Open treatment of trans-scaphoperilunar type of fracture dislocation
CPT4 code
Name of the Procedure:
Open Treatment of Trans-Scaphoperilunar Fracture Dislocation
Common Name(s): Open wrist fracture repair
Summary
The procedure involves surgically realigning and fixing a dislocated and fractured wrist, specifically addressing a complex injury where the scaphoid and surrounding bones have been displaced.
Purpose
This procedure aims to correct the alignment of wrist bones after a trans-scaphoperilunar fracture-dislocation. It ensures proper healing, restores wrist function, and alleviates pain.
Indications
- Severe wrist trauma causing bone dislocation and fracture
- Persistent pain and swelling
- Loss of wrist function and mobility
- Visible deformity of the wrist
Preparation
- Fasting for at least 6-8 hours prior to the procedure
- Medication review and possible adjustments
- Preoperative imaging (e.g., X-rays, MRI) to assess the injury
- Blood tests and physical examination
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the affected wrist.
- Realignment: The surgeon repositions the dislocated bones and reconnects them.
- Fixation: Metallic screws, pins, or plates may be used to stabilize the bones.
- Wound Closure: The incision is closed with sutures, and a splint or cast is applied.
Duration
The procedure typically takes 2-3 hours.
Setting
Usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Radiology technician (if intraoperative imaging is needed)
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Poor bone healing or non-union
- Stiffness or loss of wrist mobility
- Hardware irritation or failure
Benefits
- Realignment and stabilization of wrist bones
- Reduction in pain
- Restoration of wrist function and mobility
- Prevention of long-term complications like arthritis
Recovery
- Immediate postoperative care includes elevation and icing to reduce swelling.
- Pain management with prescribed medications.
- Splint or cast worn for several weeks.
- Physical therapy may be required to restore strength and mobility.
- Recovery time may vary but generally takes several months.
Alternatives
- Non-surgical treatment with casting or splinting (less effective for severe injuries)
- Closed reduction and percutaneous pinning (minimally invasive but not suitable for all cases)
- Pros of alternatives: Less invasive, shorter initial recovery
- Cons of alternatives: Potential for inadequate stabilization and long-term issues
Patient Experience
During the procedure, patients will be under anesthesia and feel no pain. Postoperatively, there may be discomfort and swelling, managed by pain medications and immobilization. Full recovery often involves rehabilitation, but most patients can expect a return to normal activities over time.