Name of the Procedure:

Manual preparation and insertion of drug-delivery device(s), intramedullary

Summary

This procedure involves manually preparing and inserting a device that delivers medication directly into the bone marrow cavity. It is typically an adjunct procedure performed along with other primary treatments to address bone-related conditions.

Purpose

The primary goal is to deliver medication directly to the bone marrow, effectively treating conditions such as infections, cancers, or bone diseases. It helps ensure that the medicine is delivered precisely where it's needed.

Indications

• Chronic osteomyelitis (bone infection)
• Bone cancer or metastases
• Avascular necrosis (bone tissue death due to lack of blood supply)
• Severe fractures or bone deformities requiring medication for healing

Preparation

• Fasting may be required if anesthesia is used.
• Adjustments to current medications may be necessary.
• Pre-procedure tests like blood work, imaging (X-rays, MRI, or CT scans), and bone density assessments are commonly performed.

Procedure Description

1. The patient is positioned appropriately, usually under local or general anesthesia.
2. The skin over the insertion site is cleaned and sterilized.
3. A small incision is made to access the bone.
4. The drug-delivery device is manually prepared, ensuring it's sterile and loaded with the prescribed medication.
5. The device is then carefully inserted into the bone marrow cavity.
6. The incision is closed with sutures or sterile adhesive.

Tools and equipment include surgical instruments, the drug-delivery device itself, and imaging technology for precise placement.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and patient-specific factors.

Setting

Conducted in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Radiology technician (if imaging is used)

Risks and Complications

• Infection at the insertion site
• Device displacement or malfunction
• Bleeding or hematoma formation
• Nerve or vascular injury
• Bone fracture around the device site
• Allergic reactions to materials used

Benefits

• Targeted drug delivery for effective treatment
• Reduction of systemic side effects compared to oral or intravenous medication
• Enhanced drug absorption and efficiency

Recovery

• Post-procedure pain and discomfort management
• Keeping the insertion site clean and dry
• Avoiding heavy activities that may strain the insertion area
• Follow-up appointments for monitoring and potential adjustments or removal of the device

Alternatives

• Oral or intravenous medication
• External fixators or other surgical options for bone conditions
• Each alternative has its pros and cons, with oral medications being less invasive but potentially less effective in severe localized conditions.

Patient Experience

• The procedure itself is typically painless, thanks to anesthesia.
• Some discomfort and swelling at the insertion site post-procedure are expected.
• Pain management will be provided as needed, ensuring patient comfort during recovery.