29850 Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)

Name of the Procedure:

Arthroscopically Aided Treatment of Intercondylar Spine(s) and/or Tuberosity Fracture(s) of the Knee, Without Internal or External Fixation

Summary

This minimally invasive procedure uses an arthroscope to treat fractures in the intercondylar spines or tuberosity of the knee. It includes the visual inspection and manipulation of the fractured area without the use of plates, screws, or other fixation devices.

Purpose

This procedure addresses knee fractures involving the intercondylar spine or tibial tuberosity, which can impede motion and cause pain. The goal is to realign the bone fragments and promote healing while minimizing surgical trauma and recovery time.

Indications

• Fractured intercondylar spine(s) or tuberosity of the knee.
• Difficulty in knee movement due to fracture.
• Persistent knee pain due to the injury.
• Failure of conservative treatments to improve the condition.

Preparation

• Fasting typically required 6-12 hours before the procedure.
• Adjustments to certain medications as advised by the doctor.
• Pre-procedure imaging studies such as X-rays or MRIs to assess the fracture.
• Pre-surgical evaluation, including blood tests and possibly a physical exam.

Procedure Description

1. Anesthesia: The procedure starts with the administration of regional or general anesthesia.
2. Arthroscopy: Small incisions are made around the knee, and an arthroscope (a small camera) is inserted to provide a clear view inside the joint.
3. Manipulation: Surgical instruments are introduced through additional small incisions to manipulate and realign the fractured bone fragments.
4. Inspection: The surgeon visually inspects the joint and ensures bones are properly positioned.
5. Closure: The procedure ends with the closure of incisions using sutures or staples, and the application of sterile dressings.

Duration

Typically takes between 1 to 2 hours.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding or bruising
• Blood clots
• Injury to surrounding tissues or nerves
• Persistent pain or stiffness
• Re-fracture or improper healing of bone

Benefits

• Minimally invasive with smaller incisions.
• Shorter recovery time compared to open surgery.
• Reduced postoperative pain and faster return to normal activities.

Recovery

• Initial recovery period includes rest, ice, compression, and elevation (RICE therapy).
• Pain management with prescribed medications.
• Physical therapy may be recommended to regain strength and range of motion.
• Specific activity restrictions for several weeks.
• Follow-up appointments to monitor healing progress.

Alternatives

• Open surgical repair with internal fixation (plates/screws).
• Conservative treatments like casting or bracing (less effective for certain fractures).
• Pros: Alternate surgeries might provide more robust fixation; cons: longer recovery, increased surgical risks.

Patient Experience

• During the procedure, the patient is under anesthesia and will not feel pain.
• Post-procedure, some discomfort and mild pain at the incision sites can be expected.
• Pain management includes medications and ice packs.
• Patients might experience swelling and need crutches or a knee brace temporarily.
• Full recovery can vary but usually takes a few weeks to a few months depending on the severity of the fracture and individual healing rates.