24538 Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension

Name of the Procedure:

Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension

Summary

This procedure involves the insertion of pins or screws through the skin to stabilize a fracture in the upper arm's lower end (humerus). It is minimally invasive and typically aims to realign and fix the broken bone segments to promote proper healing.

Purpose

The procedure is performed to address fractures in the lower part of the humerus. It aims to ensure the bones heal correctly, restore arm function, and prevent potential complications such as misalignment or immobility.

Indications

• Fractures of the humerus near the elbow (supracondylar or transcondylar).
• Complex fractures involving the humerus and extending to the elbow joint (intercondylar extension).
• Patients with significant displacement of bone fragments.
• Individuals for whom non-surgical treatments are inadequate.

Preparation

• Patients are usually instructed to fast for at least 6-8 hours before the procedure.
• Medication adjustments, particularly anticoagulants, may be necessary.
• Preoperative assessments might include X-rays, CT scans, and routine blood tests.

Procedure Description

1. The patient is positioned, usually under general anesthesia.
2. The skin is cleaned and sterilized at the site of the fracture.
3. Using imaging guidance (like fluoroscopy), small incisions are made in the skin.
4. Pins, screws, or wires are inserted through these incisions to align and stabilize the fractured bone segments.
5. The devices are secured to maintain proper position.
6. The incisions are closed, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the fracture's complexity.

Setting

The procedure is performed in a hospital operating room or a surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist for imaging guidance

Risks and Complications

• Infection at the insertion sites
• Nerve or blood vessel damage
• Migration or loosening of the pins or screws
• Incomplete bone healing
• Possible need for additional surgery

Benefits

• Correct alignment and stabilization of the fracture.
• Reduced risk of bone malalignment and associated complications.
• Enhanced ability to regain normal function and range of motion.
• Shorter recovery time compared to open surgical procedures.

Recovery

• Post-operative care includes pain management, usually through medications.
• The arm may be immobilized in a cast or splint for a few weeks.
• Physical therapy may be prescribed to regain strength and mobility.
• Follow-up appointments for X-rays to monitor bone healing are necessary.
• Recovery time ranges from several weeks to a few months, depending on the patient's condition and adherence to rehabilitation.

Alternatives

• Non-surgical treatment such as casting or splinting, which may be suitable for less severe fractures.
• Open surgical fixation which involves larger incisions and direct visualization of the fracture site but might offer more stability in complex cases.

Patient Experience

Patients might experience discomfort or mild pain at the insertion sites post-procedure, managed with pain relievers. Movement limitations during the initial healing phase are expected. Gradual improvement in mobility and function is anticipated with adherence to rehabilitation protocols.