Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna
CPT4 code
Name of the Procedure:
Partial Excision (Craterization, Saucerization, or Diaphysectomy) of Bone - Ulna
Summary
Partial excision of the bone (ulna) involves surgically removing a portion of the bone affected by infection or disease, such as osteomyelitis. This can help in clearing out the infected tissue and prevent further spread of the infection.
Purpose
This procedure addresses chronic bone infections, specifically osteomyelitis in the ulna. The goal is to remove the infected or necrotic (dead) bone tissue, relieve pain, and prevent the infection from spreading, thereby promoting healing.
Indications
- Persistent pain in the ulna.
- Recurrent or chronic osteomyelitis.
- Failure of previous treatments such as antibiotics.
- Presence of necrotic bone tissue.
Preparation
- Patients may need to fast for 6-8 hours before the procedure.
- Adjustments to current medications as advised by the physician.
- Pre-procedure imaging studies like X-rays or MRI scans.
- Blood tests to assess overall health and infection markers.
Procedure Description
- The patient is given general anesthesia to ensure comfort and pain control.
- An incision is made over the affected area of the ulna.
- Specialized surgical tools are used to remove the diseased or infected bone.
- The area is thoroughly cleaned and irrigated to remove all infected material.
- The incision is then closed with sutures.
- A sterile dressing is applied to the surgical site to prevent infection.
Duration
The procedure typically takes 1 to 2 hours depending on the extent of infection and amount of bone removal required.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Damage to nearby nerves or blood vessels
- Poor wound healing
- Recurrent osteomyelitis
Benefits
- Relief from chronic pain caused by osteomyelitis
- Removal of infected bone tissue to prevent further spread of infection
- Improved function and mobility of the affected arm
Recovery
- Initial recovery involves a hospital stay of 1-2 days for monitoring.
- Pain management with prescribed medications.
- Keeping the surgical site clean and dry.
- Follow-up appointments to monitor healing progress.
- Physical therapy may be needed to regain strength and mobility.
- Full recovery may take several weeks, with activities slowly reintroduced as advised by the healthcare team.
Alternatives
- Long-term antibiotic therapy
- Hyperbaric oxygen therapy to promote healing
- More extensive surgical procedures if the infection is widespread
- Each alternative has its own risks and benefits, with conservative treatments taking longer but posing fewer immediate surgical risks, while more extensive surgeries might offer quicker resolution but with greater operative risks.
Patient Experience
During the procedure, patients will not feel anything due to general anesthesia. Post-procedure, there may be discomfort and pain managed with medication. Patients will need to keep the surgical site clean, follow recovery protocols, and may experience temporary limitations in arm mobility.
Pain management is a priority, with prescribed medications and possible use of ice packs to reduce swelling and discomfort.