20696 Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of

Name of the Procedure:

Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (e.g., spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s).

Summary

This procedure involves attaching a device to a bone using pins or wires that are inserted in multiple planes. The device, referred to as an external fixator, is adjusted with the help of computer technology to ensure precise alignment and correction of bone deformities. Imaging techniques are used to aid in the initial and subsequent adjustments, assessments, and computations.

Purpose

The procedure is designed to correct complex bone deformities, stabilize fractures, and aid in bone lengthening or reconstruction. The expected outcome is the proper alignment of the bone, allowing for normal function and movement.

Indications

• Severe bone fractures
• Bone deformities or malunions
• Limb length discrepancies
• Complicated orthopedic trauma
• Conditions that require precise bone alignment for healing

Preparation

• Fasting for a certain period before the procedure, usually required if general anesthesia is to be used.
• Adjustments to certain medications, especially blood thinners.
• Pre-operative imaging studies (e.g., X-rays, CT scans) to plan the procedure.
• Routine blood tests and a physical examination.

Procedure Description

1. Anesthesia: The procedure typically begins with the administration of general or regional anesthesia.
2. Pin/Wire Insertion: Multiple pins or wires are surgically inserted into the bone in different planes.
3. Fixator Application: An external fixator is attached to the pins or wires.
4. Initial Alignment: Stereotactic computer-assisted technology is used to adjust the fixator for initial alignment.
5. Imaging: Various imaging techniques (X-rays, CT scans) are used to confirm correct alignment.
6. Adjustments: Based on imaging results and computer calculations, the fixator is adjusted for precise bone correction.
7. Follow-up: Subsequent alignments, assessments, and computations as required.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

This procedure is performed in a hospital setting, usually in an operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technicians

Risks and Complications

• Infection at the pin/wire insertion sites
• Nerve or blood vessel damage
• Pain and discomfort
• Potential for incomplete bone correction
• Hardware failure or loosening
• Blood clots

Benefits

• Precise correction of bone deformities or fractures
• Improved bone stability and alignment
• Facilitation of bone healing and remodeling
• Enhanced limb function and mobility
• Expected benefits may be realized within weeks to months, depending on healing.

Recovery

• Post-operative pain management with medications
• Regular cleaning of pin/wire sites to prevent infection
• Physical therapy to regain movement and strength
• Regular follow-up visits for imaging and adjustments
• Recovery time varies, typically from a few weeks to several months.

Alternatives

• Internal fixation (plates, screws)
• Casting or splinting
• Non-surgical methods (bracing, physical therapy)
• Each alternative has its own pros and cons, with internal fixation being less visible but possibly involving more extensive surgery.

Patient Experience

• Anesthesia will prevent pain during the procedure.
• Expect discomfort and soreness at the pin/wire sites post-surgery.
• Pain management will include medications and possibly nerve blocks.
• Patients may need crutches or a wheelchair during recovery.
• Emotional and psychological support may be beneficial for dealing with the visual and physical aspects of the external fixator.