Name of the Procedure:

Closed Treatment of Proximal Humeral (Surgical or Anatomical Neck) Fracture; with Manipulation, with or without Skeletal Traction.

Summary

This procedure involves the non-surgical realignment and stabilization of a broken upper arm bone near the shoulder. Doctors physically manipulate the bone fragments into their correct position and may use traction to help align the bones.

Purpose

The procedure aims to treat fractures of the proximal humerus, particularly at the neck (either surgical or anatomical). The goal is to ensure proper bone healing, restore shoulder function, and minimize pain.

Indications

• Fractures of the proximal humerus, particularly at the surgical or anatomical neck.
• Patients who have sustained trauma or falls resulting in such fractures.
• Situations where surgical intervention is not deemed necessary or is contraindicated.

Preparation

• Patients may need to fast for a few hours before the procedure, especially if sedation or anesthesia is planned.
• Diagnostic imaging such as X-rays or CT scans will be required to assess the fracture.
• Review of current medications, with possible adjustments (e.g., stopping blood thinners).

Procedure Description

1. Anesthesia/Sedation: Local anesthesia or sedation may be administered to manage pain.
2. Manipulation: The physician will manually adjust the position of the fractured bone using specific techniques.
3. Traction (if applicable): Skeletal traction may be used to help align the bone fragments.
4. Immobilization: The arm will be immobilized using a sling, brace, or cast to maintain proper bone alignment during healing.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity of the fracture.

Setting

The procedure is usually performed in a hospital setting, an outpatient clinic, or a surgical center.

Personnel

• Orthopedic surgeon or trained physician
• Nurse
• Anesthesiologist (if sedation or anesthesia is used)

Risks and Complications

• Pain and discomfort during manipulation.
• Potential for improper bone healing or misalignment.
• Risks associated with anesthesia or sedation.
• Infection, though rare.
• Temporary immobilization-related stiffness or muscle atrophy.

Benefits

• Non-surgical approach with fewer associated risks compared to open surgery.
• Pain relief and proper bone healing.
• Restored arm and shoulder function.
• Reduced recovery time compared to surgical alternatives.

Recovery

• Follow-up appointments for X-rays to monitor healing.
• Pain management using prescribed medications.
• Physical therapy may be recommended to restore strength and mobility.
• Generally, the recovery period ranges from 6 to 12 weeks, varying by patient age and fracture severity.
• Patients should avoid heavy lifting or strenuous activity during recovery.

Alternatives

• Surgical fixation with plates, screws, or rods.
• Conservative management with immobilization alone (no manipulation).
• Pros: Surgery might provide a more stable fixation but comes with higher risks and longer recovery. Conservative management avoids procedural risks but may result in less precise bone alignment.

Patient Experience

• Patients might feel some discomfort or pain during manipulation, especially if sedation or anesthesia is not used.
• After the procedure, there could be soreness, which can be managed with pain medication and icing.
• Restricted arm movement during immobilization can impact daily activities, but physical therapy will aid recovery and return to normal function.