25259 Manipulation, wrist, under anesthesia

Name of the Procedure:

Manipulation, Wrist, Under Anesthesia
Common name(s): Wrist manipulation under anesthesia
Medical term: Closed reduction and manipulation of the wrist

Summary

In this procedure, the wrist is carefully manipulated to correct dislocations or fractures while the patient is under anesthesia to ensure they do not feel pain and to allow the physician to make the necessary adjustments.

Purpose

The procedure addresses conditions such as wrist dislocations or misaligned wrist fractures. The goal is to realign the bones and restore normal function and appearance to the wrist without requiring an open surgical approach.

Indications

• Acute wrist dislocations
• Misaligned wrist fractures
• Severe wrist pain or limited mobility due to improper bone positioning
• Unsuccessful previous attempts at nonsurgical realignment

Preparation

• Fasting typically required for 6-8 hours before the procedure (as instructed by healthcare provider).
• Avoidance of certain medications as advised (e.g., blood thinners).
• Necessary diagnostic tests such as X-rays or CT scans to assess the extent of dislocation or fracture.

Procedure Description

1. The patient is administered anesthesia, either general or regional, to numb the wrist and ensure they are unaware and do not feel pain.
2. The orthopedic surgeon manually manipulates the wrist to realign the bones.
3. X-rays may be taken during the procedure to verify bone alignment.
4. A splint or cast is applied to maintain the correct position of the bones during healing. Tools used: Splints, casts, and imaging devices such as X-ray machines. Anesthesia: General or regional anesthesia, depending on the case and patient's condition.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the condition.

Setting

The procedure is usually performed in a hospital's operating room or a surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Radiologic technologist (for intraoperative imaging)

Risks and Complications

Common risks:

• Temporary pain or discomfort after the procedure
• Swelling and stiffness Rare risks:
• Infection
• Nerve damage
• Persistent misalignment requiring further intervention
• Adverse reactions to anesthesia

Benefits

• Restoration of normal wrist function and alignment
• Reduction of pain and improvement in mobility
• Avoidance of open surgical methods and associated complications Expected benefits are typically realized within a few weeks as the wrist heals.

Recovery

• Keep the wrist elevated to reduce swelling.
• Follow instructions regarding the use of the splint or cast.
• Pain management with prescribed medications.
• Physical therapy may be recommended to restore strength and flexibility.
• Follow-up appointments to monitor healing and remove the cast or splint if necessary. Recovery time varies but usually spans 4-6 weeks.

Alternatives

• Non-surgical methods such as bracing or splinting without manipulation, though these may be less effective for severe cases.
• Open surgical reduction if closed manipulation is unsuccessful or contraindicated. Pros and cons: Non-surgical methods may require longer healing times and may be less effective in achieving proper alignment; open surgery has a higher risk of complications and longer recovery.

Patient Experience

• During the procedure: Patient will not feel pain due to anesthesia.
• After the procedure: Some pain and discomfort are expected but can be managed with medications. Patients typically feel progressive improvement as healing occurs. Physical therapy can help in restoring full function and strength.