26546 Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation)

Name of the Procedure:

Repair Non-Union, Metacarpal or Phalanx (includes obtaining bone graft with or without external or internal fixation)

Summary

This procedure involves repairing a non-union, which is a broken bone that hasn't healed properly, in the metacarpal (hand bone) or phalanx (finger bone). The surgery may involve placing a bone graft (a small piece of bone from another part of your body) and using metal hardware like pins or plates to stabilize the bone while it heals.

Purpose

The procedure addresses non-union fractures of the hand or fingers, where the bones have failed to heal on their own. The goal is to stabilize the bones, promote healing, and restore function and strength to the affected hand or finger.

Indications

• Persistent pain at the fracture site
• Visible deformity or abnormal movement at the fracture site
• Lack of healing seen in X-rays over an extended period
• Decreased function or strength in the hand or finger
• Symptoms persisting more than 6 months after initial fracture

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or pausing certain medications as directed by the surgeon
• Blood tests and imaging studies like X-rays or a CT scan to evaluate the non-union
• Preoperative consultation with the surgical team

Procedure Description

1. The patient is given general or regional anesthesia.
2. An incision is made over the site of the non-union.
3. The surgeon removes any tissue preventing proper healing.
4. A bone graft is obtained, usually from the patient's hip or another donor source.
5. The bone graft is placed at the non-union site.
6. Metal hardware, such as screws, plates, or external fixators, is applied to stabilize the bone.
7. The incision is closed with sutures, and the hand is bandaged.

Duration

The surgery typically takes 1.5 to 3 hours, depending on the complexity of the fracture and the extent of the bone grafting required.

Setting

This procedure is usually performed in a hospital or specialized surgical center.

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Allergic reactions to anesthesia
• Damage to surrounding tissues like nerves or blood vessels
• Non-union reoccurrence
• Hardware irritation or failure

Benefits

The procedure aims to stabilize the bone, promote proper healing, relieve pain, and restore hand or finger function. Benefits are often realized within a few months as the bone heals and strength returns.

Recovery

• Pain management with prescribed medications
• Immobilization with a cast or brace for a few weeks
• Physical therapy to restore movement and strength
• Regular follow-up appointments to monitor bone healing
• Restrictions on heavy lifting or vigorous activities until fully healed
• Full recovery typically takes 3 to 6 months

Alternatives

• Continued non-surgical treatment (e.g., bone stimulators, physical therapy)
• Alternative surgical procedures without bone grafting
• Each alternative has its pros and cons, such as longer healing times or less effective outcomes compared to surgical repair.

Patient Experience

Patients may experience post-operative pain and discomfort, managed by prescription pain relief. Swelling and stiffness are common in the initial recovery phase. Physical therapy may be necessary to regain full function. Overall, most patients report significant improvement in pain and function once fully recovered.