Name of the Procedure:

Closed Treatment of Humeral Epicondylar Fracture, Medial or Lateral with Manipulation

Summary

This procedure involves resetting a fracture of the humeral epicondyle—either on the medial (inner) or lateral (outer) side of the elbow—without making an incision into the skin. The fractured bone fragments are manipulated back into place from the outside.

Purpose

This procedure is performed to treat a fracture of the humeral epicondyle, which is a common injury often caused by a fall or direct impact to the elbow. The goal is to reposition the bone fragments to allow proper healing and restore normal elbow function.

Indications

This procedure is indicated for:

• Visible deformity or abnormal positioning of the elbow.
• Pain, swelling, and bruising around the elbow.
• Limited range of motion in the elbow joint.
• X-ray confirmation of a displaced humeral epicondylar fracture.

Preparation

Preparation involves:

• Fasting for a certain period if general anesthesia will be used.
• Adjusting or temporarily discontinuing certain medications as advised by the healthcare provider.
• Pre-procedure X-rays to assess the fracture alignment.

Procedure Description

1. The patient is positioned comfortably, and sedation or local/general anesthesia is administered as needed.
2. The orthopedic specialist applies gentle but firm manipulation to realign the fractured bone fragments.
3. Once aligned, the elbow is immobilized with a splint or cast to maintain the correct position during healing.
4. Post-procedure X-rays may be taken to confirm proper alignment.

Duration

The entire procedure usually takes about 30 to 60 minutes.

Setting

The procedure is typically performed in an outpatient clinic, emergency room, or surgical center.

Personnel

The procedure involves:

• An orthopedic surgeon or a trained emergency room physician.
• Nurses or medical assistants.
• An anesthesiologist or anesthetist (if sedation or general anesthesia is administered).

Risks and Complications

Common risks include:

• Pain and discomfort during manipulation.
• Swelling and bruising.
• Possible nerve or blood vessel injury. Rare complications may include:
• Poor bone healing or malunion.
• Stiffness or decreased range of motion.
• Need for surgical intervention if closed treatment is unsuccessful.

Benefits

The primary benefit is the proper alignment of the fractured bone, which facilitates healing and the restoration of normal elbow function. Benefits are typically realized within a few weeks to months, depending on the severity of the fracture and the patient's adherence to post-procedure care.

Recovery

• Post-procedure care involves wearing a cast or splint for several weeks.
• Regular follow-up appointments for X-rays to monitor healing.
• Physical therapy may be recommended to restore elbow range of motion and strength.
• Full recovery typically takes 6 to 8 weeks, with varying restrictions based on the fracture's severity and healing progress.

Alternatives

• Conservative management with immobilization only (no manipulation), though this may not be effective for displaced fractures.
• Surgical treatment to realign and fix the fracture with pins or screws may be necessary if closed manipulation is unsuccessful.
• Each alternative has its own risks and benefits, with surgical intervention often having a longer recovery period but providing a more stable fixation.

Patient Experience

During the procedure, the patient may experience discomfort or pain, which is managed with anesthesia. After the procedure, some soreness and swelling are common, which can be managed with pain medication and ice packs. The immobilization required for healing may limit daily activities, but this is typically temporary. Regular follow-up and adherence to recovery guidelines are crucial for optimal outcomes.