Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulation
CPT4 code
Name of the Procedure:
Closed treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process[es]); with manipulation.
Summary
This procedure involves the non-surgical realignment and stabilization of a fractured proximal end of the ulna, which is the bone in the forearm close to the elbow. The process uses manual manipulation to ensure the bone is properly aligned.
Purpose
This treatment addresses fractures of the upper part of the ulna, such as the olecranon or coronoid processes. The goal is to ensure proper bone alignment to promote healing, restore function, and alleviate pain.
Indications
- Acute pain and swelling at the elbow or forearm.
- Visible deformity or inability to move the elbow or forearm.
- X-ray or imaging confirming a fracture of the proximal ulna.
- Patients with reasonably stable fractures that do not require surgical intervention.
Preparation
- The patient may be advised to fast for a few hours if sedation is planned.
- Adjustments in medication, particularly blood thinners, as suggested by the doctor.
- Pre-procedural imaging like X-rays to assess the extent and exact location of the fracture.
Procedure Description
- Anesthesia: Local anesthesia or mild sedation might be administered to minimize discomfort.
- Reduction: The healthcare provider manually manipulates the elbow and forearm to realign the fractured bone.
- Stabilization: A splint or cast is applied to keep the bone aligned and stabilize the fracture during healing.
- Imaging: Post-reduction X-rays may be taken to confirm proper alignment.
Duration
The procedure typically takes about 30 minutes to an hour, including preparation and post-procedural imaging.
Setting
The procedure is usually performed in an emergency room, outpatient clinic, or a hospital setting.
Personnel
- Orthopedic surgeon or specialist
- Radiology technician for imaging
- Nursing staff for patient care and support
- Anesthesiologist, if sedation is required
Risks and Complications
- Pain or discomfort during manipulation.
- Risk of misalignment or delayed healing.
- Potential for nerve or blood vessel injury.
- Possible need for surgical intervention if closed treatment fails.
Benefits
- Non-invasive with no surgical incision.
- Faster recovery compared to surgical options.
- Immediate pain relief from proper bone alignment.
- Reduced risk of infection compared to open surgical procedures.
Recovery
- Immediate post-procedural care includes keeping the limb elevated and applying ice packs to reduce swelling.
- Regular follow-up appointments to monitor healing progress via X-rays.
- Physical activity restrictions and prescribed physical therapy to regain strength and mobility.
- Typical recovery time ranges from 6 to 12 weeks.
Alternatives
- Open reduction and internal fixation (surgical intervention) if the fracture is complex or unstable.
- Conservative management with immobilization in a cast or brace without manipulation, which may risk suboptimal healing.
Patient Experience
During the procedure, the patient may feel pressure or mild discomfort if local anesthesia is used. Post-procedure, the patient might experience swelling and soreness at the fracture site, managed with pain medications. Comfort measures, such as elevation and cold compresses, assist in alleviating symptoms. Physical therapy will aid in restoring function and strength to the arm.