24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage

Name of the Procedure:

Open Treatment of Humeral Shaft Fracture with Plate/Screws, with or without Cerclage
Common Name: ORIF (Open Reduction and Internal Fixation) of Humeral Shaft Fracture

Summary

In layman's terms, this surgery involves making an incision to access a broken upper arm bone (humerus) and using metal plates and screws to hold the bone pieces together so they can heal properly. Sometimes, wire loops (cerclage) are also used for extra stability.

Purpose

This procedure addresses fractures of the humerus (the bone in the upper arm) that cannot heal properly with non-surgical treatments. The goals include:

• Realigning the broken bone fragments
• Stabilizing the bone to allow proper healing
• Reducing pain and improving function

Indications

• Severe fractures or fractures with multiple pieces
• Non-healing fractures from previous treatments
• Fractures involving nerve or blood vessel damage
• Open fractures where the bone has pierced the skin
• Patients unable to keep the arm immobilized for long periods

Preparation

• Fasting for at least 8 hours before the procedure
• Stopping certain medications (e.g., blood thinners) as advised by the surgeon
• Blood tests, X-rays, and possibly an MRI or CT scan to assess the fracture

Procedure Description

1. Anesthesia: The patient is given general anesthesia so they are asleep and pain-free.
2. Incision: A surgical incision is made over the fracture site.
3. Reduction: The bone fragments are realigned to their normal position.
4. Fixation: A metal plate is placed along the bone and screwed into place. Cerclage wire may be used if needed for additional stabilization.
5. Closure: The incision is closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection at the surgery site
• Nerve or blood vessel damage
• Non-union or delayed union of the fracture
• Hardware irritation or failure
• Blood clots
• Pain and/or stiffness

Benefits

• Proper alignment and healing of the fracture
• Reduced pain and improved arm function
• Quicker return to daily activities compared to prolonged immobilization methods Improvement is usually noticed within a few weeks, but full healing may take several months.

Recovery

• Initial immobilization of the arm with a splint or brace
• Physical therapy to restore movement and strength
• Follow-up appointments to monitor healing via X-rays
• Avoiding heavy lifting and strenuous activities for several months

Alternatives

• Non-surgical treatment with casts or braces (for less severe fractures)
• External fixation (using an external frame to stabilize the bone)
• Goals and success rates vary, and non-surgical options might prolong recovery.

Patient Experience

• Pre-operative anxiety typically managed with medications or relaxation techniques.
• Post-operative pain managed with prescription painkillers and over-the-counter medications.
• Initially, mild to moderate discomfort at the incision site, which generally improves after a few days.
• Physical therapy to aid recovery and minimize stiffness.