Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Tarsometatarsal Joint Dislocation with Internal Fixation
Summary
This surgical procedure involves realigning a dislocated tarsometatarsal joint in the foot and securing it with internal fixation, such as screws or plates, to ensure proper healing.
Purpose
This procedure addresses tarsometatarsal joint dislocations, which can cause severe pain and instability in the foot. The goal is to restore normal alignment, alleviate pain, and maintain foot function.
Indications
- Severe pain and swelling at the midfoot
- Visible deformity or misalignment of the foot
- Inability to bear weight on the affected foot
- Diagnostic imaging showing dislocation and/or associated fractures
Preparation
- Fast for at least 8 hours before surgery
- Adjust or stop certain medications as advised by the doctor
- Undergo preoperative assessments like X-rays, MRI, or CT scans
Procedure Description
- Anesthesia: Administer general or regional anesthesia.
- Incision: Make an incision over the dislocated joint.
- Realignment: Manually realign the dislocated bones.
- Fixation: Insert screws or plates to hold the bones in place.
- Closure: Close the incision with sutures or staples and apply a sterile dressing.
- Immobilization: Place the foot in a cast or brace to prevent movement.
Duration
The procedure typically takes 2 to 3 hours.
Setting
Usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologist
Risks and Complications
- Infection
- Blood clots
- Nerve damage
- Nonunion or improper healing of bones
- Chronic pain or arthritis
- Complications from anesthesia
Benefits
- Pain relief
- Restored foot alignment and function
- Improved ability to walk and bear weight
- Reduction in the risk of long-term foot deformities or complications
Recovery
- Keep the foot elevated and apply ice to reduce swelling.
- Follow medication instructions for pain management.
- Avoid putting weight on the foot for several weeks.
- Wear a cast or brace as directed.
- Attend follow-up appointments for X-rays and to monitor healing.
- Physical therapy may be required to restore strength and mobility.
Alternatives
- Closed reduction (non-surgical realignment) with casting or splinting, suitable only for less severe dislocations.
- Conservative management: rest, ice, compression, elevation (RICE), and physical therapy.
- Pros and cons:
- Closed reduction: Less invasive but higher risk of re-dislocation.
- Conservative management: Non-surgical but may not resolve severe dislocations and can prolong recovery time.
Patient Experience
- Expect initial pain and swelling; pain management will be provided.
- Feelings of discomfort and limited mobility during recovery.
- Physical therapy may be needed to regain strength and flexibility.
- Full recovery can take several months, with gradual improvement in function and reduction in pain.