26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each

Name of the Procedure:

Open Treatment of Articular Fracture, Metacarpophalangeal or Interphalangeal Joint
Common name(s): Open Reduction and Internal Fixation (ORIF) of Finger Joint Fractures

Summary

Open treatment of an articular fracture involving the finger joints, such as the metacarpophalangeal (MCP) or interphalangeal (IP) joints, involves surgically exposing the fracture site and securing the broken bones using internal fixation devices like screws, plates, or wires.

Purpose

This procedure aims to treat fractures in the finger joints that cannot be managed with non-operative methods like casting or splinting. The goals are to restore the normal alignment, function, and stability of the joint and to promote proper healing.

Indications

• Severe finger joint fractures with displacement or misalignment
• Fractures that involve the articular surface of the joint
• Fractures that have failed to heal with conservative treatment
• Patients experiencing significant pain, swelling, or impaired function

Preparation

• Fasting typically required for a specified period before surgery
• Adjustments to medications as directed by the healthcare provider
• Pre-operative diagnostic tests such as X-rays or CT scans to assess the extent of the fracture

Procedure Description

1. The patient is given anesthesia (general or regional).
2. An incision is made over the affected joint to expose the fracture.
3. The surgeon manually realigns the bone fragments.
4. Internal fixation devices such as screws, plates, or wires are used to hold the bones in place.
5. The incision is closed with sutures.
6. A splint or cast may be applied to protect the joint post-surgery.

Duration

The procedure typically lasts around 1-2 hours, depending on the complexity of the fracture.

Setting

This procedure is usually performed in a hospital or a surgical center equipped for orthopedic surgeries.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Loss of joint movement or stiffness
• Hardware complications (e.g., migration or failure)
• Nonunion or malunion of the fracture

Benefits

• Improved alignment and stability of the fractured joint
• Enhanced healing and recovery of joint function
• Reduced pain and improved ability to use the hand

Recovery

• Post-operative care includes managing pain with medications and keeping the hand elevated.
• Physical therapy may be recommended to restore function and strength.
• Recovery time varies but typically ranges from 6 to 12 weeks.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Non-operative treatment with splints or casts (best for less severe fractures)
• Closed reduction and pinning (no open surgery required, suitable for specific types of fractures)
• Pros and cons should be discussed with the healthcare provider to choose the best approach for the patient's specific situation.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-operatively, patients may experience pain, swelling, and stiffness, which can be managed with pain relief medications and physical therapy. It’s important to follow the surgeon's instructions for post-operative care to ensure the best possible outcome.