26686 Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction

Name of the Procedure:

Open Treatment of Carpometacarpal Dislocation, Other Than Thumb; Complex, Multiple, or Delayed Reduction

Summary

The open surgical treatment of a carpometacarpal dislocation involves repositioning and stabilizing the bones in the wrist (carpometacarpal joints) that have dislocated. This procedure is complex and is often used when multiple dislocations are present, or if the dislocations are chronic and have been untreated for a period.

Purpose

This procedure addresses dislocations of the carpometacarpal joints (excluding the thumb) to restore proper alignment, stability, and function of the wrist. The goal is to alleviate pain, improve movement, and prevent further damage or long-term complications in the wrist.

Indications

• Persistent pain and swelling in the wrist.
• Visible deformity and impaired wrist function.
• Multiple dislocations of the carpometacarpal joints.
• Delayed treatment of dislocation leading to complexity in realignment.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Review of medications; adjustments may be required, especially blood thinners.
• Diagnostic imaging (e.g., X-rays, MRI) to assess the extent of the dislocation.
• Preoperative assessment of overall health including blood tests, ECG, etc.

Procedure Description

1. The patient is placed under either general or regional anesthesia.
2. An incision is made over the affected carpometacarpal joints.
3. The dislocated bones are manually repositioned back into their correct alignment.
4. Surgical hardware such as pins, screws, or plates may be used to stabilize the joints.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.
6. A splint or cast is placed to immobilize the wrist during initial healing.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and number of dislocations.

Setting

The procedure is performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic surgeon or hand surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and support staff.

Risks and Complications

• Infection at the surgical site.
• Bleeding or blood clots.
• Damage to nearby nerves or blood vessels.
• Nonunion or malunion of the bones.
• Stiffness or reduced range of motion in the wrist.
• Need for additional surgeries.

Benefits

• Relief from pain and swelling.
• Restoration of normal alignment and function of the wrist.
• Prevention of long-term complications like arthritis.
• Improved overall hand strength and dexterity.

Recovery

• Initial immobilization in a splint or cast for several weeks.
• Pain management with prescribed medications.
• Physical therapy to restore movement and strength.
• Avoidance of heavy lifting or strenuous activity until cleared by the surgeon.
• Follow-up appointments to monitor healing and remove any surgical hardware if necessary.

Alternatives

• Closed reduction (manipulation without surgery) if feasible in less complex cases.
• Physical therapy as a non-surgical approach for minor dislocations, although this is rarely effective alone in complex or multiple dislocations.
• Functional bracing or orthotic devices in milder cases or when surgery is contraindicated.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-surgery, there might be discomfort or pain, which can be managed with medications. The patient may experience gradual improvement in wrist function as healing progresses. Following all post-operative care instructions is crucial for a smooth recovery process.