Name of the Procedure:

Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Cast Orthosis, Custom Fabricated (HCPCS Code: L2108)

Summary

This procedure involves creating a custom-made brace designed to immobilize and support an ankle and foot that has been fractured, particularly when the tibia (shinbone) is also involved. The orthosis is fabricated specifically for the patient’s anatomy to ensure optimal healing and comfort.

Purpose

Medical Conditions:

• Ankle fractures
• Foot fractures
• Tibial fractures

Goals:

• Stabilize the fractured bones
• Facilitate proper bone alignment and healing
• Prevent further injury
• Improve mobility and comfort during the healing process

Indications

Specific Symptoms/Conditions:

• Acute or chronic ankle and/or foot fractures
• Tibial fractures
• Conditions warranting stabilization for proper healing

Patient Criteria:

• Patients with fractures in the ankle, foot, or tibia requiring immobilization
• Patients needing customized orthotic support for effective fracture management

Preparation

Pre-Procedure Instructions:

• No special fasting or medication adjustments typically required.
• Initial evaluation of the fracture via X-rays or other imaging techniques.
• Consultation with an orthopedic specialist to determine the need for the custom orthosis.

Procedure Description

Steps:

1. Assessment: A thorough examination to assess the fracture and measure the affected area.
2. Impression: The healthcare provider takes an impression or digital scan of the ankle, foot, and lower leg.
3. Fabrication: The custom orthosis is manufactured based on the patient's measurements and specific fracture characteristics.
4. Fitting: The orthosis is fitted and adjusted for comfort and effectiveness.
5. Instruction: The patient is educated on how to wear and care for the orthosis.

Tools and Equipment:

• Casting materials or digital scanners for impressions
• Orthotic fabrication materials (plastic, foam padding, straps)

Anesthesia:

• Not typically required for the orthotic fitting process.

Duration

• The fitting process typically takes about 1-2 hours, including the assessment, measurement, and initial fitting.
• The actual fabrication of the custom orthosis may take several days.

Setting

• Outpatient clinic
• Orthopedic specialist's office

Personnel

• Orthopedic specialist
• Orthotist (a specialist in the design and fitting of orthopedic braces)

Risks and Complications

Common Risks:

• Skin irritation or pressure sores
• Discomfort from improper fit

Rare Risks:

• Allergic reactions to materials

Management:

• Regular follow-up appointments to adjust fit and address any issues.
• Immediate consultation if skin irritation or significant discomfort occurs.

Benefits

Expected Benefits:

• Proper bone healing and alignment
• Increased mobility and reduced pain during recovery
• Prevention of further injury

Timeline:

• Benefits are typically realized within a few days to weeks as the orthosis aids in stabilization and healing.

Recovery

Post-Procedure Care:

• Regular monitoring and adjustments as needed.
• Wearing the orthosis as prescribed.
• Keeping the orthosis clean and dry.

Expected Recovery Time:

• Varies depending on the severity of the fracture; typically, 6-8 weeks for uncomplicated fractures.

Restrictions:

• Avoid weight-bearing activities unless approved by the healthcare provider.
• Follow-up appointments to monitor healing progress.

Alternatives

Other Options:

• Traditional plaster or fiberglass casts
• Prefabricated ankle-foot orthoses

Comparison:

• Custom-fabricated orthoses provide a personalized fit and better comfort.
• Traditional casts may be less expensive but are often bulkier and less comfortable.

Patient Experience

During the Procedure:

• Comfort during the assessment and impression; no significant pain as the procedure is non-invasive.

After the Procedure:

• Some initial discomfort as the patient adjusts to wearing the orthosis.
• Regular adjustments might be needed to ensure a proper fit.
• Pain management with over-the-counter medications if needed.