Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation
CPT4 code
Name of the Procedure:
Closed Treatment of Distal Radial Fracture (e.g., Colles or Smith Type) or Epiphyseal Separation, Includes Closed Treatment of Fracture of Ulnar Styloid, When Performed, Without Manipulation.
Summary
This procedure involves the non-surgical alignment and stabilization of a fracture in the distal part of the radius (near the wrist) without changing the position of the bone fragments. It may also include the treatment of a fracture in the ulnar styloid (a small bone near the wrist joint).
Purpose
This procedure addresses fractures of the distal radius, commonly resulting from falls or accidents. The goal is to allow the broken bone(s) to heal properly without surgical intervention, ensuring restored function and minimized discomfort.
Indications
- Acute pain, swelling, and deformity in the wrist.
- Diagnostic imaging (X-rays) confirming a distal radial fracture.
- Patients who have sustained a recent fall or trauma to the wrist.
- Suitable for patients where the bone fragments are adequately aligned and do not require manipulation.
Preparation
- Patients are usually advised to avoid eating or drinking a few hours before the procedure if sedation is required.
- Review of current medications and possible adjustments.
- Diagnostic imaging such as X-rays or MRI to assess the fracture.
Procedure Description
- The patient's wrist is immobilized, often using a splint or cast.
- The area is cleaned and sterilized if there is an associated wound.
- No bone manipulation is done; the natural alignment is maintained.
- The cast or splint is then secured to keep the bone fragments in place.
- Follow-up X-rays may be performed to ensure proper alignment.
Duration
The procedure typically takes about 15-30 minutes.
Setting
The procedure is usually performed in an outpatient clinic or the emergency department of a hospital.
Personnel
- Orthopedic surgeon or emergency medicine physician.
- Radiologist for imaging.
- Nurses for assistance and patient care.
Risks and Complications
- Pain and swelling during the recovery period.
- Possible cast-related issues like skin irritation or pressure sores.
- There is a small risk of the fracture not healing correctly (malunion) or not healing at all (nonunion).
- Rarely, nerve or vascular damage may occur.
Benefits
- Non-invasive treatment option.
- Reduced recovery time compared to surgical options.
- Gradual return of wrist function without the need for surgery.
Recovery
- Keep the cast or splint dry and clean.
- Regular follow-up appointments for X-rays to monitor healing.
- Possible use of ice and elevation to reduce swelling.
- Wrist exercises and physical therapy after cast removal.
- Full recovery can take 6-8 weeks depending on the fracture severity.
Alternatives
- Closed treatment with manipulation if bone fragments are misaligned.
- Surgical options such as Open Reduction and Internal Fixation (ORIF).
- Pros and cons vary; surgical options may involve longer recovery but can offer better alignment in severe cases.
Patient Experience
- The patient might experience discomfort during the initial application of the cast or splint.
- Pain management with over-the-counter pain relievers or prescribed medication.
- Restrictions on wrist movement and lifting heavy objects during recovery.
- Most patients can expect gradual improvement in pain and function as the bone heals.