Name of the Procedure:

Open Treatment of Distal Phalangeal Fracture, Finger or Thumb (including internal fixation, if performed)

Summary

This procedure involves surgically opening the distal part of the finger or thumb to treat a fracture. The treatment may include the use of internal fixation, such as screws or pins, to ensure the broken bone heals correctly.

Purpose

• Medical Condition: Fracture of the distal phalanx (the bone at the tip) of the finger or thumb.
• Goals: To realign and stabilize the broken bone to ensure proper healing, relieve pain, restore normal function, and prevent deformity.

Indications

• Visible deformity or displacement of the fingertip.
• Severe pain and swelling in the affected finger or thumb.
• Inability to move the finger or thumb properly.
• Open fractures with exposed bone.
• Failure of non-surgical treatments, such as splinting, to heal the fracture.

Preparation

• Pre-procedure Instructions: The patient may need to fast (avoid eating or drinking) for a certain period before the procedure.
• Medication Adjustments: Some medications, particularly blood thinners, may need to be paused.
• Diagnostic Tests: X-rays or other imaging tests to assess the fracture.

Procedure Description

1. Anesthesia: The procedure typically requires local or regional anesthesia; in some cases, general anesthesia may be used.
2. Incision: A surgical cut is made over the fractured bone.
3. Realignment: The fractured bone fragments are realigned to their proper position.
4. Internal Fixation: Screws, pins, or plates may be inserted to hold the bone fragments in place.
5. Closure: The incision is closed using stitches or surgical staples.
6. Dressing: The area is then covered with a sterile dressing or bandage.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the fracture.

Setting

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

Personnel

• Orthopedic or hand surgeon.
• Surgical nurses.
• Anesthesiologist or nurse anesthetist.

Risks and Complications

• Common Risks: Infection, bleeding, and swelling.
• Rare Complications: Nerve damage, poor bone healing, chronic pain, and implant failure.

Benefits

• Proper alignment and stabilization of the fracture.
• Faster and more effective healing.
• Restoration of normal finger or thumb function.
• Pain relief and improved quality of life.

Recovery

• Post-procedure Care: Keeping the surgical site clean and dry, following wound care instructions, and possibly wearing a splint or brace.
• Recovery Time: Generally, several weeks to a few months, depending on the severity of the fracture and the patient's health.
• Restrictions: Limited use of the affected hand, avoiding heavy lifting and strenuous activities.
• Follow-up: Regular visits to the doctor for progress monitoring and possible removal of fixation devices if needed.

Alternatives

• Non-surgical Options: Splinting or cast immobilization, which may be sufficient for less severe fractures.
• Pros and Cons: Non-surgical options may avoid surgical risks but may not provide as stable a fixation, potentially leading to a longer or less certain healing process.

Patient Experience

• During the Procedure: The patient will be under anesthesia and should not feel pain during surgery.
• After the Procedure: Some pain and swelling are to be expected, managed with prescribed pain medications and anti-inflammatory drugs. The patient may need physical therapy to restore full function and strength.