Name of the Procedure:

Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone

Summary

In this procedure, a fractured bone in the hand (metacarpal) is realigned (manipulated) without making an incision (closed treatment). External devices, such as pins or braces, are used to keep the bone in place while it heals.

Purpose

This procedure is used to address fractures in one or more of the metacarpal bones in the hand. The goal is to ensure that the bones are properly aligned and stabilized to promote optimal healing and restore hand function.

Indications

• Visible deformity or misalignment of the hand
• Pain and swelling in the metacarpal region
• Inability to move fingers correctly
• X-ray or imaging showing a displaced or angulated fracture of the metacarpal bone

Preparation

• Patients may be asked to fast for a few hours prior to the procedure if sedation is used.
• Cease certain medications, such as blood thinners, as advised by the healthcare provider.
• Pre-procedure imaging, like X-rays or CT scans, to assess the fracture.

Procedure Description

1. The patient is positioned comfortably, and anesthesia or sedation is administered if necessary.
2. The healthcare provider manipulates the fractured bone externally to realign it properly.
3. External fixation devices, such as pins, wires, or braces, are applied to maintain the alignment. These devices are anchored outside the skin, allowing immobilization of the bone.
4. The overall alignment is checked via imaging to ensure proper positioning.
5. Dressings or protective coverings are applied over the fixation devices to protect the site.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the fracture and number of bones involved.

Setting

The procedure is often performed in a hospital, outpatient clinic, or surgical center, typically in a setting equipped for orthopedic treatments.

Personnel

• Orthopedic surgeon
• Nurses
• Anesthesiologist (if sedation or anesthesia is required)
• Radiology technician (for imaging)

Risks and Complications

• Infection at the fixation site
• Non-union or malunion of the fracture (bones not healing properly)
• Nerve or blood vessel damage
• Hardware malfunction or displacement
• Skin irritation or sores from the external fixator

Benefits

• Proper alignment promotes better healing and functional recovery of the hand.
• Reduced pain and discomfort once the bone is stabilized.
• Prevention of long-term deformities or improper healing.

Recovery

• Pain management with prescribed medications
• Keep the external fixation device and dressing clean and dry.
• Follow-up visits for monitoring bone healing and adjusting the fixation device.
• Physical therapy may be recommended once the bone begins to heal, to restore strength and flexibility.
• Full recovery varies but generally takes several weeks to a few months.

Alternatives

• Open reduction and internal fixation (surgical approach with internal hardware)
• Cast immobilization without manipulation (less invasive, but may not be suitable for all fractures)
• Conservative treatments like splinting if the fracture is non-displaced

Pros and Cons of Alternatives:

• Open reduction offers direct visualization and precise alignment but involves surgery and a longer recovery.
• Cast immobilization is less invasive but may not provide adequate stabilization for all types of fractures.
• Splinting is the least invasive but may only be suitable for simple, non-displaced fractures.

Patient Experience

• During the procedure, the patient may feel some manipulation discomfort if sedation is not used.
• Post-procedure, there may be swelling and pain managed by medications.
• The external fixation device can restrict some hand movements, and care must be taken to protect it from impacts or moisture.