Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each
CPT4 code
Name of the Procedure:
Open Treatment of Fracture, Phalanx or Phalanges (other than great toe), includes internal fixation, when performed, each.
- Common names: Open Fixation of Finger or Toe Fracture, Phalanx Surgery
- Medical term: Phalangeal Fracture Open Reduction and Internal Fixation (ORIF)
Summary
An open treatment of a fracture in the phalanx or phalanges (the bones in the fingers or toes, other than the big toe) involves surgically exposing the broken bone and manually aligning it. This procedure often includes the use of internal fixation devices such as screws, wires, or plates to hold the bone fragments in place while they heal.
Purpose
This procedure addresses fractures of the fingers or toes that cannot be properly aligned using non-surgical methods. The goal is to stabilize the broken bone, ensuring proper alignment and healing to restore normal function and reduce pain.
Indications
- Severe fractures with bone misalignment
- Fractures that have not healed properly with conservative treatment (e.g., splinting or casting)
- Open fractures (bone breaks through the skin)
- Multiple fractures of the same bone
- Fractures with associated nerve or vascular injury
Preparation
- Fasting for at least 8 hours before the procedure if general anesthesia is used.
- Stopping certain medications, such as blood thinners, as advised by the doctor.
- Pre-operative imaging tests, such as X-rays or CT scans, to assess the extent of the fracture.
Procedure Description
- The patient is given anesthesia (local, regional, or general) for pain control.
- An incision is made over the fractured area to expose the bone.
- The surgeon aligns the bone fragments correctly.
- Internal fixation devices (screws, wires, or plates) are applied to stabilize the bone.
- The incision is closed with sutures or staples, and a dressing is applied.
- A splint or cast may be placed to further immobilize the area.
Duration
The procedure typically takes 1 to 2 hours, depending on the complexity of the fracture.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist or nurse anesthetist
- Surgical technician
Risks and Complications
- Infection at the incision site
- Nerve or blood vessel damage
- Complications from anesthesia
- Nonunion (bone does not heal properly)
- Malunion (bone heals in an incorrect position)
- Hardware irritation or failure
Benefits
- Proper alignment and stabilization of the fracture for optimal healing
- Restoration of function to the affected finger or toe
- Reduction in pain and prevention of long-term deformity
Recovery
- Pain management with prescribed medications.
- Keeping the area elevated and iced to reduce swelling.
- Limited use of the affected limb for a specified time.
- Follow-up appointments for X-rays to monitor healing.
- Physical therapy may be recommended to restore strength and flexibility.
- Complete recovery can take several weeks to months, depending on the severity of the fracture.
Alternatives
- Non-surgical treatments such as splinting or casting (only effective for certain types of fractures).
- Closed reduction (manual realignment without incision) with or without external fixation.
- Each alternative has its pros and cons and may not be suitable for all types of fractures.
Patient Experience
- During the procedure, the patient will be under anesthesia and should not feel pain.
- Post-procedure, patients may experience pain and swelling, manageable with medication.
- Temporary restrictions on the use of the affected finger or toe.
- Gradual improvement in function as healing progresses and physical therapy is undertaken.