Name of the Procedure:

Fusion in Opposition, Thumb, with Autogenous Graft (includes obtaining graft)

Summary

Fusion in opposition for the thumb is a surgical procedure to join the bones of the thumb joint using a graft taken from the patient's own body. This involves permanently fusing the bones together to eliminate movement at the joint, thereby reducing pain and improving thumb stability and function.

Purpose

The procedure is performed primarily to treat severe arthritis or instability in the thumb, which can cause significant pain and impair hand function. The goal is to reduce pain, restore stability to the thumb, and enhance the ability to perform daily tasks.

Indications

• Severe arthritis of the thumb joint
• Chronic instability of the thumb
• Failed previous surgeries affecting the thumb
• Deformities or injuries that compromise thumb function
• Significant pain that impairs daily activities despite non-surgical treatments

Preparation

• Remain fasting for at least 6-8 hours prior to the procedure.
• Adjust medications as instructed by your physician, especially blood thinners.
• Pre-operative assessments might include blood tests, imaging studies (X-rays or MRI), and a physical exam.

Procedure Description

1. Administration of regional or general anesthesia to ensure comfort.
2. Harvesting of an autogenous graft, typically from the patient's wrist or pelvis.
3. The surgeon makes an incision to expose the affected thumb joint.
4. The bones of the thumb are prepared by removing any remaining cartilage.
5. The graft is shaped and placed between the bones to be fused.
6. The bones and graft are then secured using screws or plates.
7. The incision is closed with sutures, and the thumb is immobilized with a splint or cast.

Duration

The entire procedure usually takes about 1-2 hours.

Setting

This surgery is typically performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Nonunion or delayed union of the bones
• Graft rejection or complications with graft site
• Reduced thumb mobility
• Pain that persists after surgery

Benefits

• Significant reduction or elimination of thumb pain
• Improved thumb stability and function
• Enhanced ability to perform daily activities without discomfort
• Long-term resolution of the underlying issue

Recovery

• Post-procedure, the thumb will be immobilized in a splint or cast for several weeks.
• Pain management may include prescribed pain relievers and anti-inflammatory medications.
• Physical therapy might be required to improve strength and flexibility once initial healing has occurred.
• Full recovery and return to normal activities typically take several months, with follow-up appointments to monitor progress.

Alternatives

• Non-surgical treatments like physical therapy, medications, or corticosteroid injections
• Less invasive surgeries such as arthroscopy or ligament reconstruction
• Joint replacement in severe cases Pros and cons vary based on the patient's condition and overall health, with alternatives potentially offering less invasiveness but also possibly limited long-term success compared to fusion.

Patient Experience

Patients may experience discomfort and swelling after the procedure, managed with pain medications and ice packs. Some stiffness is common during the early healing phase, but mobility improves gradually. Post-operative care including physical therapy helps maximize functional outcomes and comfort.