Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement
CPT4 code
Name of the Procedure:
Open Treatment of Radial Head or Neck Fracture with Radial Head Prosthetic Replacement
Common name(s): Radial head fracture surgery, Radial head prosthetic replacement
Summary
This surgical procedure involves repairing a fractured radial head or neck, including the installation of a prosthetic radial head if necessary. The radial head is part of the radius, one of the two bones in the forearm, near the elbow. The surgery is performed through an open incision, and internal fixation or removing the fractured pieces might be required before placing the prosthesis.
Purpose
The procedure addresses fractures of the radial head or neck, which can impair elbow function and cause pain. It aims to restore the normal anatomy and function of the elbow, leading to improved range of motion, decreased pain, and prevention of future complications such as arthritis or chronic instability.
Indications
- Severe fractures of the radial head or neck that cannot be treated with casting or splinting.
- Displaced fractures where the bone fragments are not properly aligned.
- Fractures accompanied by multiple bone fragments (comminuted fractures).
- Previous unsuccessful treatments or chronic issues related to a radial head fracture.
Preparation
- Patients may be instructed to fast for a specific period before the procedure, typically starting the night before.
- Medication adjustments may be needed, including possibly stopping blood thinners.
- Diagnostic tests such as X-rays, CT scans, and blood tests are required to plan the surgery and assess the patient's health.
Procedure Description
- The patient is administered anesthesia, usually general anesthesia.
- An incision is made over the elbow to expose the radial head and neck.
- The fractured pieces are assessed; if viable, internal fixation (screws or plates) is used to stabilize them.
- If the radial head is severely damaged, it is excised (removed), and a prosthetic radial head is implanted.
- The prosthesis is secured to the remaining bone, ensuring proper alignment and function.
- The incision is closed with sutures, and a sterile bandage is applied.
Tools and equipment include surgical instruments for cutting and fixing bones, prosthetic components, and possibly fluoroscopy for real-time imaging.
Duration
The procedure typically takes around 1 to 2 hours, depending on the complexity of the fracture and the amount of reconstruction required.
Setting
This surgery is performed in a hospital or a surgical center equipped with the necessary facilities for orthopedic surgeries.
Personnel
- Orthopedic surgeon specialized in arm and elbow surgeries
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Infection at the incision site or deep within the joint
- Nerve damage leading to numbness or weakness
- Blood clots
- Prosthesis-related complications, such as loosening or dislocation
- Long-term stiffness or reduced range of motion
Benefits
- Restored elbow anatomy and function
- Relief from pain
- Improved range of motion and stability
- Prevention of long-term complications like arthritis
Recovery
- Following surgery, the arm is usually placed in a splint to immobilize the elbow.
- Physical therapy may begin shortly after surgery to regain motion and strength.
- Pain management includes prescribed medications and, occasionally, ice packs.
- Full recovery can take several months; activity restrictions will vary depending on the progress.
- Follow-up appointments are necessary to monitor healing and prosthesis placement.
Alternatives
- Non-surgical treatments: casting, splinting, or functional braces.
- Closed reduction with internal fixation.
Radial head excision without replacement.
Each alternative has its pros and cons; non-surgical methods might result in less effective outcomes for severe fractures, whereas other surgical options might not fully restore function compared to prosthetic replacement.
Patient Experience
Patients will be under anesthesia and won't feel pain during the procedure. Post-operatively, they may experience pain, swelling, and discomfort, which can be managed with pain relievers and ice packs. Physical therapy will be required for optimal recovery and return to daily activities is gradual.