Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation
CPT4 code
Name of the Procedure:
Percutaneous Skeletal Fixation of Carpometacarpal Fracture Dislocation, Thumb (Bennett Fracture) with Manipulation
Summary
This procedure involves repositioning and stabilizing a dislocated fracture at the base of the thumb using minimally invasive techniques. A Bennett fracture-dislocation specifically affects the carpometacarpal joint of the thumb, requiring both realignment of the bone and stabilization to ensure proper healing.
Purpose
The procedure addresses a Bennett fracture, a dislocation of the thumb's carpometacarpal joint. The goal is to realign the bone fragments and stabilize the joint to restore normal function and prevent long-term complications such as arthritis or loss of thumb mobility.
Indications
- Dislocation of the thumb joint (Bennett fracture)
- Severe swelling and pain in the thumb
- Inability to move or use the thumb effectively
- Visible deformity at the base of the thumb
Preparation
- Patients may need to fast for 6-8 hours before the procedure if general anesthesia will be used.
- Adjustments to existing medications should be discussed with the healthcare provider.
- Pre-procedure imaging tests such as X-rays are required to assess the extent of the fracture.
Procedure Description
- Anesthesia is administered, which could be local or general, depending on the case.
- The surgeon makes a small incision near the base of the thumb.
- Using fluoroscopy (a type of live X-ray), the surgeon manipulates the bone fragments into their proper positions.
- Percutaneous pins or screws are inserted through the skin and into the bone to hold the fragments in place.
- The incision is usually closed with a small suture or bandage.
Duration
The procedure typically takes around 30 minutes to 1 hour.
Setting
Performed in a hospital or outpatient surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurse
- Anesthesiologist
Risks and Complications
- Infection at the surgical site
- Damage to surrounding nerves or blood vessels
- Incomplete healing or improper alignment of bone fragments
- Potential for future arthritis or loss of thumb function
- Possible need for additional surgery
Benefits
- Proper alignment and stabilization of the thumb joint
- Restoration of thumb function and mobility
- Reduced risk of long-term complications, such as arthritis
Recovery
- Patients are often discharged the same day.
- The thumb may be immobilized in a splint or cast for several weeks.
- Physical therapy may be recommended to restore strength and mobility.
- Follow-up appointments are necessary to monitor healing.
- Full recovery can range from several weeks to a few months depending on the patient's condition and adherence to post-care advice.
Alternatives
- Closed reduction and casting (less invasive but may not provide as stable fixation)
- Open surgical repair (more invasive with potential for better visualization and alignment)
- Conservative management with splinting (limits movement but may not fully heal the fracture)
Patient Experience
- During the procedure, the patient will be under anesthesia and should not feel pain.
- After the procedure, some discomfort and swelling are expected; pain medication will be prescribed to manage this.
- The patient might experience limited thumb movement initially but should regain function gradually with proper rehabilitation.
This markdown text should provide a comprehensive overview of the procedure suitable for patient information or educational purposes.