Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; with proximal humeral prosthetic replacement
CPT4 code
Name of the Procedure:
Open Treatment of Proximal Humeral Fracture with Proximal Humeral Prosthetic Replacement
Summary
This surgical procedure involves the open treatment of a fracture in the upper part of the humerus (upper arm bone), specifically at the surgical or anatomical neck. It includes the internal fixation of the bone, which may also involve repairing the tuberosities (bony prominences). In addition, it involves the replacement of the proximal humerus with a prosthetic implant.
Purpose
This procedure addresses fractures of the proximal humerus that are severe or complex and cannot be treated effectively with simpler methods like casting or splinting. The goals are to reduce pain, restore anatomy, and improve function of the shoulder by stabilizing the fracture and, if necessary, replacing the fractured part with a prosthetic implant.
Indications
- Severe fractures of the proximal humerus
- Fractures not amenable to non-surgical treatments
- Presence of multiple fractures or comminuted (broken into multiple pieces) fractures
- Cases where blood supply to the bone is compromised
- Elderly patients with osteoporosis
- Failure of previous non-surgical treatments
Preparation
- Fasting for at least 6-8 hours before the procedure
- Medication adjustments, especially if on blood thinners
- Preoperative assessments including X-rays, MRI or CT scans to understand the extent of the fracture
- Physical examination and medical history review
- Meeting with the anesthesia team to discuss anesthesia plan
Procedure Description
- Anesthesia: The patient is given general anesthesia.
- Incision: A surgical cut is made over the shoulder area to access the fractured bone.
- Reduction and Fixation: The fractured bone fragments are aligned (reduced) and held together with surgical hardware such as plates, screws, or pins.
- Tuberosity Repair: If the tuberosities are involved, they are repaired to ensure the rotator cuff muscles can function properly.
- Prosthetic Replacement: In cases where the bone cannot be saved, the proximal part of the humerus is replaced with a prosthetic implant.
- Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes about 2 to 3 hours, depending on the complexity of the fracture.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic Surgeon
- Surgical Assistants
- Anesthesiologist
- Operating Room Nurses
- Surgical Technicians
Risks and Complications
- Infection
- Blood clots
- Nerve damage
- Blood vessel injuries
- Prosthetic device issues
- Stiffness or reduced range of motion
- Pain
- Need for additional surgeries
Benefits
- Reduction in shoulder pain
- Improved shoulder function and range of motion
- Stabilized bone fractures
- Potentially quicker return to daily activities compared to non-surgical treatment
Recovery
- Immediate post-operative physical therapy may be recommended
- Pain management with medications
- Wearing a sling for a few weeks to immobilize the shoulder
- Gradual increase in activity and physical therapy over several months
- Follow-up appointments for X-rays and monitoring of progress
Alternatives
- Non-surgical treatment (casting or splinting)
- Closed reduction and percutaneous pinning
- Hemiarthroplasty (only part of the humeral head is replaced)
- Reverse total shoulder arthroplasty (for severe arthritis or rotator cuff damage)
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, pain and discomfort are managed with medications. Patients can expect some pain, swelling, and bruising around the surgical site, which gradually improves with proper care and physical therapy.
Patients should avoid strenuous activities and follow their surgeon’s instructions carefully to ensure a smooth recovery.