25624 Closed treatment of carpal scaphoid (navicular) fracture; with manipulation

Name of the Procedure:

Closed Treatment of Carpal Scaphoid (Navicular) Fracture; with Manipulation

Summary

This procedure involves the non-surgical (closed) realignment and stabilization of a fractured carpal scaphoid bone in the wrist, using manual techniques.

Purpose

This procedure addresses fractures of the carpal scaphoid (navicular) bone, a common wrist injury. The goal is to realign the bone fragments, stabilize the bone for proper healing, and restore wrist function while preventing complications.

Indications

• Acute pain, swelling, and tenderness in the wrist following trauma.
• X-ray or imaging diagnosis confirming a fracture of the carpal scaphoid bone.
• Patients unable to undergo surgical intervention or those for whom closed treatment is deemed appropriate.

Preparation

• The patient may be asked to fast for a few hours if sedation is to be used.
• Adjustment or temporary cessation of certain medications, such as blood thinners, may be necessary.
• Diagnostic tests like X-rays, CT scans, or MRIs are performed to assess the fracture.

Procedure Description

1. The patient is positioned comfortably, typically lying down.
2. Sedation or local anesthesia is administered to minimize discomfort.
3. The healthcare provider uses manual manipulation techniques to realign the fractured bone fragments.
4. Immobilization is achieved using a cast, splint, or brace to maintain proper alignment during the healing process.
5. Follow-up X-rays are taken to ensure proper alignment.

Duration

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

Setting

This procedure is usually performed in an outpatient clinic, emergency room, or a surgical center.

Personnel

• Orthopedic surgeon or emergency physician
• Nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection
• Nonunion or delayed union of the fracture
• Malalignment
• Stiffness or reduced range of motion in the wrist
• Potential need for surgical intervention if closed treatment is unsuccessful

Benefits

• Non-surgical approach, reducing risks associated with surgery.
• Shorter recovery time compared to open surgical procedures.
• Immediate pain relief and improved function in the wrist.

Recovery

• The patient will need to wear a cast or splint for several weeks.
• Regular follow-up appointments are necessary for X-rays and to monitor healing.
• Gradual return to normal activities; physical therapy may be recommended.
• Complete recovery may take several months, with restrictions on heavy lifting or wrist-intensive activities.

Alternatives

• Open surgical treatment to directly visualize and fixate the bone using screws or pins.
• Application of bone stimulators to enhance fracture healing.
• Pros and cons: Open surgery may provide more rigid fixation but comes with higher surgical risks and longer recovery.

Patient Experience

• The patient may feel pressure or mild pain during manipulation, which is mitigated by sedation or local anesthesia.
• Post-procedure, there might be mild pain and swelling, managed with pain relievers and ice packs.
• Discomfort typically subsides within a few days, with significant functional improvement as the bone heals.