Name of the Procedure:

Percutaneous Skeletal Fixation of Distal Radioulnar Dislocation
Common Name: Pinning of Wrist Dislocation

Summary

Percutaneous skeletal fixation of distal radioulnar dislocation is a minimally invasive surgical procedure to correct and stabilize a dislocation of the wrist joint where the radius and ulna bones meet. This involves inserting pins through the skin to hold the bones in place.

Purpose

Medical Condition:

• Addresses unstable distal radioulnar joint (DRUJ) dislocations. ##### Goals:
• Realign and stabilize the bones.
• Restore wrist function and minimize pain.

Indications

Specific Symptoms:

• Severe wrist pain.
• Visible deformity.
• Inability to move the wrist. ##### Patient Criteria:
• Acute dislocation.
• Unstable DRUJ.
• Considered after non-surgical methods fail.

Preparation

Pre-Procedure Instructions:

• Fasting for 6-8 hours prior if under general anesthesia.
• Adjustments to medications, particularly blood thinners. ##### Diagnostic Tests:
• X-rays or MRI to assess the extent of dislocation.

Procedure Description

1. The patient is positioned, and the area is sterilized.
2. Local or general anesthesia is administered.
3. The surgeon makes a small incision or uses a needle to guide the pins through the skin into the bones of the wrist.
4. The bones are realigned and held in place with the pins.
5. The incision site is closed and bandaged.

Tools and Equipment:

• X-ray or fluoroscopy machines for guidance.
• Surgical pins and instruments for insertion. ##### Anesthesia:
• General or local anesthesia based on patient and surgeon preference.

Duration

Typically takes about 1-2 hours.

Setting

Performed in a hospital operating room or outpatient surgical center.

Personnel

• Orthopedic Surgeon
• Surgical Nurses
• Anesthesiologist

Risks and Complications

Common Risks:

• Infection at the pin site.
• Minor bleeding. ##### Rare Risks:
• Nerve or blood vessel damage.
• Pin displacement or hardware failure. ##### Management:
• Antibiotics for infection.
• Additional procedures if complications arise.

Benefits

• Restores wrist stability and function.
• Reduces pain.
• Shorter recovery time compared to open surgery.

Recovery

Post-Procedure Care:

• Keep the wrist elevated.
• Follow a rehabilitation plan involving physical therapy. ##### Expected Recovery Time:
• Typically 6-8 weeks for full recovery. ##### Restrictions:
• Avoid heavy lifting or strenuous activities initially.
• Follow-up appointments to monitor healing.

Alternatives

Non-Surgical Options:

• Manual reduction and splinting.
• Physical therapy. ##### Surgical Options:
• Open reduction and internal fixation (ORIF). ##### Pros and Cons:
• Non-surgical options may not provide a stable fix for severe dislocations.
• ORIF is more invasive but may be needed in complex cases.

Patient Experience

During the Procedure:

• Under anesthesia, the patient should feel no pain. ##### After the Procedure:
• Some discomfort or pain, managed with medication.
• Swelling and bruising around the wrist. ##### Pain Management:
• Prescribed pain relievers.
• Ice packs and elevation to reduce swelling.