Open treatment of acute or chronic elbow dislocation
CPT4 code
Name of the Procedure:
Open Treatment of Acute or Chronic Elbow Dislocation
Common Name(s): Open Reduction of Elbow Dislocation
Technical/Medical Term: Open Reduction and Internal Fixation (ORIF) for Elbow Dislocation
Summary
Open treatment of an elbow dislocation involves surgically realigning the bones of the elbow joint. This type of surgery is typically performed when non-surgical methods, such as traction or closed reduction, are not sufficient to correct the dislocation.
Purpose
This procedure addresses both acute (recent) and chronic (long-standing) dislocations of the elbow joint. The goal is to restore normal alignment and function to the elbow, alleviate pain, and prevent further complications such as permanent joint instability or elbow stiffness.
Indications
Elbow dislocations that do not improve with closed reduction methods
Severe dislocations involving fractures (fracture-dislocation)
Persistent instability or compromised joint function
Significant soft tissue injuries around the elbow
Preparation
Patients may be instructed to fast for 8 hours before the procedure.
Medications (especially blood thinners) might need to be adjusted.
Pre-operative imaging studies like X-rays or MRI scans will be performed to assess the extent of the dislocation and any associated injuries.
Procedure Description
- Anesthesia: The patient is administered general anesthesia or regional anesthesia to ensure they are unconscious or the area is numbed.
- Incision: A surgical incision is made over the elbow to access the dislocated joint.
- Reduction: The surgeon manipulates the bones to realign the dislocated joint.
- Internal Fixation: Metal pins, screws, or plates may be used to secure the bones in the correct position.
- Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes 1 to 2 hours, depending on the complexity of the dislocation and any associated fractures.
Setting
The procedure is performed in a hospital or a specialized surgical center.
Personnel
Surgeons (typically orthopedic surgeons), anesthesiologists, surgical nurses, and operating room technicians are involved in the procedure.
Risks and Complications
Common Risks: Infection, bleeding, and swelling
Rare Risks: Nerve or blood vessel damage, stiffness, nonunion or malunion of bones, recurrence of dislocation
Complications: Handling of complications may involve antibiotics for infections, additional surgery for nonunion, or physical therapy for stiffness.
Benefits
Restoration of normal joint alignment and function
Pain relief and prevention of chronic instability
Return to daily activities and sports more efficiently
Recovery
Patients will need to keep the arm immobilized for a specified period, usually in a splint or brace.
Follow-up appointments are necessary to monitor healing, remove sutures, and adjust treatment plans.
Physical therapy is often recommended to restore full range of motion and strength.
Complete recovery can take from several weeks to months, depending on the severity of the dislocation and patient's adherence to postoperative care.
Alternatives
Closed Reduction: Non-surgical realignment, suitable for less severe dislocations without fractures.
Immobilization: Using a splint or cast to allow spontaneous healing, less effective for complex dislocations.
Arthroscopic Surgery: Minimally invasive but typically used for milder cases and without associated fractures.
Cons: May not be as effective for severe dislocations or those with significant tissue damage.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel any pain.
After the procedure, pain management strategies will be implemented, including medications and possibly nerve blocks.
Some discomfort and swelling are normal post-operatively, and these can be managed with prescribed pain relievers and ice packs.