Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/in
CPT4 code
Name of the Procedure:
Closed Treatment of Posterior Pelvic Ring Fracture(s), Dislocation(s), Diastasis, or Subluxation of the Ilium, Sacroiliac Joint, and/or Sacrum, with or without Anterior Pelvic Ring Fracture(s) and/or Dislocation(s) of the Pubic Symphysis
Summary
This procedure involves the non-surgical (closed) treatment of fractures, dislocations, or separations of the bones and joints in the pelvis. This can include the ilium, sacrum, and sacroiliac joint, as well as associated areas like the pubic symphysis.
Purpose
The primary goal of this procedure is to stabilize the pelvic bones and joints that have been fractured or dislocated, allowing them to heal correctly without the need for surgical intervention. It aims to relieve pain, restore function, and prevent complications associated with unstable pelvic fractures.
Indications
- Severe pelvic pain and inability to walk or stand.
- X-ray or CT scan findings showing fractures or dislocations in the pelvic ring.
- Hemodynamic instability due to pelvic fractures.
- Patients where surgery is not a viable option due to medical conditions or personal choice.
Preparation
- Patients may need to fast if anesthesia or sedation is planned.
- Blood tests and imaging studies such as X-rays or CT scans may be required.
- Adjustments in certain medications, particularly blood thinners, may be necessary as directed by the physician.
Procedure Description
- Anesthesia/Sedation: Depending on the specifics of the case, local or general anesthesia may be administered.
- Reduction: The physician will manipulate the pelvis externally to align the fractured or dislocated bones.
- Stabilization: In some cases, external devices like pelvic binders may be used to hold the bones in place while they heal.
- Imaging: X-rays or CT scans may be used during the procedure to ensure proper alignment.
Duration
The procedure typically takes 1-2 hours, depending on the complexity of the fractures or dislocations being treated.
Setting
This procedure is performed in settings such as hospitals, emergency departments, or surgical centers, depending on the patient's condition and required facilities.
Personnel
- Orthopedic surgeon or trauma specialist
- Anesthesiologist
- Nurses
- Radiologic technologist
Risks and Complications
- Pain or discomfort during manipulation
- Incomplete alignment of bones
- Potential need for surgical intervention if closed reduction fails
- Risk of infection, if any invasive devices are used
- Blood clots due to immobilization
Benefits
- Avoidance of surgical risks and recovery.
- Restoration of normal pelvic alignment and function.
- Immediate pain relief.
- Reduced hospital stay compared to surgical treatment.
Recovery
- Post-procedure immobilization and use of supportive devices like pelvic binders.
- Gradual mobilization and physical therapy may be required.
- Regular follow-up appointments for imaging and assessment.
- Recovery time varies; it could range from a few weeks to several months, depending on injury severity.
Alternatives
- Surgical Treatment: Invasive surgery to fix the pelvic bones with plates and screws.
Conservative Management: Pain management and physical therapy alone, although less effective for unstable fractures.
Patient Experience
- During the procedure, patients might experience manipulation discomfort if under local anesthesia.
- Post-procedure, patients may feel soreness and need pain management, usually through medications and physical therapy.
- Comfort measures include using supportive devices and gradual physical activity to aid recovery.