20693 Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])

Name of the Procedure:

Adjustment or Revision of External Fixation System Requiring Anesthesia (e.g., new pin[s] or wire[s] and/or new ring[s] or bar[s])

Summary

This procedure involves making changes or repairs to an external fixation system, which is a frame outside the body used to hold bones in the correct position for healing. This may require the addition or replacement of pins, wires, rings, or bars. Anesthesia is used to ensure the patient is comfortable throughout the procedure.

Purpose

External fixation systems are used to stabilize complex fractures or to correct deformities. The goal of adjustment or revision is to ensure the system continues to function effectively to support bone healing and alignment.

Indications

• Instability or malfunction of the current external fixation system.
• Infection at the pin sites.
• Changes in the alignment of bones requiring repositioning.
• Pain or discomfort due to hardware issues.
• X-ray findings indicating the need for system modification.

Preparation

• The patient might be required to fast for several hours before the procedure.
• Blood tests, imaging studies (like X-rays), and pre-surgical evaluations by the anesthesiologist may be necessary.
• Adjustments to current medications might be needed, particularly blood thinners.

Procedure Description

1. The patient is brought to the operating room or procedural area.
2. Anesthesia is administered, commonly general or regional, depending on the situation.
3. The surgical site is cleaned and sterilized.
4. The surgeon assesses the existing external fixation system and identifies the required adjustments or replacements.
5. New pins, wires, rings, or bars are added or current ones are repositioned or replaced.
6. The system is checked for stability and proper alignment.
7. The area is cleaned and dressings are applied.

Tools and Equipment:

• External fixation components (pins, wires, rings, bars)
• Surgical instruments for fixation adjustments
• Imaging devices like fluoroscopy for real-time guidance

Duration

The procedure typically takes between 1 to 2 hours, but this can vary based on the complexity of the adjustments.

Setting

This procedure can be performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic Surgeons
• Surgical Nurses
• Anesthesiologist
• Radiologic Technologist (if imaging is used)

Risks and Complications

• Infection at the pin or wire sites
• Nerve or blood vessel damage
• Anesthesia-related risks
• Misalignment requiring further correction
• Delayed bone healing
• Hardware failure

Benefits

• Improved stability and alignment of fractured bones
• Reduced pain and discomfort from previous malfunctioning hardware
• Enhanced bone healing and recovery

Recovery

• The patient typically stays for a short observation period post-procedure.
• Pain management will be provided.
• Wound care instructions and hygiene practices for the fixation site.
• Follow-up appointments for monitoring healing and hardware function.
• Activity restrictions and guidelines to ensure proper recovery.

Alternatives

• Internal fixation (plates and screws inside the body)
• Casting or splinting
• Non-surgical management with careful monitoring

Each alternative has its own pros and cons, such as differences in stability, risk of infection, and patient comfort.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, there may be some discomfort or pain at the site which can be managed with pain medications. The patient might experience improved comfort and function as the revised fixation system holds the bones appropriately. Regular follow-up ensures optimal recovery.