21813 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs

Name of the Procedure:

Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs.

Summary

This surgical procedure involves repairing broken ribs by inserting and securing hardware, such as plates and screws, directly onto the bones to stabilize them. The procedure often uses a thoracoscope, a specialized camera, for better visualization during the surgery, performed on just one side of the chest.

Purpose

The procedure is designed to address severe rib fractures that may not heal properly on their own. The goal is to stabilize the broken ribs, alleviate pain, restore normal breathing mechanics, and promote proper healing.

Indications

• Severe rib fractures involving 7 or more ribs on one side.
• Unstable chest wall (flail chest).
• Persistent pain or respiratory issues due to rib fractures.
• Rib fractures that have failed to heal with conservative treatment.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications may need to be adjusted as per the doctor's advice.
• Pre-procedure tests may include chest x-rays, CT scans, blood tests, and pulmonary function tests.

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made over the fractured ribs.
3. A thoracoscope may be inserted to provide a clear view of the ribs and surrounding structures.
4. Fragments of the broken ribs are aligned and secured using metal plates and screws.
5. The incision is closed with sutures or staples.
6. A chest drain may be placed to remove excess fluid or air.

Duration

The procedure typically takes around 2-4 hours, depending on the complexity and number of ribs involved.

Setting

The procedure is typically performed in a hospital operating room.

Personnel

• Orthopedic or thoracic surgeon
• Surgical nurses
• Anesthesiologist
• Possibly a respiratory therapist

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs such as the lungs
• Pain at the surgical site
• Hardware failure or displacement
• Adverse reaction to anesthesia

Benefits

• Stabilizes the chest wall and promotes healing
• Reduces pain and improves breathing
• Decreases the risk of long-term complications from improperly healed ribs
• Faster recovery compared to non-surgical treatment

Recovery

• Pain management with medications
• Breathing exercises and possibly physical therapy
• Restrictions on heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor healing and remove any drains

Alternatives

• Conservative management with pain control and rest (for less severe fractures)
• External bracing
• Benefits of surgery include quicker recovery and better outcomes in severe cases, while conservative treatment avoids surgical risks.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Post-procedure, there may be pain which is managed with medications.
• Some discomfort from the chest drain, if placed.
• Gradual improvement in pain and breathing as healing progresses.