Name of the Procedure:

Percutaneous Skeletal Fixation of Distal Radial Fracture or Epiphyseal Separation

Summary

Percutaneous skeletal fixation is a minimally invasive surgical technique used to treat fractures of the distal radius or separation at the growth plate. It involves using pins or screws inserted through the skin to stabilize the bone without making large incisions.

Purpose

This procedure is performed to treat fractures at the distal end of the radius (near the wrist) or separation at the growth plate. The goal is to realign and stabilize the broken bone to ensure proper healing and restore normal function.

Indications

• Distal radial fractures that are displaced or unstable.
• Epiphyseal separation in children where the growth plate is affected.
• Fractures that do not align properly with non-surgical treatments.
• Patients who require a minimally invasive option due to other health factors.

Preparation

• Patients are usually required to fast for 6-8 hours before the procedure if general anesthesia is used.
• Adjustments to medications may be required, particularly blood thinners.
• Diagnostic imaging like X-rays or CT scans to assess the fracture.
• Pre-operative clearance and assessments, including blood tests and medical history review.

Procedure Description

1. Anesthesia: The patient receives regional or general anesthesia to prevent pain during the procedure.
2. Imaging: Fluoroscopy (real-time X-ray) is used to guide the procedure.
3. Incision: Small incisions are made in the skin near the fracture site.
4. Fixation: Pins or screws are inserted through the skin and into the bone to stabilize the fracture.
5. Closure: The small incisions are closed with sutures or sterile dressings.
6. Imaging Confirmation: Post-procedure imaging to ensure proper placement of fixation devices and alignment of the bone.

Duration

The procedure typically takes around 30 minutes to 1 hour.

Setting

Usually performed in a hospital operating room or outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technologist (for imaging guidance)

Risks and Complications

• Infection at the pin or incision sites
• Nerve or blood vessel damage
• Failure to maintain bone alignment or healing issues
• Need for additional surgery
• Possible irritation or pain from hardware

Benefits

• Stabilizes the fracture for optimal healing
• Minimally invasive with smaller incisions and quicker recovery time
• Reduces pain and improves function compared to non-treated fractures

Recovery

• Patients may go home the same day or stay overnight for observation.
• Pain management with medications as prescribed.
• Activity restrictions: avoid heavy lifting and strenuous activities.
• Follow-up appointments for X-rays and to monitor healing.
• Physical therapy may be recommended for rehabilitation.

Alternatives

• Non-surgical treatment such as casting or splinting, which may be less effective for certain fractures.
• Open reduction and internal fixation (ORIF), which involves a larger incision and longer recovery.
• Pros and cons vary based on the nature of the fracture and patient-specific factors.

Patient Experience

• Mild to moderate pain post-procedure, managed with pain medications.
• Some bruising or swelling around the wrist.
• Limited use of the affected hand and wrist initially.
• Gradual return to normal activities as healing progresses.
• Physical therapy may help regain strength and mobility.