Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)
CPT4 code
Name of the Procedure:
Application of a Multiplane (pins or wires in more than 1 plane), Unilateral, External Fixation System (e.g., Ilizarov, Monticelli type)
Summary
This procedure involves using an external fixation system, which consists of metal pins or wires inserted into the bone and connected externally to stabilize and support bone structures. It's commonly used for complex fractures, limb lengthening, or correcting deformities.
Purpose
The external fixation system is mainly used to stabilize severe bone fractures, correct bone deformities, or facilitate limb lengthening. The goal is to ensure proper bone alignment and healing, often in situations where traditional casting or internal fixation is unsuitable.
Indications
- Complex or open fractures
- Bone deformities requiring correction
- Limb length discrepancies
- Non-union or delayed union of fractures
- Severe soft tissue damage around fractures
Preparation
- Fasting is usually required if general anesthesia will be used.
- Patients may need to stop certain medications, such as blood thinners, according to their doctor's advice.
- Pre-procedure diagnostic tests may include X-rays, CT scans, or MRIs to assess bone structure and plan the fixation.
Procedure Description
- Anesthesia is administered (general or local, based on the case).
- The skin is cleaned and sterilized.
- Pins or wires are inserted into the bone through small skin incisions, typically in more than one plane for added stability.
- An external frame is attached to the pins or wires outside the body to hold the bones in the correct position.
Adjustments may be made over time to ensure proper alignment and healing.
Tools include:
- Kirschner wires (K-wires)
- Schanz screws
- External fixation frame components (e.g., Ilizarov or Monticelli type)
Anesthesia can be either local, regional, or general, depending on the procedure complexity and patient condition.
Duration
The procedure typically takes between 1 to 3 hours, depending on the severity of the case.
Setting
This procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Radiologic technician (if intraoperative imaging is needed)
Risks and Complications
- Infection at the pin or wire sites
- Nerve or blood vessel damage
- Delayed bone healing or nonunion
- Joint stiffness or restricted movement
- Irritation or discomfort from the external frame
Benefits
- Effective stabilization for complex fractures
- Possibility to adjust alignment during healing
- Can treat conditions that may not be manageable with internal fixation alone
- Promotes proper bone healing and alignment
Recovery
- Pain and discomfort management with prescribed medications.
- Routine cleaning and care of pin or wire insertion sites to prevent infection.
- Physical therapy may be needed to restore movement and strength.
- Follow-up appointments to monitor bone healing with imaging studies.
- Recovery time varies depending on the condition but generally ranges from a few weeks to several months.
Alternatives
- Internal fixation with plates and screws
- Cast immobilization
- Intramedullary nailing
- Conservative management for less severe cases
Pros: Less bulky, potentially fewer risk of infection compared to internal hardware. Cons: May not be suitable for all types of fractures or deformities.
Patient Experience
During the procedure, patients under general anesthesia will not feel anything. If local or regional anesthesia is used, they may feel some pressure but should not experience significant pain. Post-procedure, there will be some discomfort or pain managed by medications. The external frame may feel cumbersome but is crucial for the healing process. Regular follow-ups will be necessary to adjust the frame and monitor healing progress.