Name of the Procedure:

• Common Name: Pre-Tibial Shell Addition
• Technical/Medical Term: Addition to Lower Extremity, Pre-Tibial Shell, Molded to Patient Model (HCPCS L2340)

Summary

The procedure involves adding a pre-tibial shell, a supportive brace, to the lower extremity. This shell is custom-molded to fit the patient's specific anatomical contours, providing targeted support to the shin area to improve stability and function.

Purpose

• Conditions Addressed: It is typically used for conditions such as shin splints, stress fractures, or chronic lower leg pain that require immobilization or stabilization.
• Goals: The primary aim is to alleviate pain, improve mobility, and prevent further injury by providing precise support to the lower leg.

Indications

• Symptoms: Persistent lower leg pain, recurrent shin splints, stress fractures, or instability in the lower extremity.
• Criteria: Patients with diagnosed conditions affecting the shin who have not responded adequately to other treatments, or who require additional support to prevent further complications.

Preparation

• Instructions: Patients may need to cease certain medications that impact bleeding or swelling. It's vital to keep the skin clean and dry before the procedure.
• Diagnostic Tests: X-rays, MRIs, or other imaging studies to accurately diagnose the condition and plan the mold.

Procedure Description

1. Initial Assessment: A thorough examination and possibly a scan of the leg to determine the precise shape and size of the shell.
2. Mold Creation: A cast or digital scan is used to create a model of the patient’s leg.
3. Shell Fabrication: The model is sent to a specialized lab where the pre-tibial shell is custom-made.
4. Fitting: The shell is fitted to ensure it conforms perfectly to the patient’s anatomy. Adjustments are made as necessary.
5. Instructions: Patient receives guidelines on how to wear, adjust, and clean the shell.

• Tools/Equipment: Casting materials, digital scanners, fabrication tools.
• Anesthesia: Typically, no anesthesia is needed; the procedure is non-invasive.

Duration

The entire process, from mold creation to final fitting, generally takes several days to weeks. Each fitting session is typically 30 minutes to an hour.

Setting

It is usually performed in outpatient orthopedic clinics or specialized prosthetic and orthotic centers.

Personnel

• Orthopedists or orthopedic surgeons
• Prosthetists or orthotists
• Nurses or medical assistants

Risks and Complications

• Common Risks: Skin irritation, discomfort, improper fit requiring readjustment.
• Rare Risks: Allergic reactions to materials, pressure sores, or long-term dependency on the orthotic device.

Benefits

• Expected Benefits: Relief from pain, improved stability, and potentially enhanced mobility.
• Realization: Benefits are often realized immediately after fitting, with continual improvement as adjustments are made based on usage.

Recovery

• Post-Procedure Care: Regular check-ups to monitor the fit and function. Keeping the skin under the shell clean and dry.
• Recovery Time: Immediate functional improvements with full recovery dependent on the underlying condition. Restrictions on activities might be advised.

Alternatives

• Other Options: Rest and physical therapy, medication for pain management, alternative orthotics, or surgical intervention.
• Pros and Cons: Alternatives like medication and rest may be less effective in providing immediate support, whereas surgery carries higher risks and recovery time compared to the orthotic solution.

Patient Experience

• During the Procedure: Minimal discomfort during mold creation and fitting.
• After the Procedure: Initial adjustment period where slight discomfort may occur. Pain management usually involves over-the-counter medication. Daily activities might need modification to accommodate the new device. Regular follow-ups ensure proper adjustment and fit.