore proper alignment and function, prevent future dislocations, and allow for normal movement and weight-bearing activity.

Indications

• Severe pain and swelling in the ankle and foot.
• Visible deformity of the ankle or foot.
• Inability to bear weight on the affected foot.
• Failure of conservative treatments like casting or bracing.
• Traumatic injuries causing joint dislocation.

Preparation

• Patients may need to fast for 6-8 hours before the surgery.
• Adjustments to medications (e.g., blood thinners) as advised by the doctor.
• Pre-operative imaging studies, such as X-rays or MRI, to assess the extent of the dislocation.

Procedure Description

1. Anesthesia: The patient is given either general anesthesia or regional anesthesia to numb the lower extremity.
2. Incision: A surgical incision is made over the affected area to access the talotarsal joint.
3. Realignment: The dislocated bones are carefully manipulated back into their correct positions.
4. Internal Fixation: Screws, plates, or other internal fixation devices are used to stabilize the bones and ensure they stay in place during healing.
5. 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 dislocation and the extent of internal fixation required.

Setting

This procedure is usually performed in a hospital or a surgical center with appropriate orthopedic surgical facilities.

Personnel

• Orthopedic Surgeon
• Surgical Nurses
• Anesthesiologist
• Operating Room Technicians

Risks and Complications

• Infection at the surgical site.
• Nerve damage or numbing sensations.
• Blood clots in the legs or lungs.
• Loosening or failure of the internal fixation hardware.
• Long-term stiffness or reduced range of motion.

Benefits

• Pain relief and improved function of the foot and ankle.
• Restoration of proper bone alignment.
• Prevention of further dislocations.
• Increased stability and ability to bear weight.

Recovery

• Post-surgery, patients may need to keep weight off the affected foot using crutches or a walker.
• Pain management with prescribed medications.
• Physical therapy to regain strength and mobility.
• Follow-up appointments to monitor healing and potentially remove hardware.
• Full recovery may take several months, with specific activity restrictions advised by the surgeon.

Alternatives

• Non-surgical management (e.g., casting or bracing), though generally less effective for severe dislocations.
• Arthroscopic surgery, which is less invasive but might not be suitable for complex dislocations.
• Each alternative has its pros and cons, typically offering varying degrees of recovery time, effectiveness, and risks.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, there might be discomfort and pain, especially for the first few days, which can be managed with medication. Patients may feel some stiffness or restricted movement that improves with physical therapy. Being prepared for a gradual recovery process can help manage expectations and improve outcomes.