Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation
CPT4 code
Name of the Procedure:
Closed Treatment of Trans-Scaphoperilunar Type of Fracture Dislocation (Closed Reduction of Scaphoperilunate Dislocation)
Summary
This procedure involves the non-surgical realignment of a dislocation of the scaphoid and surrounding bones in the wrist. The bones are manually manipulated back into place without making an incision, and the wrist is then immobilized to allow for healing.
Purpose
This procedure addresses fracture dislocations in the wrist, specifically involving the scaphoid bone and surrounding structures. The goal is to restore the normal alignment and function of the wrist, reduce pain, and facilitate proper healing.
Indications
- Severe wrist pain and swelling due to a scaphoperilunate dislocation
- Obvious deformity or restricted movement of the wrist
- Evidence of fracture dislocation on imaging tests
- Inability to use the wrist normally
Preparation
- Fasting may be required if sedation or anesthesia will be used
- Review of medical history and current medications with the healthcare provider
- Diagnostic imaging such as X-rays, CT scans, or MRI to assess the extent of the injury
Procedure Description
- Anesthesia/Sedation: Local anesthesia or sedation may be administered to ensure patient comfort.
- Manipulation: The healthcare provider manually maneuvers the scaphoid and surrounding bones back into their correct positions.
- Immobilization: After the bones are realigned, the wrist is immobilized using a cast or splint to maintain proper positioning and allow for healing.
Duration
The procedure typically takes about 30 minutes to an hour, depending on the complexity of the dislocation and the time needed for optimal manipulation.
Setting
This procedure is commonly performed in an emergency room, hospital, or outpatient clinic.
Personnel
- Orthopedic surgeon or specialized healthcare provider
- Nursing staff for assistance
- Anesthesiologist or sedation nurse, if necessary
Risks and Complications
- Pain or discomfort during and after the procedure
- Risk of re-dislocation or improper alignment
- Potential for nerve or blood vessel damage
- Rarely, infection or adverse reaction to anesthesia/sedation
Benefits
- Relief from pain and swelling
- Restoration of normal wrist alignment and function
- Prevention of long-term complications such as arthritis or chronic pain
Recovery
- Keep the wrist elevated and immobilized as directed
- Follow-up appointments for monitoring healing and progress
- Physical therapy may be recommended to restore full function
- Typical recovery time ranges from 6 to 12 weeks
Alternatives
- Open surgical reduction with internal fixation, which involves making an incision and securing the bones with hardware
- Conservative management with splinting or casting alone, which may not be effective for severe dislocations
Patient Experience
Patients may feel pressure or mild discomfort during manipulation. Post-procedure, the wrist may be sore, and pain management will be provided. Immobilization will require some lifestyle adjustments, but most patients can gradually return to normal activities following recovery guidelines.
Pain management typically includes over-the-counter pain relievers and following care instructions to minimize discomfort.