20650 Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)

Name of the Procedure:

Insertion of Wire or Pin with Application of Skeletal Traction, Including Removal
Common names: Skeletal Traction, Wire or Pin Traction

Summary

This procedure involves inserting a wire or pin into a bone to apply skeletal traction, which helps to align and stabilize broken bones. The procedure also includes the removal of the wire or pin once the treatment is complete.

Purpose

Medical Condition/Problem: Used to treat severe bone fractures, especially in cases where a stable and prolonged alignment is needed.
Goals/Outcomes: The procedure aims to properly align and stabilize the fractured bone, promote healing, and reduce pain.

Indications

Specific Symptoms/Conditions: Severe fractures in long bones (like the femur or tibia), complex bone fractures, displaced fractures.
Patient Criteria: Patients requiring prolonged stabilization, those who cannot undergo immediate surgical repair, or in whom other methods (like casting or external fixation) are not sufficient.

Preparation

• Pre-Procedure Instructions: Fasting (if general anesthesia is used), medication adjustments as advised by the doctor.
• Diagnostic Tests: X-rays, MRI, or CT scans to assess the extent of the fracture. Pre-anesthetic evaluation if required.

Procedure Description

• Step-by-Step Explanation:
  1. Administration of anesthesia (local, regional, or general).
  2. Cleaning and sterilization of the area where the pin or wire will be inserted.
  3. Insertion of the pin or wire into the bone using specialized surgical instruments.
  4. Application of the traction device to the pin or wire to align the bone.
  5. Continuous monitoring and adjustment of the traction as needed.
  6. Removal of the pin or wire once the bone has sufficiently healed, typically done in a similar procedural setting.
• Tools/Equipment: Traction weights and pulleys, pins or wires, surgical drill, sterilization equipment.
• Anesthesia: Local, regional, or general anesthesia based on the extent and location of the fracture.

Duration

The insertion procedure typically takes about 1-2 hours. The duration of traction application can range from a few weeks to several months, depending on the fracture severity and healing process.

Setting

Typically performed in a hospital setting, including the operating room for insertion and removal.

Personnel

A team usually consisting of an orthopedic surgeon, anesthesiologist, surgical nurses, and radiologic technologists.

Risks and Complications

• Common Risks: Infection at the pin site, pain at the insertion site.
• Rare Risks: Nerve or vessel damage, delayed bone healing, non-union of the fracture.
• Management: Antibiotics for infection, pain management protocols, monitoring for complications.

Benefits

• Expected Benefits: Proper alignment and stabilization of the fracture, accelerated healing, reduced pain.
• Timeline: Benefits realized gradually over the healing period, with noticeable improvements often within weeks to a few months.

Recovery

• Post-Procedure Care: Regular cleaning of the pin site, monitoring for signs of infection, following weight-bearing restrictions.
• Recovery Time: Varies but generally several weeks to months. Regular follow-up appointments to adjust traction and assess healing.

Alternatives

• Other Treatments: Casting, external fixation, surgical internal fixation with plates and screws.
• Pros and Cons: Alternatives may offer less invasiveness (casting) or quicker function (surgery), but may not provide the precise alignment and stability needed for certain fractures.

Patient Experience

• During Procedure: Patients may feel pressure or discomfort during pin insertion if local anesthesia is used; general anesthesia would prevent awareness of the procedure.
• After Procedure: Mild to moderate pain at the pin site, managed with pain medications. Discomfort from traction weights but usually well-tolerated.
• Pain Management: Regular pain medications, possible use of ice packs, and careful monitoring for any severe discomfort.