24685 Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed

Name of the Procedure:

Open Treatment of Ulnar Fracture, Proximal End (e.g., Olecranon or Coronoid Process[es]), Including Internal Fixation

Summary

This surgical procedure involves the open reduction and internal fixation (ORIF) of a fracture at the proximal end of the ulna, specifically in the olecranon or coronoid processes. This is done to properly align and stabilize the broken bone using hardware like plates or screws.

Purpose

The procedure addresses fractures in the proximal ulna to ensure proper healing and restore function to the elbow and arm. This is especially critical for complex fractures where closed reduction (non-surgical realignment) isn't possible.

Indications

• Acute fractures of the olecranon or coronoid process.
• Displaced fractures where the bone fragments are not in their normal position.
• Fractures that don't heal properly with non-surgical treatments.
• Patients experiencing severe pain, loss of function, or instability in the elbow joint.

Preparation

• Patients may need to fast for a specified period before surgery.
• Temporary discontinuation of certain medications, especially blood thinners, as advised by the physician.
• Pre-operative imaging, such as X-rays or CT scans, to assess the fracture.

Procedure Description

1. The patient is placed under general anesthesia or regional block anesthesia.
2. An incision is made over the fracture site to expose the bone.
3. The fractured bone fragments are realigned (reduced).
4. Internal fixation devices, such as plates, screws, and/or wires, are used to stabilize the fracture.
5. The incision is closed with sutures, staples, or surgical glue.
6. A sterile dressing is applied, and the arm may be placed in a splint or cast.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the fracture.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Nerve damage or impairment
• Blood vessel injury
• Malunion or nonunion of the fracture
• Hardware complications (loosening, irritation)
• Compartment syndrome (increased pressure in a muscle compartment) Management of complications may involve additional medical treatments or surgeries.

Benefits

• Proper healing of the fracture
• Restoration of normal elbow function
• Reduction in pain and discomfort
• Improved arm strength and mobility

Recovery

• The arm may be immobilized with a splint or cast for several weeks.
• Pain management with prescribed medications.
• Physical therapy may be necessary to restore function and strength.
• Follow-up appointments to monitor healing.
• Full recovery can take several months, with gradual return to normal activities.

Alternatives

• Non-surgical treatment with immobilization (e.g., casting or splinting), suitable for less severe fractures.
• Minimally invasive surgical options, if applicable.
• Each alternative has its pros and cons, for instance, non-surgical methods may have a longer recovery time and a higher risk of improper healing.

Patient Experience

During the procedure, the patient will be under anesthesia and should feel no pain. Post-procedure, the patient may experience pain, swelling, and discomfort, which are managed with medications. Physical therapy may cause some discomfort but is essential for recovery. Patient comfort is a priority throughout the treatment process.