27218 Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes ipsilateral ilium, sacroiliac joint and/or sacrum)

Name of the Procedure:

Open Treatment of Posterior Pelvic Bone Fracture and/or Dislocation with Internal Fixation

Summary

This surgical procedure involves the repair of fractures or dislocations of the posterior pelvic bones that disrupt the pelvic ring. The surgery aims to realign the bones and stabilize them using internal fixation devices like plates and screws to ensure proper healing.

Purpose

The procedure addresses fractures and dislocations of the posterior pelvic bones that affect the stability of the pelvic ring. The primary goals are to provide stability, reduce pain, and restore normal function and alignment of the pelvis for proper healing and mobility.

Indications

• Severe pain and instability due to pelvic ring fractures.
• Dislocation of posterior pelvic bones, including the ilium, sacroiliac joint, or sacrum.
• Inability to walk or stand without significant pain.

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be required.
• Preoperative imaging studies like X-rays, CT scans, or MRIs to assess the extent of the injury.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made over the affected area to access the pelvic bones.
3. Reduction: The fractured or dislocated bones are realigned to their natural position.
4. Fixation: Internal fixation devices, such as plates, screws, or rods, are applied to stabilize the bones.
5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the injury.

Setting

The surgery is performed in a hospital operating room equipped with advanced imaging and surgical tools.

Personnel

• Orthopedic surgeon specialized in pelvic fractures
• Anesthesiologist
• Surgical nurses
• Radiologic technologist

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Malunion or nonunion of the bone
• Need for additional surgeries

Benefits

• Stabilization of the pelvis
• Reduction in pain
• Restoration of normal pelvic alignment
• Improved mobility and function

Recovery

• Hospital stay for several days post-surgery
• Pain management with medications
• Physical therapy to regain strength and mobility
• Follow-up appointments for X-rays to monitor healing
• Full recovery may take several months, with restrictions on weight-bearing activities.

Alternatives

• Non-surgical management (often not feasible for severe cases)
  • Pros: Lower immediate risk, no surgery required
  • Cons: Prolonged immobilization, potential for incomplete healing
• Percutaneous fixation
  • Pros: Minimally invasive, shorter recovery time
  • Cons: Not suitable for all fracture types, may require further surgery

Patient Experience

• Under general anesthesia during the procedure, so no pain will be felt.
• Postoperative pain managed with medications.
• Initial difficulty with mobility, requiring assistance and rehabilitation.
• Gradual improvement in function and reduction in pain over the recovery period.