Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, single
CPT4 code
Name of the Procedure:
Open Treatment of Interphalangeal Joint Dislocation (Includes Internal Fixation, Single)
Common Name(s): Finger Joint Surgery, Interphalangeal Dislocation Repair
Technical Term: Open Reduction with Internal Fixation (ORIF) of Interphalangeal Joint Dislocation
Summary
This surgical procedure involves repairing a dislocated interphalangeal joint in a finger. It requires making an incision to realign the dislocated joint and might include the use of internal fixation devices like pins, screws, or plates to stabilize the joint.
Purpose
Addresses: Severe dislocations of the interphalangeal joints of the fingers that cannot be remedied with non-surgical methods.
Goals: To realign the joint, restore function, and alleviate pain.
Indications
Symptoms/Conditions:
- Severe pain and swelling in the finger
- Visible deformity or malalignment
- Inability to move the finger properly
Patient Criteria:
- Failed closed reduction
- Unstable joint after reduction
- Associated fractures that require stabilization
Preparation
Instructions:
- Fasting typically required if general anesthesia is used.
- Adjust or pause certain medications as advised by the doctor.
Assessments:
- Physical examination
- X-rays or other imaging to assess the extent of the dislocation and any associated fractures.
Procedure Description
- Anesthesia: Local or general anesthesia is administered to ensure patient comfort.
- Incision: A small incision is made over the affected joint.
- Reduction: The dislocated joint is carefully realigned.
- Internal Fixation: Pins, screws, or plates may be placed to hold the bones in the correct position.
- Closure: The incision is closed with sutures, and a sterile dressing is applied.
Tools and Equipment: Scalpels, retractors, pins, screws, or plates.
Duration
Approximately 1 to 2 hours, depending on the complexity of the dislocation.
Setting
The procedure is typically performed in an outpatient surgical center or hospital operating room.
Personnel
- Orthopedic Surgeon or Hand Surgeon
- Surgical Nurses
- Anesthesiologist or Nurse Anesthetist
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Pain and swelling
Rare Risks:
- Nerve damage
- Blood vessel damage
- Joint stiffness or reduced mobility
Possible Complications:
- Nonunion or malunion of the bones
- Recurrence of dislocation
Benefits
- Realignment of the joint
- Pain relief
- Improved finger function and mobility
Expected Timeline for Benefits: Improvement is generally noticed as the healing progresses, typically within weeks to a few months.
Recovery
Post-Procedure Care:
- Keep the surgical site clean and dry.
- Follow specific instructions regarding wound care and activity restrictions.
Expected Recovery Time: Full recovery can take several weeks to months. Temporary splinting or bracing may be required, followed by physical therapy.
Follow-Up: Regular follow-up appointments to monitor healing and to remove any internal fixation devices, if necessary.
Alternatives
Non-Surgical:
- Closed reduction (realigning without surgery)
- Splinting or bracing
Surgical Alternatives:
- Arthroscopic surgery (minimally invasive but less common for severe dislocations)
Pros and Cons:
- Closed reduction is less invasive but may not be effective for severe dislocations.
Patient Experience
During the Procedure: The patient will be under anesthesia and should not feel pain. Local anesthesia will numb the area, while general anesthesia will keep the patient unconscious.
After the Procedure: Some pain and swelling are normal; pain management will be provided. Discomfort can be managed with prescribed pain medication and ice application.
Comfort Measures: Pain medication, elevation of the hand, and adherence to post-surgical care can enhance comfort and aid in recovery.