# excision of a nonunion fragment of shoulder



## trose45116 (Aug 10, 2010)

i was thinking of 23130 but not sure it that is it. 


Fibrous nonunion of acromion fracture. 

2.  Bursitis.  


PROCEDURES:   1.  Excision of nonunion fragment, right shoulder. 

2.  Bursectomy. 

3.  Inspection of rotator cuff. 


ANESTHESIA:   General.   



INDICATIONS:  This patient underwent arthroscopic rotator cuff repair approximately six months ago.  She continued to have pain and discomfort in the shoulder area, and sought my attention.  An MRI was performed and showed that there was a recurrent tear of the rotator cuff, and therefore, we discussed surgical intervention.  We discussed an open procedure.  The patient understood this and agreed to surgery.  



DESCRIPTION OF PROCEDURE:  The patient was transferred via gurney to operative theater and placed under general anesthesia without difficulty or problems.  A scalene block was administered.  A small incision over the anterior aspect of the shoulder was placed.  We sharply dissected down through the subcutaneous tissue. The tissue was divided longitudinally in both the medial and lateral planes, and we were able to identify the deltoid as it attached on the acromion.  Electrocautery was utilized, and we were able to remove the deltoid from its anterior aspect.  We noticed immediately that the acromion was movable.  We identified it.  There was a nonunion fibrous tissue fragment present over the anterior aspect of the acromion.  We initially looked to repair it; however, at that point in time, we elected not to repair it, and we felt that a debridement of the fibrous tissue and excision of the fragment was more appropriate.  The fragment was excised.  This allowed visualization of the undersurface.  There was an extensive amount of scar tissue present on the undersurface.  There was an extensive amount of bursal tissue appreciated.  We irrigated copiously.  We inspected the rotator cuff.  The arm was placed through a full and complete range of motion, and under direct visualization and digital palpation we were unable to appreciate a tear of the tendon.  We removed the bony fragment and nonunion site.  At that point in time, we inspected the entire rotator cuff pathology and no rotator cuff tear was seen.  There was an extensive amount of scuffing, but I was unable to identify a complete tear.   We irrigated once again.  At that point in time we reapproximated the deltoid to the acromion.  Subcutaneous sutures followed.  Sutures followed in the skin.  A sterile dressing was applied.  He was awakened from anesthesia, transferred via gurney and taken to the recovery room stable.


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