Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed
CPT4 code
Name of the Procedure:
Open Treatment of Proximal Humeral (Surgical or Anatomical Neck) Fracture
Summary
The open treatment of a proximal humeral fracture involves surgically repairing a broken upper arm bone. This often includes internal fixation to stabilize the bone and may involve the repair of the surrounding shoulder muscles and tendons.
Purpose
This procedure is done to treat fractures near the top of the humerus (upper arm bone), particularly around the neck of the bone. The goal is to realign and stabilize the bone to promote proper healing and restore functionality to the shoulder and arm.
Indications
- Severe pain and inability to move the arm due to a humeral fracture.
- X-ray or imaging confirming a fracture near the proximal humerus.
- The fracture is displaced or involves multiple broken pieces.
- Non-surgical treatments are inadequate or inappropriate.
Preparation
- Patient may need to fast for a certain period before surgery.
- Adjustments to medications, particularly blood thinners, may be required.
- Preoperative imaging studies such as X-rays or CT scans.
- Preoperative assessments to evaluate overall health and surgical risk.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made over the shoulder area to expose the fracture.
- The broken bone ends are aligned (reduced) anatomically.
- Internal fixation devices such as plates, screws, or rods are used to secure the bone.
- If the rotator cuff or other tendons are injured, they are repaired.
- The wound is closed with sutures or staples, and a dressing is applied.
Duration
The procedure typically takes 1 to 3 hours, depending on complexity.
Setting
The procedure is performed in a hospital's operating room or a dedicated surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Infection at the surgical site
- Bleeding or blood clots
- Nerve or blood vessel damage
- Nonunion or poor healing of the bone
- Complications related to anesthesia
Benefits
- Proper alignment and stabilization of the fracture.
- Improved chances of restoring full functionality.
- Reduced pain after recovery.
- Prevention of long-term deformity or shoulder dysfunction.
Recovery
- Pain management with medications.
- The arm may be immobilized in a sling or brace initially.
- Physical therapy may be required to restore movement and strength.
- Full recovery can take several months, with follow-up appointments to monitor healing.
Alternatives
- Non-surgical treatments like arm slings, physical therapy, or closed reduction.
- Pros: Less invasive, lower immediate risk.
- Cons: Higher risk of improper healing, longer immobilization, potentially less effective for severe fractures.
Patient Experience
Patients will likely experience surgical pain initially, managed with medication. During recovery, they may need help with daily tasks and should avoid heavy lifting or strenuous activities until cleared by their doctor. Physical therapy will aid in regaining mobility and strength.