Name of the Procedure:

Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, each bone

Summary

This non-surgical procedure aims to treat fractures of carpal bones (excluding the carpal scaphoid) by manually adjusting and aligning the bone back into place without making any incisions.

Purpose

Carpal bone fractures can cause pain, swelling, reduced mobility, and deformity of the hand and wrist. The goal of this procedure is to realign the fractured bone to ensure proper healing, alleviate pain, and restore function.

Indications

This procedure is recommended for patients with:

• Non-displaced or minimally displaced carpal bone fractures (excluding the scaphoid).
• Fractures that require manipulation to ensure proper alignment.
• Symptoms such as severe pain, swelling, and limited range of motion.

Preparation

• Normally, patients may be advised not to eat or drink for a few hours prior to the procedure if anesthesia is planned.
• Patients should inform the healthcare provider of any medications, allergies, or existing health conditions.
• X-rays or other imaging tests are typically performed to assess the fracture.

Procedure Description

1. Initial Assessment: The healthcare provider conducts a physical exam and reviews imaging studies.
2. Anesthesia/Sedation: Local anesthesia or sedation may be administered to minimize discomfort during manipulation.
3. Manipulation: The physician carefully manipulates the fractured bone segments back into their correct alignment using manual techniques.
4. Immobilization: Once properly aligned, the area is immobilized with a cast or splint to maintain the position during healing.
5. Post-Procedure Imaging: Follow-up X-rays may be taken to confirm that the bones are correctly set.

Duration

The entire procedure typically takes around 30 minutes to 1 hour, depending on the complexity of the fracture.

Setting

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

Personnel

A team consisting of:

• An orthopedic surgeon or a trained emergency room physician.
• Nurses or medical assistants.
• An anesthesiologist or nurse anesthetist, if sedation is used.

Risks and Complications

Potential risks and complications include:

• Improper alignment leading to malunion or nonunion of the bone.
• Persistent pain or stiffness.
• Risk of infection if skin integrity is compromised.
• Nerve or blood vessel injury.
• Need for surgical intervention if closed treatment is unsuccessful.

Benefits

• Non-invasive compared to surgical options.
• Lower risk of infection and shorter recovery time.
• Immediate pain relief and improved function after successful manipulation.
• Minimizes the need for complex surgeries.

Recovery

• Patients may need to wear a cast or splint for several weeks, depending on the fracture's severity.
• Follow-up appointments will be necessary to monitor healing through additional imaging.
• Patients are often advised to avoid strenuous activities or heavy lifting.
• Physical therapy may be recommended to restore full function.

Alternatives

• Open reduction and internal fixation (ORIF): Surgical option involving incisions and hardware to fix the bone.
• External fixation: Using an external frame to stabilize the bone.
• Non-manipulative treatment: Simply using a cast or splint without bone manipulation, suitable for very minor fractures.

Pros and cons should be discussed with a healthcare provider based on individual cases.

Patient Experience

• During the procedure, patients might feel pressure or discomfort, especially if minimal sedation is used.
• Post-procedure, mild to moderate pain is common and can be managed with prescribed pain relievers.
• Swelling and bruising around the treated area are typical.
• Gradual improvement in pain and function as the bone heals.

Patients are encouraged to follow their healthcare provider's instructions closely to ensure optimal recovery.