26645 Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation

Name of the Procedure:

Closed Treatment of Carpometacarpal Fracture Dislocation, Thumb (Bennett Fracture), with Manipulation

Summary

The closed treatment of a Bennett fracture involves manually realigning the dislocated thumb joint without making any incisions. This procedure helps restore the thumb's normal function and alignment.

Purpose

This procedure addresses Bennett fractures, which are breaks or dislocations at the base of the thumb. The goal is to correct the dislocation and allow the bone to heal so that the thumb can regain its normal range of motion and strength.

Indications

• Severe pain and swelling at the base of the thumb
• Visible deformity of the thumb
• Reduced thumb mobility
• X-ray confirmation of a Bennett fracture

Preparation

• No eating or drinking for a specified period before the procedure if sedation is used.
• Inform the doctor of any medications, allergies, or underlying health conditions.
• Complete any necessary pre-procedure imaging such as X-rays.

Procedure Description

1. The patient is positioned comfortably, and sedation or local anesthesia is administered to ensure no pain during the manipulation.
2. The healthcare provider will manually manipulate the thumb to realign the dislocated joint and fracture.
3. Once the thumb is realigned, it may be immobilized with a cast or splint to maintain the correct position during healing.
4. X-rays are taken afterward to confirm that the bones are properly aligned.

Duration

The procedure typically takes around 30 minutes to 1 hour.

Setting

The procedure is usually performed in an outpatient clinic, emergency room, or a hospital.

Personnel

• Orthopedic surgeon or emergency physician
• Assistant or nurse
• Radiology technician (for imaging)

Risks and Complications

• Recurrence of dislocation
• Nerve or blood vessel injury
• Incomplete healing or malunion
• Persistent pain or stiffness
• Infection (if complication arises post-procedure)

Benefits

• Restores normal thumb alignment and function
• Relief from pain and swelling
• Minimally invasive compared to surgical options
• Quicker recovery time compared to open surgical methods

Recovery

• The thumb will need to be immobilized for several weeks.
• Patient may need follow-up appointments for X-rays to monitor healing.
• Physical therapy may be recommended post-immobilization to regain full mobility and strength.
• Avoid strenuous activities involving the thumb until fully healed.

Alternatives

• Open surgical treatment to directly visualize and fix the fracture.
• Continued immobilization without manipulation, though this may prolong healing and not correct the alignment.
• Each alternative has its pros and cons, with surgical options generally offering more direct correction but with higher risk and longer recovery.

Patient Experience

• The patient should expect limited use of the thumb during the immobilization period.
• Discomfort or mild pain may be managed with over-the-counter pain relievers.
• Follow provided care instructions to reduce swelling and promote healing.
• Gradual return to normal activities is expected as healing progresses.