25440 Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)

Name of the Procedure:

Repair of Nonunion, Scaphoid Carpal (Navicular) Bone, with or without Radial Styloidectomy

Summary

This surgical procedure addresses a nonunion (a broken bone that has not properly healed) of the scaphoid, a small bone in the wrist. It may include removing a portion of the radial styloid (a part of the radius bone near the wrist), obtaining and using a bone graft, and fixing the bone in place to facilitate proper healing.

Purpose

The procedure treats a nonunion of the scaphoid bone, which can lead to chronic pain, limited wrist movement, and arthritis if left untreated. Goals include stabilizing the bone, promoting healing, reducing pain, and restoring wrist function.

Indications

• Persistent wrist pain despite non-surgical treatments
• Confirmed nonunion of the scaphoid bone via imaging tests
• Restricted wrist motion
• Signs of wrist instability or early arthritis

Preparation

• Fasting typically required for 8-12 hours before surgery
• Adjustments to medications, particularly blood thinners
• Pre-operative imaging tests (X-rays, MRI or CT scans) to assess bone condition
• Possible pre-surgery physical exams and lab tests

Procedure Description

1. Patient is placed under general anesthesia or regional anesthesia (nerve block).
2. An incision is made over the wrist to access the scaphoid bone.
3. Any fibrous tissue or failed union between bone fragments is removed.
4. A bone graft (usually taken from the patient’s pelvis or distal radius) is prepared.
5. The graft is placed at the site of the nonunion.
6. The scaphoid and graft are stabilized using screws or pins.
7. If needed, the radial styloid is partially removed to reduce impingement.
8. Incision is closed with stitches or sutures, and a dressing is applied.

Duration

The procedure typically takes 1.5 to 3 hours.

Setting

Performed in a hospital operating room or outpatient surgical center.

Personnel

• Orthopedic surgeon specializing in hand and wrist surgery
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technologists

Risks and Complications

• Infection at the surgical site
• Nerve or blood vessel damage
• Failure of the bone to heal (persistent nonunion)
• Hardware complications (e.g., screw loosening)
• Post-surgical stiffness or decreased wrist mobility
• Pain at the graft site

Benefits

• Improved bone healing and stabilization
• Reduction or elimination of chronic wrist pain
• Increased range of motion and wrist functionality
• Potential prevention of arthritis development

Recovery

• Immobilization of the wrist using a cast or splint for 6-12 weeks
• Pain management with prescribed medications
• Physical therapy may begin after initial healing
• Regular follow-up appointments for X-rays and assessments
• Full recovery typically ranges from 3 to 6 months

Alternatives

• Continued nonsurgical management (e.g., splinting, medications)
• Alternative surgical options like percutaneous screw fixation
• Each alternative carries its own benefits and risks, with the non-surgical route often resulting in prolonged symptoms and lesser functional improvement.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia. Post-surgery, some discomfort and pain at the wrist and graft site are expected, which can be managed with medications. Initial immobilization may be inconvenient but is crucial for healing, and physical therapy will aid in regaining wrist function.