23184 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus

Name of the Procedure:

Partial Excision (Craterization, Saucerization, or Diaphysectomy) of Bone (e.g., Osteomyelitis), Proximal Humerus

Summary

Partial excision of the bone involves removing a portion of the proximal humerus to treat conditions like osteomyelitis. The procedure includes specific techniques such as craterization and saucerization to remove infected or damaged bone tissue.

Purpose

The primary aim is to eliminate infected bone tissue to manage osteomyelitis, reduce pain, and promote healing. It may also prevent the spread of the infection and restore normal function to the affected arm.

Indications

• Persistent or severe osteomyelitis (bone infection) not responding to antibiotics
• Chronic pain and swelling in the proximal humerus
• Failure of previous treatments to eliminate the infection
• Evidence of bone damage or necrosis on imaging studies

Preparation

• Fasting for at least 8 hours before the procedure if general anesthesia is used.
• Adjustment or temporary discontinuation of certain medications as advised by the doctor.
• Preoperative imaging studies (X-rays, MRI, CT scans) to assess the extent of bone infection.
• Blood tests and other routine pre-surgical evaluations.

Procedure Description

1. The patient is positioned, and the targeted area is sterilized.
2. General or regional anesthesia is administered.
3. An incision is made over the proximal humerus to expose the infected bone.
4. Specialized instruments are used to perform craterization or saucerization, removing the diseased bone tissue.
5. The area is thoroughly cleaned, and the surgical wound is closed with sutures or staples.
6. A drainage tube may be placed to prevent fluid build-up.

Duration

The procedure typically takes about 1 to 2 hours, depending on the extent of the infection and the complexity of the excision.

Setting

The procedure is performed in a hospital operating room or specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Nerve damage leading to numbness or weakness
• Fracture of the remaining bone
• Adverse reactions to anesthesia
• Recurrence of infection

Benefits

• Relief from chronic pain and discomfort
• Elimination of the bone infection
• Improved arm function and mobility
• Prevention of infection spread to other areas

Recovery

• Pain management with prescribed medications.
• Instructions on wound care, including keeping the incision site clean and dry.
• Physical therapy to restore strength and mobility.
• Avoiding strenuous activities and heavy lifting for several weeks.
• Follow-up appointments to monitor healing and address any concerns.

Alternatives

• Long-term antibiotic therapy as a non-surgical option.
• Needle aspiration or biopsy for less invasive infection management.
• Hyperbaric oxygen therapy to enhance infection control and healing.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel any pain. Post-procedure, some discomfort or pain is expected, which will be managed with medications. Patients can expect some swelling and restricted movement initially, improving progressively with proper care and physical therapy.