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Closed treatment of radial shaft fracture; with manipulation

CPT4 code

Name of the Procedure:

Closed Treatment of Radial Shaft Fracture; with Manipulation
Common Name(s): Closed Reduction of Radial Shaft Fracture

Summary

Closed treatment of a radial shaft fracture with manipulation is a non-surgical procedure to realign and stabilize a broken radial bone in the forearm. It involves using manual pressure to reposition the bone fragments without making any incisions.

Purpose

This procedure addresses fractures of the radial shaft, a common type of forearm fracture. The goals are to correctly align the bone fragments, facilitate proper healing, and restore normal function to the forearm.

Indications

  • Visible deformity or swelling in the forearm
  • Inability to move the wrist or elbow
  • Severe pain in the forearm
  • Diagnosis of a radial shaft fracture through X-rays

Preparation

  • The patient may be asked to fast if sedation is planned.
  • Adjustments to medications, such as blood thinners, might be necessary.
  • Pre-procedure X-rays or scans to assess the fracture.

Procedure Description

  1. Anesthesia/Sedation: The patient may receive local anesthesia or conscious sedation for comfort.
  2. Manipulation: The healthcare provider uses their hands to apply controlled pressure, manipulating the bone fragments back into place.
  3. Imaging: X-rays or fluoroscopy may be used to guide the manipulation and verify correct alignment.
  4. Casting/Splinting: The arm is immobilized with a cast or splint to maintain the proper position during healing.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

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

Personnel

  • Orthopedic surgeon or emergency room physician
  • Nurses
  • Radiologic technologist (if imaging is used)
  • Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

  • Pain or discomfort during manipulation
  • Swelling and bruising
  • Improper alignment or malunion
  • Nerve or blood vessel injury
  • Risk of a compartment syndrome
  • Infection (rare)

Benefits

  • Non-surgical realignment of the bone
  • Reduced healing time compared to surgical methods
  • Restoration of normal forearm function
  • Immediate pain relief after proper alignment

Recovery

  • Keep the arm elevated to reduce swelling.
  • Regular follow-up appointments for X-rays to monitor healing.
  • Avoid heavy lifting or strenuous activity for several weeks.
  • Physical therapy may be recommended to restore strength and mobility.

Alternatives

  • Surgical intervention (open reduction and internal fixation)
    • More invasive but may be necessary if closed treatment is unsuccessful.
    • Involves placing hardware (plates, screws) to stabilize the bone.
    • Pros: More stable fixation, faster return to full activity.
    • Cons: Surgical risks, longer recovery time.

Patient Experience

Patients might feel pressure and discomfort during bone manipulation. After the procedure, pain should be controlled with prescribed pain medications and anti-inflammatory drugs. The cast or splint may cause some inconvenience but is crucial for healing. Regular check-ups help ensure the bone is healing correctly, and physical therapy may assist in regaining full function.

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