24635 Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed

Name of the Procedure:

Open Treatment of Monteggia Type Fracture Dislocation at Elbow (Proximal Ulna Fracture with Radial Head Dislocation), Includes Internal Fixation

Summary

This procedure involves surgically repairing a specific type of elbow fracture where the proximal part of the ulna (one of the forearm bones) is broken and the radial head (top part of the other forearm bone) is dislocated. The surgery includes the use of internal fixation devices like plates and screws to stabilize the bones.

Purpose

The procedure addresses Monteggia fractures, which involve a break in the proximal ulna and dislocation of the radial head. The main goals are to realign the bones, restore normal elbow function, and prevent long-term issues such as instability, deformity, or restricted movement.

Indications

• Severe elbow pain and swelling after trauma
• Visible deformity of the elbow and forearm
• Inability to move the elbow or forearm normally
• X-ray confirmation of a proximal ulna fracture with radial head dislocation

Preparation

• Patient may need to fast for 6-8 hours before surgery
• Adjustments in current medications may be required
• Pre-operative blood tests, X-rays, and possibly a CT scan
• Consent form signing and anesthesiology consultation

Procedure Description

1. Anesthesia: Patient receives general anesthesia.
2. Incision: A surgical incision is made over the elbow.
3. Exposure: The elbow structures are carefully exposed to reach the fractured ulna and dislocated radial head.
4. Reduction: The radial head is realigned into its normal position.
5. Fixation: Plates and screws or other fixation devices are used to stabilize the fracture site.
6. Closure: The incision is closed using sutures or staples. A sterile dressing is applied.

Duration

Typically, the procedure takes about 2-3 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to nerves or blood vessels
• Delayed bone healing or non-union
• Hardware failure requiring removal or replacement
• Stiffness or restricted range of motion in the elbow

Benefits

• Proper alignment and stabilization of the bones
• Restoration of normal elbow and forearm function
• Reduced pain and prevention of chronic instability
• Early functional recovery and return to daily activities

Recovery

• Post-operative instructions include pain management with medications and ice packs.
• Keeping the arm elevated and immobile initially.
• Gradual physiotherapy exercises to regain strength and flexibility.
• Follow-up appointments for X-rays and assessment.
• Full recovery may take several months, with possible temporary restrictions on heavy lifting or strenuous activities.

Alternatives

• Closed reduction and casting (less suitable for complex fractures).
• Non-operative management (rarely effective and typically reserved for non-displaced fractures).
• External fixation (used if internal fixation is not feasible).

Patient Experience

During the procedure, the patient will be under general anesthesia and won't feel any pain. After the surgery, there will be discomfort and pain at the incision site, which will be managed with medications. Pain and swelling typically subside in a few weeks, and mobility improves progressively with physical therapy.

By providing clear and concise information through this markdown styled text, patients and caregivers can better understand the complexity and necessity of the Open Treatment of Monteggia Fracture Dislocation, along with all pre and post-surgical expectations.