26675 Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia

Name of the Procedure:

Closed Treatment of Carpometacarpal Dislocation, Other than Thumb, with Manipulation, each joint; Requiring Anesthesia.

• Common name: Non-surgical realignment of wrist joint dislocation
• Technical term: Closed reduction of carpometacarpal dislocation (excluding thumb), using anesthesia

Summary

This procedure involves the non-surgical realignment of a dislocated carpometacarpal joint, which is a joint in the wrist. The realignment is done through manipulation while the patient is under anesthesia to ensure they do not feel pain during the procedure.

Purpose

This procedure aims to address the dislocation of one or more carpometacarpal joints (excluding the thumb). The goals are to restore normal joint alignment, reduce pain, prevent long-term joint damage, and restore function and mobility of the wrist.

Indications

• Symptoms warranting the procedure include severe pain, swelling, and visible deformity of the wrist.
• Indicated for patients with confirmed dislocation of carpometacarpal joints through clinical examination and imaging.
• Appropriate for patients experiencing loss of wrist function due to joint misalignment.

Preparation

• Patients may need to fast for several hours before the procedure as it involves anesthesia.
• Pre-procedure assessments include physical examination and imaging tests such as X-rays or MRI to confirm the dislocation.

Procedure Description

1. The patient is placed under anesthesia to prevent pain and discomfort during the procedure.
2. The healthcare provider assesses the exact location and severity of the dislocation.
3. Gentle manipulation techniques are used to guide the dislocated joint back into its proper position without surgical intervention.
4. Once realigned, the joint is often immobilized using a splint or cast to ensure it remains in place while healing.
5. Post-procedure imaging may be conducted to confirm successful realignment.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity and the number of joints involved.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center with access to anesthesia services.

Personnel

• Orthopedic or emergency surgeon
• Anesthesiologist
• Nurses and possibly radiologic technologists

Risks and Complications

• Common risks: swelling, bruising, temporary pain.
• Rare risks: improper joint alignment, nerve or blood vessel damage, infection, adverse reaction to anesthesia.
• Possible complications include joint instability or redislocation, requiring further treatment.

Benefits

• Relief from pain and swelling.
• Restoration of wrist function and mobility.
• Prevention of permanent joint damage.
• Benefits typically realized shortly after swelling reduces, often within days to weeks.

Recovery

• Post-procedure care includes immobilization with a splint or cast.
• Patients should follow specific instructions regarding limited movement and weight-bearing.
• Pain management includes prescribed medications.
• Recovery time varies; light activities can be resumed in a few weeks, with full healing potentially taking several months.
• Follow-up appointments for monitoring healing and additional imaging test may be required.

Alternatives

• Surgical treatment: for complex or recurrent dislocations.
• Pros: may provide a more stable repair.
• Cons: longer recovery time, higher risk of complications associated with surgery.
• Non-intervention: with risks of chronic pain and permanent joint damage.

Patient Experience

• During the procedure: No pain experienced due to anesthesia.
• After the procedure: Initial discomfort and soreness manageable with prescribed medications.
• Gradual improvement in function and reduction of pain with adherence to recovery protocols. Pain management and comfort measures include medications and supportive devices like splints.