26676 Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint

Name of the Procedure:

Percutaneous Skeletal Fixation of Carpometacarpal Dislocation, other than Thumb, with Manipulation, Each Joint

Summary

This procedure involves the realignment and stabilization of a dislocated joint in the wrist area (carpometacarpal joint) other than the thumb. It is done by manipulating the dislocated joint back into place and then fixing it with percutaneous (through the skin) pins or wires.

Purpose

The procedure is performed to correct a dislocated carpometacarpal joint, which is a joint where the wrist bone meets the hand bones, excluding the thumb. The goals are to alleviate pain, restore normal joint alignment, and ensure proper healing and function of the hand.

Indications

• Acute dislocation of a carpometacarpal joint (excluding the thumb).
• Significant pain and swelling at the dislocated joint.
• Inability to move the affected hand or fingers properly.
• Deformity or abnormal appearance of the hand.

Preparation

• Patients may need to fast for several hours before the procedure, especially if general anesthesia is planned.
• Adjustments to regular medications might be necessary, particularly with blood thinners.
• Pre-procedure imaging tests like X-rays or MRI scans to assess the extent of the dislocation.

Procedure Description

1. The patient is positioned appropriately, usually with the hand placed on a sterile field.
2. Local or general anesthesia is administered to ensure the patient is comfortable and free from pain.
3. The surgeon manually manipulates the dislocated joint back into its proper position.
4. Percutaneous pins or K-wires are inserted through the skin to stabilize and hold the joint in place.
5. The position of the pins is confirmed with fluoroscopy (real-time X-ray).
6. The insertion points are dressed, and a splint or cast may be applied to immobilize the wrist.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity of the dislocation.

Setting

The procedure is performed in a hospital operating room or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection at the pin sites
• Nerve damage leading to numbness or tingling
• Joint stiffness or reduced range of motion
• Improper healing or re-dislocation
• Necessity for further surgery if initial stabilization fails

Benefits

• Realignment of the dislocated joint
• Pain relief and improved hand function
• Prevention of long-term joint damage or arthritis

Recovery

• Patients may need to keep the affected hand elevated and apply ice to reduce swelling.
• Pain management typically involves prescribed analgesics.
• Follow-up appointments for X-rays to ensure proper healing.
• Removal of pins is generally done after a few weeks, depending on the healing progress.
• Physical therapy may be needed to restore full function.

Alternatives

• Closed reduction without fixation, though less stable.
• Open surgical repair for severe or complex dislocations.
• Immobilization with a cast or splint alone, which might be less effective for severe cases.

Patient Experience

• During the procedure: With anesthesia, the patient should feel minimal to no pain, though they might sense some pressure during manipulation.
• After the procedure: Moderate pain and swelling can be expected, manageable with prescribed medication. Discomfort is likely due to immobilization and healing, which improves over several days.

Pain management and comfort measures will be provided throughout the process to ensure the patient's well-being. Relaxation techniques and support will also be offered before and after the procedure.