Name of the Procedure:

Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)

Summary

This surgical procedure repairs a fracture in the upper arm bone (humerus) that has not healed properly. The surgeon uses bone grafts from the patient's own body, often the pelvis (iliac crest), to aid in the healing process.

Purpose

The procedure addresses fractures of the humerus that have either not healed (nonunion) or healed incorrectly (malunion). The goal is to restore proper alignment and functionality of the bone, alleviating pain and allowing for normal movement.

Indications

• Pain or discomfort at the site of the humerus fracture.
• Limited mobility or dysfunction of the arm.
• Radiographic evidence showing nonunion or malunion.
• Failure of previous treatments to promote proper healing of the fracture.

Preparation

• Patients may need to fast for a specific period before the surgery.
• Medication adjustments may be necessary, particularly for those on blood thinners.
• Preoperative imaging studies such as X-rays or CT scans are often performed.
• Discussions with the surgical team about the procedure, risks, and recovery expectations.

Procedure Description

1. The patient is given general anesthesia for comfort and pain management.
2. An incision is made at the site of the humerus fracture.
3. The fractured bone is realigned to its proper position.
4. A bone graft is harvested from the iliac crest (pelvis) or another suitable site.
5. The graft is placed at the fracture site to stimulate bone growth and proper healing.
6. Fixation devices, such as plates, screws, or rods, may be used to secure the bone.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.
8. The patient is taken to the recovery area for monitoring as they wake up from anesthesia.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the fracture and the surgery.

Setting

This procedure is performed in an operating room within a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians
• Radiologic technologist (if intraoperative imaging is used)

Risks and Complications

• Infection at the surgical site or the donor site.
• Blood clots or deep vein thrombosis.
• Nerve or blood vessel damage.
• Nonunion or malunion of the bone even after surgery.
• Allergic reactions to anesthesia or materials used.

Benefits

• Alleviation of pain and discomfort due to improper bone healing.
• Restoration of proper alignment and function of the humerus.
• Potentially faster and more complete healing with the use of an autograft.

Recovery

• Post-procedure pain management with prescribed medications.
• Instructions for wound care and activity restrictions to ensure proper healing.
• Physical therapy may be recommended to regain strength and mobility.
• Most patients can expect to resume normal activities within 3 to 6 months, though full recovery might take longer.
• Follow-up appointments to monitor healing progress.

Alternatives

• Continued conservative management with physical therapy and bracing.
• Use of bone stimulators or other non-surgical treatments.
• Revision surgery with synthetic bone grafts or allografts (donated bone).
• Each alternative has its own risks, benefits, and success rates compared to autograft surgery.

Patient Experience

• During the procedure, the patient will be under general anesthesia and won't feel or remember the surgery.
• Postoperative pain and discomfort are managed with medication.
• Patients might experience soreness at both the surgical and donor sites.
• Adherence to postoperative care instructions is crucial for successful recovery and optimal outcomes.