Indications:
This procedure is indicated for a number of problems around the shoulder joint. Common indications are for proximal humerus fractures, humerus shaft (arm bone) fractures, clavicle (collar bone) fractures, ACJ dislocations, scapula (shoulder blade) fractures. The indications for fracture surgery vary with each fracture.
What to expect before surgery
If you are to undergo this procedure with Dr Bala, you will usually consult a member from the anaesthetic team a few hours prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests and your old x-rays, CT scans or MRIs. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia with the addition of a nerve block at the base of the neck (interscalene block). The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for an hour or 2. Most shoulder fracture surgeries are day surgery procedures meaning you will usually go home the same day should you be well. Rarely if required you may have to stay overnight till, you’re more comfortable the next morning.
The nurse will instruct you on the time you should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It may not be possible to shower the night before surgery and remove jewellery at home.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. You will usually be given automatic calf compressors which massage the calf muscles during the duration of the surgery to prevent blood clots from forming. You will also be given an electrical warming blanket to ensure your body remains warm during the duration of the surgery. Some anaesthetists prefer to give the nerve block prior to the general anaesthesia while others prefer it the other way around. An IV antibiotic (usually cefazolin) is administered prior to surgical incision.
Surgery
Anaesthesia is usually given on the operating table. A special table with attachments to position the neck and support the arm is used. The procedure maybe done with you either lying on your side or sitting up. Dr Bala prefers the beach chair position with the ‘T max’ table attachment and any commercially available arm holding device (‘Spider’/ ‘Trimano”). For certain fractures such as the scapula fracture (shoulder blade fracture) surgery is best performed in the lateral or prone position with a support under the arm if needed. Once you are comfortably positioned on the operating table with adequate cushioning, a C arm is used to check to see if the fracture is visible. Then the operating side is cleaned and draped the procedure is begun. Everyone on the team will be protected against radiation with lead aprons. Dr Bala will ensure the patient is also adequately protected from radiation. Once the fracture has been adequately fixed, Dr Bala closes the wounds with absorbable suture. The operated area is cleaned and a compressive waterproof dressing is applied to soak up the ooze. A plaster maybe applied to an arm bone fracture after fixation if required. An arm sling is usually provided to support the arm after surgery. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedures performed you may visit the following pages of this website
Proximal humerus fracture https://pradeepbala.com/conditions-treated/proximal-humerus-fracture/
Shoulder dislocation https://pradeepbala.com/conditions-treated/shoulder-dislocation/
Collar bone fracture https://pradeepbala.com/conditions-treated/collar-bone-fracture/
Arm bone fracture https://pradeepbala.com/conditions-treated/arm-bone-humerus-fracture/
Scapula fracture https://pradeepbala.com/conditions-treated/shoulder-blade-fracture/
ACJ dislocation https://pradeepbala.com/conditions-treated/dislocations-of-the-acromio-clavicular-ac-and-sterno-clavicular-sc-joint/
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and may either be shifted to the ward or discharged directly from the theatre. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be discharged.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
You will be allowed to wipe the operated arm and shoulder with a wet towel on the following day and will be allowed to shower a couple of days after the surgery. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. Dr Bala sees his post op patients at around 2 weeks after surgery. There maybe a few sutures to remove if at all. You may require some sessions of physiotherapy after surgery to optimize the function of your shoulder and arm. Dr Bala will review x-rays at 6 and 12 weeks or until union.