26715 Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed

Name of the Procedure:

Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed
Common Names: MCP joint surgery, Open reduction, Internal fixation (ORIF) of finger dislocation

Summary

This procedure involves surgically repositioning a dislocated metacarpophalangeal (MCP) joint in the hand and securing it with internal fixation devices to ensure proper alignment and healing.

Purpose

The procedure addresses a dislocated metacarpophalangeal joint, which can cause pain, limited mobility, and joint instability. The goal is to realign the joint, alleviate pain, restore function, and prevent future dislocations or complications.

Indications

• Visible deformity of the finger at the MCP joint
• Severe pain and swelling at the joint
• Inability to move the affected finger
• Unsuccessful closed reduction attempts

Preparation

• Fasting for several hours before surgery
• Discontinuation of certain medications, as advised by the doctor
• Pre-operative imaging tests (e.g., X-rays, MRI) to assess the dislocation

Procedure Description

1. Anesthesia: Administer local, regional, or general anesthesia based on patient needs.
2. Incision: Make a surgical incision over the affected MCP joint.
3. Reduction: Manually or instrumentally reposition the dislocated joint.
4. Internal Fixation: Use pins, screws, or plates to secure the joint in the correct position.
5. Closure: Close the incision with sutures and apply a sterile dressing.
6. Immobilization: Apply a splint or cast to immobilize the finger for healing.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital or surgical center, usually in an operating room.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve or vessel injury
• Stiffness or limited range of motion
• Need for additional surgery if fixation fails

Benefits

• Pain relief and cessation of restricted movement
• Improved finger function and mobility
• Stabilized joint to prevent future dislocations
• Enhanced quality of life and hand dexterity

Recovery

• Keep the hand elevated to reduce swelling.
• Follow-up appointments to monitor healing and remove sutures or pins.
• Physical therapy may be recommended for regaining strength and flexibility.
• Full recovery typically takes several weeks to a few months, depending on the injury's severity and patient's healing rate.

Alternatives

• Closed reduction (if viable)
• Non-surgical management with splinting and physical therapy (for minor cases)
• Pros and Cons: Less invasive alternative may not be as effective for severe dislocations. Surgery ensures proper alignment and healing but carries inherent surgical risks.

Patient Experience

• Mild to moderate pain post-surgery, managed with prescribed pain medications.
• Initial discomfort from splint or cast.
• Gradual improvement in mobility and decrease in pain as healing progresses. Pain management and comfort measures will be taken throughout recovery, including medications, rest, and physical therapy.