25609 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments

Name of the Procedure:

Open Treatment of Distal Radial Intra-Articular Fracture or Epiphyseal Separation with Internal Fixation of 3 or More Fragments

Summary

This surgical procedure repairs a broken or dislocated wrist, specifically where the break involves the joint surface of the radius bone and there are multiple fracture fragments. The surgery uses hardware like screws or plates to stabilize the bone fragments.

Purpose

This procedure addresses severe fractures of the distal radius, especially when the break extends into the wrist joint and involves multiple fragments. The goals are to realign the bone, restore wrist function, alleviate pain, and prevent long-term complications like arthritis.

Indications

• Severe distal radial fracture with intra-articular involvement.
• Epiphyseal separation in children and adolescents.
• Cases where the fracture involves three or more fragments.
• Significant displacement or instability of the fracture that cannot be managed with casting.
• Patients who have failed nonsurgical treatments.

Preparation

• Patients may be required to fast for at least 8 hours before the procedure.
• Preoperative imaging such as X-rays or CT scans to assess the fracture.
• Adjustment or cessation of certain medications as directed by the physician.
• Blood tests to ensure proper blood clotting and organ function.
• Obtain informed consent after discussing risks and benefits with the surgeon.

Procedure Description

1. Anesthesia: The patient receives general or regional anesthesia to ensure they are pain-free and unconscious or sedated during the procedure.
2. Incision: The surgeon makes an incision over the affected wrist to access the fracture site.
3. Reduction: The bone fragments are realigned (reduced) to their proper positions.
4. Fixation: Internal fixation devices (screws, plates, or pins) are placed to hold the bone fragments together securely.
5. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Tools and equipment include surgical instruments, fixation hardware (plates and screws), and imaging devices to ensure proper alignment.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and number of fragments.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon or orthopedic trauma surgeon.
• Surgical nurse or scrub technician.
• Anesthesiologist.
• Radiologic technician (if intraoperative imaging is required).

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve or tendon injury.
• Improper bone healing or malunion.
• Hardware irritation or failure.
• Long-term stiffness or arthritis in the wrist.

Benefits

• Improved alignment and stabilization of the wrist.
• Enhanced functional recovery and range of motion.
• Reduced pain and prevention of future complications.
• Better long-term outcome compared to nonsurgical treatment for complex fractures.

Recovery

• Post-procedure, the wrist will be immobilized in a splint or cast.
• Pain management with medications.
• Physical therapy may start a few weeks after surgery to restore motion and strength.
• Recovery time varies but generally ranges from 6 to 12 weeks, with some restrictions on activities.
• Follow-up appointments to monitor healing and remove hardware if necessary.

Alternatives

• Closed reduction and casting: less invasive but not ideal for complex fractures.
• External fixation: useful in specific scenarios but may be less stable.
• Nonoperative management: limited to less severe fractures or cases where surgery is contraindicated.

Patient Experience

Patients may experience some pain and swelling post-operation, which is managed with medications. There's a temporary loss of wrist movement due to immobilization. Gradual recovery of function is expected with adherence to physical therapy and post-operative care instructions. Pain typically decreases over a few weeks as healing progresses.