Name of the Procedure:

Partial Excision of Bone (Craterization, Saucerization, or Diaphysectomy); Metacarpal

Summary

Partial excision of bone, often referred to as craterization, saucerization, or diaphysectomy, is a surgical procedure used to remove infected or damaged portions of the metacarpal bones in the hand. This is commonly performed to treat conditions like osteomyelitis, where bone infection has compromised the structural integrity of the bone.

Purpose

The procedure is aimed at treating osteomyelitis, a severe bone infection that can lead to the deterioration of the bone tissue. The primary goal is to remove the infected or necrotic bone tissue to prevent the infection from spreading and to promote the healing of healthy bone tissue.

Indications

• Persistent pain and swelling in the hand
• Diagnosis of osteomyelitis confirmed by imaging and laboratory tests
• Failure of conservative treatments (e.g., antibiotics)
• Presence of an abscess or severe infection undermining bone stability

Preparation

• Patients may be required to fast for 6-8 hours before the procedure.
• Certain medications might need to be adjusted or stopped, as instructed by the healthcare provider.
• Pre-procedural diagnostic tests might include blood tests, X-rays, MRI, and bone scans to assess the extent of the infection and the condition of the bone.

Procedure Description

1. Administration of regional or general anesthesia based on the extent of the surgery and patient condition.
2. An incision is made over the affected metacarpal bone.
3. The surgeon carefully removes the infected or necrotic bone tissue using specialized surgical instruments.
4. The area is thoroughly cleaned to eliminate any residual infection.
5. Bone stabilization may be performed if necessary.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1-2 hours, but this can vary depending on the severity of the infection and the extent of bone removal required.

Setting

The procedure is most commonly performed in a hospital operating room or a surgical center with appropriate facilities.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurse
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to surrounding nerves or blood vessels
• Nonunion or delayed healing of the bone
• Recurrence of the infection

Benefits

• Removal of infected bone tissue leading to pain relief
• Prevention of infection spread
• Improved hand function and strength
• Enhanced quality of life

Recovery

• Patients may need to keep the hand elevated and use ice packs to reduce swelling.
• Pain management involves prescribed medications.
• Hands-on physical therapy may begin a few weeks following the surgery to restore range of motion and strength.
• Full recovery can take several weeks to months, depending on the individual and the extent of the surgery.
• Follow-up appointments are essential to monitor healing and address any concerns.

Alternatives

• Long-term antibiotic therapy, though it may not effectively eradicate severe bone infections.
• More conservative surgical approaches if the infection is limited.
• Amputation in extreme cases where the infection is uncontrollable and threatens the overall function of the hand.

Patient Experience

• Patients will be sedated or under anesthesia during the procedure and will not feel any pain.
• Post-surgery, pain and swelling are common, but these can be managed with medications and proper care.
• Gradual improvement in symptoms and hand function is expected over the recovery period.
• Support from physical therapy and adhering to post-operative instructions will facilitate a smoother and quicker recovery process.