25660 Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation

Name of the Procedure:

Closed Treatment of Radiocarpal or Intercarpal Dislocation, 1 or More Bones, with Manipulation

Summary

This procedure involves manually realigning a dislocated wrist joint or the small bones within the wrist without making any incisions. The aim is to return the bones to their correct positions to restore proper function and alleviate pain.

Purpose

The procedure addresses dislocations of the wrist joint (radiocarpal) or the small bones within the wrist (intercarpal). The main goals are to reduce pain and swelling, restore normal anatomy and function of the wrist, and prevent future complications.

Indications

• Visible deformity of the wrist
• Severe pain and swelling in the wrist area
• Limited range of motion in the wrist
• Confirmation of dislocation through X-rays or other imaging methods
• Acute, traumatic injuries to the wrist

Preparation

• Patients may be asked to fast for a few hours if sedation or anesthesia is used.
• Discuss any medications with the doctor, as some may need to be adjusted or paused.
• Diagnostic tests, primarily X-rays, will be performed to assess the dislocation.

Procedure Description

1. The patient may receive sedation or local/ regional anesthesia to manage pain.
2. The healthcare provider will use their hands to manipulate and guide the dislocated bones back into their correct position.
3. This is often done under fluoroscopy (real-time X-ray) to ensure precision.
4. Once the bones are realigned, the wrist may be immobilized with a splint or cast to maintain proper positioning during the healing process.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on the complexity of the dislocation.

Setting

The procedure is typically performed in an emergency room, outpatient clinic, or surgical center.

Personnel

• Orthopedic surgeon or trained physician
• Radiologic technician (if imaging is used)
• Nurse or medical assistant

Risks and Complications

• Pain during manipulation
• Swelling and bruising
• Nerve or blood vessel injury
• Residual instability or future dislocations
• Incomplete reduction, necessitating additional procedures

Benefits

• Immediate pain relief
• Restoration of normal wrist anatomy and function
• Prevention of long-term complications like arthritis or chronic pain

Recovery

• Patients will need to keep the wrist immobilized for several weeks, usually in a splint or cast.
• Follow-up appointments will be necessary to monitor healing progress via X-rays.
• Physical therapy may be recommended to restore strength and mobility.
• Resume normal activities gradually, as per the healthcare provider's advice.

Alternatives

• Open reduction and internal fixation (surgical option if closed reduction fails)
• Conservative management with immobilization (if manipulation is not immediately required)
• Each alternative comes with its own set of risks, benefits, and recovery times which should be discussed with the healthcare provider.

Patient Experience

• During the procedure, the patient might feel pressure or discomfort, but pain is managed with anesthesia.
• Post-procedure, there may be some pain and swelling, usually controlled with pain medication and ice.
• It's typical to experience some stiffness and weakness initially, which will improve with rehabilitation and time.