Name of the Procedure:

Arthrodesis, Metacarpophalangeal Joint, with or without Internal Fixation; with Autograft (including obtaining graft)

Summary:

Arthrodesis of the metacarpophalangeal joint is a surgical procedure that involves fusing the bones in the finger joint to create one solid bone. This is done with the help of an autograft (bone taken from another part of the patient's body) and may involve internal fixation with screws or plates to hold the bones in place during healing.

Purpose:

The procedure is aimed at relieving pain, improving stability, and enhancing the function of the hand by eliminating movement at the affected joint, which can be a source of significant discomfort and disability.

Indications:

• Severe arthritis or inflammatory joint disease in the metacarpophalangeal joint
• Joint instability or deformity
• Irreparable joint damage due to trauma
• Nonunion or failed previous surgeries
• Patients experiencing significant pain and loss of function that affects daily activities

Preparation:

• Preoperative assessment and imaging studies (X-rays, CT scans)
• Blood tests and other routine pre-surgical evaluations
• Fasting for a specific period before the procedure
• Temporary cessation or adjustment of certain medications as advised by the surgeon
• Detailed discussion of the procedure, risks, and benefits with the surgical team

Procedure Description:

1. Administration of anesthesia (general or regional/local with sedation).
2. An incision is made over the metacarpophalangeal joint.
3. Preparation of the joint surfaces by removing any remaining cartilage.
4. Harvesting of the autograft from the patient’s bone (often from the pelvis).
5. Shaping and placing the autograft between the joint surfaces.
6. Fixation of the joint with screws, plates, or other internal fixation devices as needed to hold the bones in place.
7. Closure of the incision with sutures and application of a sterile bandage.
8. The hand is usually immobilized with a splint or cast to protect the fusion site during healing.

Duration:

The procedure typically takes between 1 to 2 hours, depending on complexity.

Setting:

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel:

• Orthopedic surgeon or hand surgeon
• Anesthesiologist
• Surgical nurses
• Scrub techs or surgical assistants

Risks and Complications:

• Infection
• Bleeding
• Nerve damage
• Nonunion or incomplete fusion
• Hardware irritation or failure
• Residual stiffness or loss of function in the hand

Benefits:

• Significant reduction or elimination of joint pain
• Improved hand stability and function
• Enhanced quality of life by allowing for more normal hand usage after recovery

Recovery:

• Post-surgery immobilization with a splint or cast for several weeks.
• Pain management with prescribed medications.
• Gradual return to activity, with physical therapy often recommended.
• Expected recovery time is about 8 to 12 weeks, with follow-up visits to monitor healing.
• Restrictions on heavy lifting and strenuous activities during the healing period.

Alternatives:

• Conservative treatments like medications, splints, or physical therapy
• Joint replacement (arthroplasty)
• Corticosteroid injections
• Pros and Cons of alternatives:
  • Conservative treatments may provide temporary relief but do not address the underlying issue.
  • Joint replacement can offer pain relief but may have a limited lifespan and potential complications.

Patient Experience:

Patients can expect to feel some level of discomfort during and after the procedure, which will be managed with anesthesia during surgery and pain medications postoperatively. Stiffness and a degree of restricted movement are normal initially, but physical therapy can help regain function. The fusion will eliminate joint motion, which helps alleviate pain but some adaptation to the new range of motion may be necessary.