Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws
CPT4 code
Name of the Procedure:
Treatment of Humeral Shaft Fracture with Insertion of Intramedullary Implant (IM Nail), with or without Cerclage and/or Locking Screws
Summary
This procedure involves surgically repairing a broken upper arm bone (humerus) by inserting a metal rod (intramedullary implant) into the marrow canal of the bone. Additional support using wires (cerclage) and screws (locking screws) may also be applied to stabilize the fracture and ensure proper healing.
Purpose
The procedure addresses fractures of the humeral shaft, aiming to stabilize the bone for proper alignment and healing. The expected outcome is the restored function of the arm with a reduction in pain and prevention of future complications.
Indications
- Presence of a humeral shaft fracture
- Severe pain and instability in the affected arm
- Fractures that show no signs of healing with conservative treatments (e.g., casting or bracing)
- Multiple fractures (comminuted fractures) or open fractures
- Non-union or malunion of previous fractures
Preparation
- The patient may be asked to fast for 8-12 hours before the surgery.
- Alterations in regular medications, especially blood thinners, may be necessary.
- Preoperative imaging tests like X-rays or CT scans to evaluate the fracture.
- A general health assessment and anesthesia evaluation.
Procedure Description
- Anesthesia: Administer general anesthesia to ensure the patient is unconscious and pain-free.
- Incision: Make an incision near the shoulder or the upper part of the arm.
- Fracture Alignment: Realign the broken bone ends.
- Insertion of IM Nail: Insert the intramedullary nail into the marrow canal of the humerus.
- Additional Stabilization: If needed, apply cerclage wires around the bone and secure the position with locking screws.
- Closure: Close the incision with sutures and apply a sterile bandage.
Duration
The procedure typically takes around 1 to 2 hours.
Setting
The procedure is performed in a hospital's operating room or a surgical center equipped for orthopedic surgeries.
Personnel
- Orthopedic Surgeon
- Anesthesiologist
- Surgical Nurses
- Radiologic Technologist (if intraoperative imaging is needed)
Risks and Complications
- Infection at the surgery site
- Bleeding or blood clots
- Damage to surrounding nerves or blood vessels
- Non-union or delayed union of the fracture
- Implant failure or irritation
- Allergic reactions to anesthesia
Benefits
- Stable and properly aligned fracture for optimal healing
- Reduced pain and improved arm function
- Shorter recovery time compared to non-surgical treatments for complex fractures
Recovery
- Post-procedure hospitalization for 1-2 days for monitoring
- Prescription of pain medications and antibiotics
- Arm immobilization with a sling or brace initially
- Gradual introduction of physical therapy
- Follow-up appointments for X-rays to monitor healing
- Recovery typically spans 3 to 6 months with gradual return to normal activities
Alternatives
- Non-surgical methods like casting, bracing, or functional bracing
- External fixation, where pins and external rods stabilize the fracture
- Pros: Non-surgical options avoid surgical risks and anesthesia-related complications
- Cons: May result in prolonged immobilization, higher risk of malunion or non-union
Patient Experience
- During the procedure: The patient will be unconscious and should not feel pain due to general anesthesia.
- After the procedure: Expect some pain and swelling at the surgery site, managed with pain relief medications.
- Hospital stay: Typically brief but includes monitoring for potential complications.
- Discomfort: Temporary discomfort from the incision and immobilization. Physical therapy will help regain mobility and strength.