Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)
CPT4 code
Name of the Procedure:
Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement).
Summary
This procedure involves realigning a fractured scapula (shoulder blade) without the need for an open surgical incision. The physician manipulates the bones back into the correct position, and in some cases, skeletal traction may be used to assist in proper alignment.
Purpose
The aim is to stabilize and heal a fractured scapula, alleviating pain and restoring functional use of the shoulder and arm. It addresses issues such as displaced bone fragments and joint involvement that could impede normal shoulder movement.
Indications
Patients with fractured scapulas, especially where the bones are misaligned or displaced. This procedure is suitable for individuals whose fractures can be corrected without invasive surgery.
Preparation
- Patients may be required to fast for a certain period if sedation or general anesthesia is to be used.
- Blood tests and imaging studies (like X-rays or CT scans) are typically conducted to assess the fracture.
- Adjustments to medications, particularly blood thinners, may be necessary.
Procedure Description
- Anesthesia is administered to ensure the patient is comfortable; this may be local, regional, or general depending on the case.
- The physician manipulates the fractured scapula externally to achieve proper alignment.
- In cases requiring traction, a device is used to apply force to aid in bone alignment.
- Once aligned, the shoulder may be immobilized using a sling or brace to maintain positioning.
Duration
The procedure typically takes around 30 minutes to an hour, depending on the complexity of the fracture.
Setting
Performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Orthopedic surgeon or a trained specialist in fracture care.
- Anesthesiologist or nurse anesthetist.
- Nursing staff for assistance and monitoring.
Risks and Complications
- Common risks include minor infections, bleeding, and bruising.
- Rare risks can include nerve damage, improper healing or alignment, and prolonged pain.
- Complications might be managed with further medical intervention or physical therapy.
Benefits
- Effective pain relief.
- Restoration of normal shoulder function.
- Avoidance of open surgery and related risks.
- Benefits can often be observed fairly soon after the procedure is completed, and further improvement over the weeks of healing.
Recovery
- Post-procedure care includes immobilization of the shoulder, pain management, and physical therapy.
- Patients need to follow up with their physician to monitor healing via imaging studies.
- Full recovery may take from 6 to 12 weeks, with incremental improvements over time.
Alternatives
- Open surgical treatment to realign and fix the fracture with plates and screws.
- Conservative management with prolonged immobilization if manipulation is not required or feasible.
- Each alternative has its own risks and benefits, which should be discussed with the physician.
Patient Experience
- Patients may feel discomfort during manipulation, managed with appropriate anesthesia or sedation.
- Post-procedure pain is common and managed with prescribed medications.
- Initial limited movement followed by gradual increases as healing progresses.
- Regular follow-up and adherence to rehabilitation exercises are crucial for optimal recovery.