Name of the Procedure:

Percutaneous Skeletal Fixation of Metacarpophalangeal Dislocation, Single, with Manipulation

Summary

This procedure involves realigning and stabilizing a dislocated metacarpophalangeal (MCP) joint (the joint where the fingers attach to the hand) through a minimally invasive technique. The procedure includes manipulating the joint back into place and securing it using pins or wires inserted through the skin.

Purpose

The procedure addresses dislocations of the metacarpophalangeal joint. The goals are to realign the dislocated joint, maintain stability to allow proper healing, restore function, and prevent long-term complications.

Indications

• Acute dislocation of the MCP joint.
• Inability to relocate the joint through non-invasive methods.

• Need for stable fixation to ensure proper healing.

  The procedure is typically indicated for patients who have suffered significant trauma to the hand resulting in joint dislocation.

Preparation

• Patients may be advised to fast for several hours prior to the procedure.
• Adjustments to medications, especially blood thinners.
• Pre-procedure imaging, such as X-rays or MRI, to assess the extent of the dislocation.

Procedure Description

1. Local or regional anesthesia is administered to numb the hand.
2. The surgeon makes a small puncture near the dislocated joint.
3. The joint is carefully manipulated back into its correct position.
4. Pins or wires are inserted percutaneously (through the skin) to hold the joint in place.
5. The puncture site is dressed, and a splint or cast may be applied to immobilize the joint.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist

Risks and Complications

Common risks include infection at the puncture site, pain, and swelling. Rare risks involve nerve or blood vessel damage, improper joint alignment, and the need for additional surgery if fixation fails.

Benefits

The procedure provides immediate realignment and stabilization of the joint, which promotes faster healing and restores function. Most patients experience significant pain relief and improved hand function shortly after recovery.

Recovery

• Keep the hand elevated and follow wound care instructions.
• Avoid heavy lifting or strenuous activities with the hand until cleared by the surgeon.
• Follow-up appointments for monitoring and possible removal of pins or wires.
• Expected recovery time varies but generally takes several weeks, with a return to normal activities within a few months.

Alternatives

• Closed reduction (non-surgical realignment) with immobilization.
• Open surgical repair if percutaneous fixation is not feasible.

Closed reduction may avoid surgery but might be less stable, while open surgical repair is more invasive but provides direct visualization and repair of the joint.

Patient Experience

During the procedure, the patient will feel minimal to no pain due to anesthesia. Post-procedure discomfort can be managed with pain medications and anti-inflammatory drugs. Patients should prepare for a period of immobilization and possible physical therapy to regain complete function.