CPT® Code 23670

Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed

An open treatment of shoulder dislocation with a fracture of the greater tuberosity of the humerus involves a surgical procedure where the dislocated shoulder is repositioned, and any associated fracture of the greater tuberosity is addressed. The greater tuberosity is a bony prominence on the humerus where the rotator cuff muscles attach. In cases of fracture-dislocation, this area may become displaced, leading to retraction of the rotator cuff musculature, which can complicate the dislocation. The procedure typically requires a deltopectoral approach, which allows for direct access to the shoulder joint. During the surgery, the clavipectoral fascia is divided to facilitate exposure, and the surrounding anatomical spaces are developed to provide a clear view of the joint structures. The axillary nerve, which innervates the deltoid muscle and provides sensation to the skin overlying the shoulder, is carefully located and protected throughout the procedure to prevent injury. The long head of the biceps tendon is also identified and followed to the rotator interval, which is opened to access the dislocated structures. The surgical team will then identify the displaced bone fragment of the greater tuberosity and secure it using sutures at the junction where the tendon attaches to the bone. Additional fixation techniques, such as drilling holes in the humeral shaft and passing sutures through these holes, may be employed to enhance stability. The humeral head and lesser tuberosity are then reduced and fixed, followed by the reduction and fixation of the greater tuberosity fracture. This may involve the use of sutures, staples, or internal fixation devices like wires, plates, or screws. After addressing the fracture, any damage to the rotator cuff is repaired to restore function and stability to the shoulder joint.