25337 Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint

Name of the Procedure:

Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (e.g., tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint.

Summary

This procedure involves reconstructing and stabilizing the unstable distal ulna or distal radioulnar joint using techniques like tendon transfer, tendon graft, weave, or tenodesis. It may also include repositioning the joint if necessary.

Purpose

• Medical Condition: Addresses instability in the distal ulna or distal radioulnar joint, which can cause pain, reduced motion, and functional impairment.
• Goals: To restore joint stability, improve function, reduce pain, and prevent further joint damage.

Indications

• Chronic wrist pain and instability.
• Conditions like trauma, arthritis, or ligament injuries resulting in ulnar or radioulnar joint instability.
• Patients who have failed conservative treatments like physical therapy and medications.
• Specific diagnostic findings indicating instability in the distal ulna or distal radioulnar joint.

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Medication adjustments might be required, especially if blood thinners are involved.
• Pre-procedure tests such as X-rays or MRI scans to assess joint condition.
• A thorough medical evaluation and anesthesia consultation.

Procedure Description

1. Anesthesia: General anesthesia or regional block.
2. Incision: A surgical incision is made near the wrist.
3. Stabilization: Techniques such as tendon transfer, graft, weave, or tenodesis are used to stabilize the joint.
4. Open Reduction: If necessary, the distal radioulnar joint is repositioned properly using fixation devices.
5. Closure: The incision is closed with sutures, and a sterile bandage is applied.

Tools and equipment include surgical instruments, graft materials, and sometimes fixation devices like screws or pins.

Duration

Approximately 1-2 hours, depending on the complexity of the case.

Setting

Typically performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or hand surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Common: Infection, bleeding, and stiffness.
• Rare: Nerve damage, non-union or malunion of bones, thrombosis.
• Complications might require further interventions or prolonged recovery.

Benefits

• Improved joint stability and function.
• Reduced pain and discomfort.
• Prevention of further joint damage.
• Benefits can typically be realized within weeks to a few months post-surgery.

Recovery

• Initial immobilization with a cast or splint.
• Pain management with prescribed medications.
• Gradual increase in activity with physical therapy.
• Full recovery and return to normal activities may take several months.
• Follow-up appointments for monitoring healing and progress.

Alternatives

• Conservative management like bracing, physical therapy, and medications.
• Arthroscopic surgery, which is less invasive.
• Pros and cons: Conservative treatments might not provide lasting relief, and arthroscopic procedures may not be effective for all types of instability compared to the reconstructive procedure.

Patient Experience

• During the procedure: Patients are under anesthesia and will not feel pain.
• After the procedure: Some pain and discomfort are expected, managed with pain relief measures.
• Swelling and limited mobility in the initial recovery phase.
• Pain and discomfort typically decrease as healing progresses and physical therapy initiated.