Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each
CPT4 code
Name of the Procedure:
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each.
Summary
This procedure involves the non-surgical realignment of a broken bone in the finger or thumb without making an incision. The bone is manipulated back into place and may be stabilized with skin or skeletal traction.
Purpose
The procedure is performed to treat fractures of the middle or proximal phalanx (bones of the fingers or thumb). The goal is to ensure proper healing of the bone, restore function, and minimize discomfort.
Indications
- Visible deformity or unnatural alignment of the finger or thumb.
- Severe pain, swelling, and limited range of motion due to a fracture.
- X-rays showing a displaced fracture of the middle or proximal phalanx.
- Patients are generally healthy enough to undergo manipulation and traction.
Preparation
- Patients may need to fast for a few hours if sedation is planned.
- Important to disclose all medications and health conditions to the physician.
- X-rays or other imaging studies will be conducted to assess the fracture.
Procedure Description
- The patient may receive local anesthesia or sedation to ensure comfort.
- The doctor will manually manipulate the fractured bone to realign it.
- Traction methods, either through skin or skeletal means, may be used to maintain proper alignment.
- The finger or thumb is then immobilized using a splint or cast to keep the bone in place while it heals.
- Post-procedure X-rays may be taken to confirm correct alignment.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is typically performed in a hospital emergency department, outpatient clinic, or at a dedicated orthopedic center.
Personnel
- Orthopedic surgeon or emergency physician
- Nurses or orthopedic assistants
- Anesthesiologist (if sedation is used)
Risks and Complications
- Bone may not stay in proper alignment, requiring further treatment or surgery.
- Potential for nerve damage or blood vessel injury.
- Infection, particularly if skin traction pins are used.
- Chronic pain or stiffness in the finger or thumb.
Benefits
- Proper realignment of the bone promotes natural healing.
- Restores normal function and mobility of the finger or thumb.
- Minimizes pain and reduces the risk of chronic issues related to the fracture.
Recovery
- Patients will need to wear a splint or cast for several weeks.
- Regular follow-up appointments to monitor healing progress.
- Physical therapy may be recommended to restore full function.
- Most patients can resume normal activities within a few weeks to months.
Alternatives
- Open reduction and internal fixation (surgical option).
- Conservative management with immobilization only, though this may not be effective for all fractures.
- Pros: Non-surgical options avoid surgical risks. Cons: May be less successful in complicated fractures, possibly requiring later surgery.
Patient Experience
- Some discomfort during manipulation, usually managed with anesthesia or sedation.
- Soreness and stiffness as the bone heals.
- Pain management with prescribed medications following the procedure.
- Patients are encouraged to keep the affected hand elevated to reduce swelling.