Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each
CPT4 code
Name of the Procedure:
Percutaneous Skeletal Fixation of Distal Phalangeal Fracture, Finger or Thumb
Common Names: Pinning, Finger Fracture Repair
Summary
This procedure involves the stabilization and alignment of a broken distal phalanx (the bone at the end of the finger or thumb) using pins inserted through the skin.
Purpose
Percutaneous skeletal fixation is performed to:
- Correct fractures of the distal phalange to ensure proper healing.
- Maintain proper alignment of the bone fragments.
- Reduce pain and restore the full function of the finger or thumb.
Indications
This procedure is indicated for:
- Displaced fractures of the distal phalanx in the finger or thumb.
- Open fractures or fractures with significant soft tissue injury.
- Patients who fail to maintain alignment with non-surgical treatments like splinting.
Preparation
Prior to the procedure, patients may need to:
- Fast for a certain period, usually 6-8 hours, if general anesthesia is used.
- Adjust medications as instructed by the healthcare provider.
- Undergo diagnostic tests like X-rays to assess the fracture.
Procedure Description
- Anesthesia: Local anesthesia is commonly used; however, general anesthesia may be given in some cases.
- Incision and Pin Insertion: A small incision is made near the fracture site. Pins are inserted through the skin and into the bone to hold the fragments in place.
- Alignment: The bones are carefully aligned, and additional imaging may be used to ensure proper placement.
- Stabilization: Pins are secured and the incision is closed. A splint or cast is applied to protect the area.
Tools used include:
- Surgical pins (Kirschner wires)
- Imaging equipment (X-ray or fluoroscopy)
- Standard surgical instruments (scalpel, clamps)
Duration
The procedure typically takes about 30-60 minutes.
Setting
This surgery is performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
Common risks include:
- Infection at the pin site
- Pin migration or loosening
- Damage to surrounding nerves or blood vessels
Rare but serious complications:
- Nonunion or malunion of the bone
- Loss of function or stiffness
- Anesthesia-related complications
Benefits
- Proper healing and alignment of the fractured bone
- Pain relief
- Restoration of hand function Typically, benefits can be seen within a few weeks as the bone starts to heal.
Recovery
Post-procedure care includes:
- Keeping the splint or cast dry and clean
- Limited use of the affected hand
- Pain management with prescribed medications
- Follow-up appointments to monitor healing and pin removal Full recovery can take several weeks to a few months depending on the severity of the fracture.
Alternatives
Alternative treatments may include:
- Non-surgical methods like splinting or casting.
- Open surgical fixation if percutaneous method is not suitable. Pros of alternatives:
- Non-surgical methods avoid risks related to surgery and anesthesia. Cons:
- May result in poorer alignment and longer healing time compared to percutaneous fixation.
Patient Experience
During the procedure, the patient will be anesthetized and should not experience pain. Post-procedure, some discomfort and swelling are expected, but these can be managed with pain medications. Most patients can return to normal activities gradually, following physician guidelines.