Name of the Procedure:

Osteotomy; metacarpal, each (Common names: Metacarpal Osteotomy, Bone Cutting Surgery of the Hand)

Summary

An osteotomy of the metacarpal involves surgically cutting and realigning one of the bones in the hand to correct deformities, alleviate pain, or improve function.

Purpose

Osteotomy of the metacarpal is performed to address conditions such as fractures that have healed improperly (malunion), congenital deformities, arthritis, or other structural problems in the hand. The goal is to restore proper alignment, function, and relieve pain.

Indications

• Malunion or nonunion of metacarpal fractures
• Congenital deformities of the hand
• Severe arthritis affecting the metacarpals
• Structural issues causing pain or impaired hand function

Preparation

• Patients may need to fast for a set period before the surgery.
• Adjustments to medications, especially blood thinners, might be needed.
• Pre-operative assessments including X-rays or MRIs for precise planning.

Procedure Description

1. The patient is positioned and administered anesthesia (usually general or regional).
2. An incision is made over the affected metacarpal.
3. The surgeon uses specialized tools to cut the bone.
4. The bone segments are realigned and secured with plates, screws, or pins.
5. The incision is closed with sutures or surgical staples.
6. A bandage or splint is applied to stabilize the hand.

Duration

The surgery generally takes about 1 to 2 hours.

Setting

Typically performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Common risks: Infection, bleeding, pain, swelling
• Rare risks: Nerve damage, nonunion (bone not healing properly), adverse reaction to anesthesia, stiffness or reduced hand function

Benefits

• Corrects deformities and restores proper bone alignment
• Alleviates pain and improves hand function
• Potential for faster return to normal activities

Recovery

• Patients may need to wear a splint or cast for several weeks.
• Pain management with prescribed medications.
• Physiotherapy may be required to restore strength and flexibility.
• Follow-up appointments for wound check and X-rays to monitor healing.
• Full recovery typically takes several months, depending on bone healing and individual progress.

Alternatives

• Conservative treatments like splinting, physical therapy, and pain management.
• Joint fusion or replacement if arthritis is severe.
• Pros of alternatives: Less invasive, lower immediate risk.
• Cons: May not provide complete relief or correction.

Patient Experience

• Patients may experience some pain and swelling post-surgery, managed with medications.
• Initial discomfort while wearing a splint or cast.
• Gradual improvement in hand function and reduction in pain as recovery progresses.
• Adherence to physiotherapy is crucial for optimal outcomes.