24587 Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); with implant arthroplasty

Name of the Procedure:

Open treatment of periarticular fracture and/or dislocation of the elbow with implant arthroplasty. Also known as "elbow surgery for fracture and dislocation" or "open reduction internal fixation (ORIF) with implant arthroplasty."

Summary

This surgical procedure involves repairing fractures and/or dislocations around the elbow joint, specifically targeting the distal humerus, proximal ulna, and/or proximal radius, with the additional placement of implants to replace damaged joint surfaces.

Purpose

The procedure addresses fractures and dislocations of the elbow joint that cannot be treated through closed methods. It aims to restore the integrity and function of the elbow joint, allowing for improved movement, reduced pain, and prevention of further joint degeneration by replacing damaged parts with implants.

Indications

• Severe fractures or dislocations of the elbow joint.
• Fractures that involve joint surfaces and cannot be realigned non-surgically.
• Persistent pain and instability despite conservative treatment.
• Good overall health status permitting surgery.

Preparation

• Patients may be advised to fast for 8-12 hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Preoperative imaging such as X-rays or CT scans to assess the extent of the injury.
• A thorough medical evaluation including blood tests and a physical examination.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made over the elbow joint.
3. Exposure: The muscles and tissues are carefully moved aside to expose the fractured bones and joint.
4. Reduction: The fractured bones are realigned.
5. Fixation: Screws, plates, or wires are used to secure the bones in place.
6. Implant Arthroplasty: Placement of implants to replace severely damaged joint surfaces.
7. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours, depending on complexity.

Setting

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

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technician (if intraoperative imaging is needed)

Risks and Complications

• Infection
• Bleeding or blood clots
• Nerve damage
• Impaired elbow movement or stiffness
• Implant failure or loosening
• Anesthesia-related risks

Benefits

• Improved stability and function of the elbow joint.
• Reduction in pain and discomfort.
• Increased mobility and ability to perform daily activities.
• Enhanced quality of life.

Recovery

• Hospital stay of several days post-surgery.
• Use of a splint or brace to protect the elbow.
• Physical therapy to regain strength and movement.
• Regular follow-up appointments with the surgeon.
• Full recovery can take several months, with gradual return to activities.

Alternatives

• Non-surgical management with immobilization and physical therapy (less effective for severe cases).
• Closed reduction with casting (limited effectiveness for complex fractures).
• Arthroscopic surgery (less common for severe fractures).
• Each alternative has specific indications and may not offer the same outcomes as open treatment.

Patient Experience

• Pain management will include medications and possibly nerve blocks.
• Initial discomfort, swelling, and limited mobility are common.
• Physical therapy is crucial to regaining function.
• Patients can expect a gradual reduction in pain and improvement in elbow function over time.