25608 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments

Name of the Procedure:

Open Treatment of Distal Radial Intra-Articular Fracture or Epiphyseal Separation with Internal Fixation of 2 Fragments

Summary

This surgical procedure involves the open repositioning and internal fixation of a broken or dislocated distal radius (the end of the radius bone near the wrist) that has fractured into two pieces. It aims to restore proper bone alignment and stability using surgical hardware like screws or plates.

Purpose

The procedure addresses distal radial fractures that extend into the joint space (intra-articular) or involve the growth plate (epiphyseal separation). The goal is to re-align the bone fragments to ensure proper healing and restore wrist function and stability, thus preventing long-term complications such as arthritis or deformity.

Indications

• Severe distal radial fractures with intra-articular involvement.
• Epiphyseal separations of the distal radius.
• Displaced fractures where non-surgical treatments (e.g., casting) are insufficient.
• Fractures with bone instability or those that failed to heal with conservative treatment.

Preparation

• Pre-operative fasting for at least 6-8 hours.
• Adjustment of medications, especially blood thinners, as per doctor’s advice.
• Pre-operative imaging tests like X-rays or CT scans to assess the fracture.
• General health assessment including blood tests and physical examination.

Procedure Description

1. The patient is administered general anesthesia or regional anesthesia.
2. An incision is made over the wrist to expose the fractured bone.
3. The bone fragments are carefully repositioned into their normal alignment.
4. Internal fixation is achieved using screws, plates, or pins to secure the bone fragments.
5. The incision is closed with sutures, and a sterile bandage is applied.
6. The wrist may be immobilized with a cast or splint to promote healing.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the fracture.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection at the surgical site
• Damage to nerves or blood vessels
• Poor bone healing or non-union
• Loss of wrist motion
• Need for additional surgeries
• Rare complications: hardware failure or migration

Benefits

• Proper alignment and stabilization of the bone
• Improved healing and wrist function
• Reduced risk of long-term complications such as arthritis
• Shorter recovery time compared to non-surgical methods

Recovery

• Post-procedure immobilization of the wrist.
• Pain management with medications.
• Physical therapy to regain strength and mobility.
• Regular follow-up appointments for X-rays and evaluation.
• Full recovery typically takes 3 to 6 months, depending on the individual and severity of the fracture.

Alternatives

• Non-surgical treatment like casting or splinting, suitable for less severe fractures.
• External fixation methods in certain cases.
• Pros: Less invasive, shorter initial recovery time.
• Cons: Higher risk of improper bone healing and long-term complications.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, there may be moderate pain managed with medications, potential swelling, and restricted wrist movement. Physical therapy and regular check-ups will be needed to ensure proper recovery and functional restoration of the wrist.