Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation
CPT4 code
Name of the Procedure:
Closed Treatment of Monteggia Fracture Dislocation (Non-Surgical Realignment of a Fractured Ulna with Dislocated Radial Head)
Summary
This procedure involves the non-surgical realignment of a specific type of elbow injury where the upper part of the ulna (one of the forearm bones) is fractured and the radial head (part of the other forearm bone) is dislocated. The doctor will reposition the bones manually without opening the skin.
Purpose
Addresses: Monteggia fracture dislocation, specifically the fracture of the proximal end of the ulna with dislocation of the radial head. Goals: To realign the bones, promote proper healing, restore elbow function, and prevent long-term complications.
Indications
- Visible deformity of the elbow and forearm
- Severe pain and swelling at the site of injury
- Inability to move or bend the elbow
- X-ray confirmation of fractured ulna and dislocated radial head
- Suitable for patients where non-surgical intervention is deemed appropriate by the physician.
Preparation
- Fasting may be required if sedation is anticipated.
- Discontinue certain medications as advised by the doctor.
- Pre-procedure imaging (X-rays, MRI) to assess the extent of the injury.
Procedure Description
- Patient positioning: The patient is positioned comfortably, often lying down.
- Sedation or anesthesia: Local anesthesia, sedation, or general anesthesia may be administered to ensure comfort.
- Manipulation: The doctor performs manual manipulation to align the ulna and radial head correctly.
- Immobilization: Once aligned, the elbow is often immobilized using a splint or cast to maintain proper position during healing.
- Tools: Immobilization device (splint or cast), imaging for confirmation if necessary.
Duration
Typically, the procedure takes about 30-60 minutes, depending on the complexity and the need for anesthesia.
Setting
The procedure is usually performed in a hospital emergency department or an outpatient clinic.
Personnel
- Orthopedic surgeon or emergency physician
- Nurse or medical assistant
- Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)
Risks and Complications
- Common: Pain, swelling, and bruising at the site of manipulation.
- Rare: Nerve injury, improper alignment requiring surgical intervention, joint stiffness, and chronic instability.
Benefits
- Non-invasive method to correct severe injury
- Reduced healing time compared to surgical intervention
- Restoration of normal elbow function with proper alignment
Recovery
- Immediate post-procedure: Rest and elevate the arm, use ice packs to reduce swelling.
- Immobilization: Typically, the arm is kept immobilized for several weeks.
- Follow-up: Regular follow-up appointments to monitor healing via X-rays.
- Physical therapy: May be recommended to restore full function and range of motion.
Alternatives
- Surgical intervention if closed treatment is unsuccessful.
- Pros: More precise realignment, possible better long-term outcomes.
- Cons: More invasive, longer recovery time, higher risk of complications.
Patient Experience
During: If sedated, the patient may feel drowsy or be completely unaware of the procedure. After: Some discomfort or mild pain, managed with pain medications. Feelings of tightness or restricted movement due to the splint or cast. Pain and discomfort usually diminish within a few days.