Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula
CPT4 code
Name of the Procedure:
Partial excision (craterization, saucerization, or diaphysectomy), bone (e.g., osteomyelitis); fibula
Summary
In layman's terms, this procedure involves the surgical removal of a part of the fibula bone. It is typically done to treat a severe bone infection, known as osteomyelitis, by eliminating the diseased bone tissue.
Purpose
The procedure is aimed at treating osteomyelitis, which is a severe bone infection. The goal is to remove the infected bone tissue to prevent the infection from spreading. Expected outcomes include alleviation of pain, resolution of infection, and improved functionality of the affected leg.
Indications
- Persistent or chronic osteomyelitis (bone infection) that does not respond to antibiotics.
- Severe symptoms such as deep bone pain, fever, and inflammation.
- Diagnostic imaging confirming the presence of an infected area in the fibula.
- Suitable for patients who have not responded to conservative treatments.
Preparation
- The patient may be instructed to fast for several hours before the procedure.
- Medication adjustments might be necessary, especially if the patient is on blood thinners or other medications affecting surgery.
- Pre-operative imaging tests, such as X-rays or MRI, to determine the extent of the infection.
- Blood tests to check for overall health status.
Procedure Description
- The patient is placed under general anesthesia or regional anesthesia (depending on the case).
- An incision is made over the fibula to expose the bone.
- The surgeon identifies and removes the infected part of the bone using specialized surgical instruments.
- The bone surface may be smoothed or reshaped (craterization or saucerization) if needed.
- The surgical site is thoroughly cleaned to remove any remaining infected tissue.
- The incision is closed with sutures or staples and dressed appropriately.
Duration
The procedure typically takes 1 to 2 hours, depending on the extent of the infection and complexity of the surgery.
Setting
This procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Injury to surrounding tissues or structures
- Delayed bone healing or non-union
- Possible need for additional surgeries
- Anesthesia-related risks
Benefits
- Resolution of the bone infection
- Reduction in pain and inflammation
- Improved leg function and mobility
- Prevention of the infection spreading to other areas
Recovery
- Post-procedure, the patient will stay in the hospital for observation until stable.
- Instructions for wound care, medications (e.g., antibiotics, pain relief), and activity restrictions will be provided.
- Physical therapy might be recommended to restore leg function.
- Follow-up appointments will be scheduled to monitor healing.
- Full recovery can vary from several weeks to a few months, depending on the individual case.
Alternatives
- Long-term antibiotic therapy, though not always effective for chronic infections.
- Complete fibula excision, a more invasive procedure.
- Hyperbaric oxygen therapy as an adjunct to antibiotics.
- Pros of alternatives include less invasive options, but they may not be as effective for chronic or severe infections.
Patient Experience
- During the procedure, the patient will be under anesthesia and will not feel pain.
- Post-operatively, there might be discomfort and swelling, managed with pain medication.
- The patient should anticipate a period of restricted activity and use of crutches or a walker.
- Gradual resumption of normal activities as healing progresses and physical therapy may be recommended.