24400 Osteotomy, humerus, with or without internal fixation

Name of the Procedure:

Osteotomy, humerus, with or without internal fixation
Common name(s): Humeral Osteotomy, Corrective Osteotomy of the Humerus

Summary

An osteotomy of the humerus is a surgical procedure that involves cutting and realigning the bone of the upper arm (humerus) to correct deformities or allow for better functioning. Internal fixation, such as plates, screws, or rods, may be used to stabilize the bone during healing.

Purpose

Medical Condition or Problem:

• Correct deformities of the humerus
• Address malunited fractures
• Relieve joint pain or improve joint function

Goals/Expected Outcomes:

• Align the humerus properly
• Restore normal function and range of motion
• Alleviate pain
• Prevent future complications

Indications

• Severe humeral deformities or angulations
• Malunion or nonunion of humeral fractures
• Osteoarthritis or rheumatoid arthritis affecting the humerus
• Developmental conditions affecting arm alignment

Patient Criteria:

• Symptoms that significantly impair daily activities
• Failure to respond to conservative treatments (e.g., physical therapy)
• Suitable overall health for undergoing surgery

Preparation

• Fasting for at least 8 hours prior to surgery
• Potential medications adjustments as advised by the surgeon
• Preoperative imaging studies (X-rays, CT scans) to assess bone structure

Procedure Description

1. Anesthesia: General anesthesia is typically administered to ensure the patient is unconscious and pain-free.
2. Incision: An incision is made over the humerus.
3. Bone Cutting: The surgeon cuts the bone at the predetermined site.
4. Realignment: The bone is realigned to the correct position.
5. Fixation: Internal fixation devices such as plates, screws, or rods are used to stabilize the bone.
6. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Tools and Equipment:

• Bone saw
• Internal fixation devices (plates, screws, rods)
• Imaging equipment for guidance

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Pain

Rare Complications:

• Nerve or blood vessel damage
• Nonunion or delayed union of the bone
• Hardware failure
• Blood clots

Benefits

• Improved alignment and function of the arm
• Reduction in pain and discomfort
• Enhanced ability to perform daily activities
• Prevention of further joint issues

Recovery

• Hospital stay of 1-2 days for monitoring
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility
• Activity restrictions during the healing process (typically 6-8 weeks)
• Follow-up appointments for X-rays and assessment of healing

Alternatives

• Non-surgical treatments: Physical therapy, medication, bracing
• Other surgical options: It may depend on the specific deformity or condition but might include different types of osteotomy

Pros and Cons:

• Advantages of Osteotomy: Directly corrects bone deformity, provides stability with internal fixation
• Disadvantages: Surgical risks, longer recovery period compared to conservative treatments

Patient Experience

• Expect mild to moderate pain post-surgery, managed with pain relief medications.
• Some discomfort and swelling around the surgical site.
• The need for mobility aids (e.g., sling) immediately after the procedure.
• Gradual improvement in pain and function with adherence to physical therapy and rehabilitation protocols.