Excision distal ulna partial or complete (eg, Darrach type or matched resection)
CPT4 code
Name of the Procedure:
Excision of Distal Ulna (Partial or Complete), also known as Darrach Procedure or Matched Resection.
Summary
In layman’s terms, excision of the distal ulna involves surgically removing part or all of the end of the ulna bone in the forearm near the wrist. This procedure helps to alleviate pain and restore function in the wrist.
Purpose
This procedure addresses conditions related to the ulna bone of the wrist that cause pain and functional limitations. The goals are to relieve pain, restore wrist motion, and improve grip strength and overall hand function.
Indications
- Persistent wrist pain due to arthritis
- Instability or damage to the distal radioulnar joint
- Post-traumatic deformities
- Failed previous wrist surgery
Eligible patients typically experience significant wrist pain, restricted motion, and decreased wrist function despite non-surgical treatments.
Preparation
- Pre-procedure fasting, usually from midnight before the surgery
- Adjustments to current medications, particularly blood thinners
- Diagnostic imaging such as X-rays or MRIs to assess the extent of bone and joint damage
Procedure Description
- The patient receives anesthesia, typically general or regional.
- An incision is made over the wrist to expose the ulna bone.
- Surgeons identify and protect surrounding nerves and blood vessels.
- The distal part of the ulna is carefully excised, either partially or completely.
- The site is irrigated and checked for stability and alignment.
- The incision is closed with sutures, and the wrist is bandaged.
Tools used include surgical retractors, oscillating saws, and suturing materials.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is performed in a hospital or surgical center, often in an operating room.
Personnel
- Orthopedic Surgeon
- Nurses
- Anesthesiologist
- Surgical Technicians
Risks and Complications
- Infection
- Nerve or blood vessel damage
- Nonunion or delayed healing of bone
- Instability of the wrist joint
- Chronic pain or stiffness
- Complications from anesthesia
Benefits
- Alleviation of chronic wrist pain
- Improved wrist motion and function
- Enhanced quality of life and ability to perform daily activities
Benefits are usually noticed within a few weeks to a few months post-surgery.
Recovery
- Initial recovery involves wrist immobilization with a cast or splint.
- Physical therapy usually starts a few weeks post-surgery to improve strength and range of motion.
- Full recovery can take several months, with activity restrictions gradually lifted.
- Follow-up appointments are critical to monitor healing and progress.
Alternatives
- Non-surgical management: physical therapy, anti-inflammatory medications, and wrist braces.
- Arthroscopic debridement or synovectomy.
- Distal Ulnar Hemiresection Arthroplasty, which minimizes bone removal.
Each alternative has its pros and cons regarding recovery time, risk factors, and effectiveness.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Post-surgery, there will be some degree of pain and discomfort which will be managed with pain medications. Swelling and bruising are common and will subside over time. Patients will need to manage post-operative care and attend physical therapy sessions to ensure successful recovery.