Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed
CPT4 code
Name of the Procedure:
Open Treatment of Metatarsophalangeal Joint Dislocation (includes internal fixation)
Summary
This surgical procedure involves making an incision to access and repair a dislocation in the metatarsophalangeal (MTP) joint, typically located where the toes meet the foot. Internal fixation devices, such as pins or screws, may be used to stabilize the joint and ensure proper alignment for healing.
Purpose
The procedure addresses dislocations of the MTP joint, which can result from trauma or severe injury. The goal is to realign the joint, reduce pain, restore function, and prevent long-term complications such as arthritis or deformity.
Indications
- Severe pain and swelling at the MTP joint
- Visible deformity or misalignment of the toe
- Inability to move the affected toe
- Failure of conservative treatments (e.g., splinting, rest) to resolve the dislocation
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- A pre-operative assessment including blood tests, imaging (X-rays or MRI), and a review of medical history is required.
- Adjustment or cessation of certain medications may be necessary.
Procedure Description
- The patient is given anesthesia (usually general or regional).
- A surgical incision is made near the affected MTP joint.
- The dislocated joint is carefully realigned by the surgeon.
- Internal fixation devices, such as screws or pins, are placed to stabilize the joint.
The incision is closed with sutures, and a dressing is applied.
Tools used include:
- Surgical scalpel
- Fixation devices (screws, pins)
- Imaging tools for guidance
Duration
The procedure typically takes between 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Physician assistants or surgical techs
Risks and Complications
- Infection at the incision site
- Bleeding or blood clots
- Nerve damage or loss of sensation
- Improper joint healing or recurrence of dislocation
- Post-operative pain or stiffness
Benefits
- Relief from pain and discomfort
- Improved joint function and mobility
- Reduced risk of long-term complications
- Enhanced quality of life
Recovery
- Patients may need to wear a protective boot or cast.
- Pain management with medications and ice therapy.
- Gradual return to weight-bearing activities as per doctor's advice.
- Physical therapy may be recommended.
- Follow-up appointments to monitor healing and potentially remove fixation devices.
Alternatives
- Non-surgical methods (splinting, casting) for less severe dislocations
- Closed reduction without internal fixation
- Long-term use of orthotics or shoe modifications
Patient Experience
Patients will be under anesthesia during the procedure, so they won't feel pain. Post-procedure, they might experience swelling, discomfort, or pain which can be managed with medication. Initial movement may be restricted, but gradual improvement occurs with proper care and adherence to recovery protocols.