Name of the Procedure:

Open Treatment of Carpal Bone Fracture (Other than Carpal Scaphoid [Navicular])

Summary

In this surgical procedure, broken bones in the carpal (wrist) area, excluding the carpal scaphoid bone, are repaired. The surgery involves making an incision to access the fractured bone, aligning it properly, and securing it with surgical hardware.

Purpose

The procedure aims to treat complex fractures of the carpal bones to restore normal wrist function and alleviate pain. It is typically performed when non-surgical methods such as casting are insufficient for proper bone healing.

Indications

• Persistent pain and swelling after a wrist injury
• X-ray or imaging evidence of a displaced or unstable carpal bone fracture (excluding the scaphoid)
• Failure of non-operative treatment methods like splinting or casting
• Severe fractures involving multiple carpal bones

Preparation

• Patients may need to fast for 6-8 hours before the surgery.
• Adjustments to medications, especially blood thinners, might be required.
• Preoperative imaging tests such as X-rays or CT scans to assess the extent of the fracture.
• Briefing with the surgical team to discuss the procedure and anesthesia plan.

Procedure Description

1. Incision: An incision is made near the fracture site to expose the bone.
2. Alignment: The fractured bone fragments are realigned into their normal position.
3. Fixation: Surgical hardware such as screws, pins, or plates are used to hold the bone fragments together.
4. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Tools/Equipment Used: Surgical scalpel, bone saw, fixation devices (screws, pins, plates), sutures/staples.

Anesthesia: General anesthesia or regional anesthesia like a nerve block is typically used to ensure the patient does not feel pain during the procedure.

Duration

The procedure usually takes about 1-2 hours, depending on the complexity of the fracture.

Setting

This surgery is typically performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection at the surgical site
• Nerve damage
• Blood vessel damage
• Nonunion or malunion of the fracture
• Hardware-related issues (e.g., loosening or breakage)
• Prolonged wrist stiffness or limited movement

Benefits

• Proper healing of the fractured bone
• Restoration of wrist function and strength
• Reduced pain and discomfort
• Decreased likelihood of long-term complications

Recovery

• Immobilization of the wrist with a cast or splint for several weeks
• Pain management with medications
• Physical therapy or rehabilitation exercises to restore mobility and strength
• Follow-up appointments to monitor healing progress
• Expected full recovery time ranges from a few months to a year, depending on the fracture severity and individual patient factors.

Alternatives

• Non-surgical methods like casting or splinting, which may be less invasive but are not always effective for complex fractures.
• Arthroscopic surgery, which is less invasive but may not be suitable for all types of carpal fractures.
• Pros of alternatives include reduced surgical risks, while cons may include suboptimal fracture healing and prolonged recovery time.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Postoperatively, some pain, swelling, and discomfort are expected, which can be managed with pain medication and rest. Physical therapy may be necessary for complete recovery, and patients should avoid activities that put stress on the wrist until fully healed.