24546 Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extension

Name of the Procedure:

Open Treatment of Humeral Supracondylar or Transcondylar Fracture, with Intercondylar Extension

Summary

This surgical procedure involves the open reduction (realignment) of a fractured humerus (upper arm bone) near the elbow. It includes the internal fixation of the bone fragments, often using metal plates, screws, or wires to ensure stability and proper healing. Specifically, this procedure deals with complex fractures that extend between the condyles (rounded parts of the humerus that form part of the elbow joint).

Purpose

The purpose of this surgery is to treat and stabilize fractures of the humerus near the elbow, which may extend into the joint itself. The goals are to realign the bone fragments, stabilize the fracture, restore normal elbow function, and prevent future complications such as arthritis or deformity.

Indications

• Severe fractures of the humerus near the elbow with intercondylar extension.
• Fractures that cannot be properly aligned with non-surgical methods.
• Open (compound) fractures where the bone breaks through the skin.
• Fractures associated with nerve or vascular injury.
• Non-union or malunion of previously treated fractures.

Preparation

• Patients may be asked to fast for a specific period before surgery (usually 8-12 hours).
• Medications adjustments may be necessary, especially blood thinners.
• Pre-operative assessments typically include X-rays, CT scans, or MRI, and blood tests.
• Anesthesia consultation to discuss the patient's medical history and anesthesia plan.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made over the elbow to expose the fracture.
3. Reduction: The surgeon realigns the bone fragments to their normal anatomical positions.
4. Internal Fixation: Metal plates, screws, or wires are placed to stabilize the bone fragments and maintain alignment.
5. Intercondylar Extension: Special attention is given to ensure proper alignment and stabilization of the intercondylar area.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
7. Immobilization: The elbow may be immobilized using a splint, cast, or brace.

Duration

The procedure typically takes about 2-3 hours, depending on the complexity of the fracture.

Setting

This procedure is performed in a hospital operating room, often equipped with specialized orthopedic surgical equipment.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Blood loss or hematoma formation
• Nerve or blood vessel injury
• Non-union or delayed healing of the fracture
• Hardware irritation or failure
• Stiffness or limited range of motion in the elbow
• Complications related to anesthesia

Benefits

• Stabilization and proper healing of the humeral fracture
• Restoration of normal elbow function
• Reduction of pain and discomfort
• Prevention of future complications like arthritis, deformity, or loss of function

Recovery

• Hospital stay of 1-2 days post-surgery is common.
• Pain management will involve prescribed medications.
• Physical therapy typically starts within a few days to weeks to restore range of motion and strength.
• Activity restrictions may be in place for several weeks.
• Follow-up appointments are necessary to monitor healing and adjust rehabilitation plans.
• Full recovery can take several months.

Alternatives

• Non-Surgical Treatment: Involves immobilization with a cast or splint, but is often insufficient for complex or unstable fractures.
  • Pros: Non-invasive, no surgical risk.
  • Cons: Higher risk of misalignment and poor functional outcome.
• Closed Reduction and Percutaneous Pinning: Minimally invasive but suitable only for specific fracture types.
  • Pros: Less invasive.
  • Cons: Less precise for complex fractures.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Post-operatively, there may be discomfort or pain at the surgical site, managed with medications.
• The patient may experience temporary swelling, bruising, and limited mobility.
• Physical therapy and rehabilitation are crucial for regaining function and strength in the elbow.
• Pain and discomfort typically decrease significantly within a few weeks, with continued improvement over several months.