Name of the Procedure:

Arthrodesis, Interphalangeal Joint, with or without Internal Fixation; with Autograft (Includes Obtaining Graft), Each Additional Joint

Summary

Arthrodesis of the interphalangeal joint is a surgical procedure to fuse the bones in a finger or toe joint. This can involve internal fixation devices and using a bone autograft, where bone tissue is taken from another area of the patient’s body.

Purpose

The procedure aims to alleviate pain and restore function by stabilizing the joint. It is particularly beneficial for patients suffering from severe arthritis, deformities, or joint instability that has not responded to conservative treatments.

Indications

• Severe arthritis causing debilitating pain
• Deformities like hammer toe or claw finger
• Joint instability
• Failed previous surgical interventions
• Trauma or injury leading to joint deterioration

Preparation

• Patients may need to fast for a specified period before surgery.
• Adjustments to current medications will be advised, especially blood thinners.
• Pre-operative diagnostic tests, such as X-rays or MRIs, to assess the joint condition.
• Blood tests and a physical examination to ensure overall fitness for surgery.

Procedure Description

1. Anesthesia: The patient is administered either local, regional, or general anesthesia, depending on the case.
2. Incision: A small surgical cut is made over the affected joint.
3. Preparing the Joint: Damaged cartilage and joint surfaces are removed.
4. Internal Fixation: Metal pins, screws, or plates may be used to hold the bones in the correct position.
5. Autograft Harvesting: Bone graft material is taken from another site, often the pelvis, and placed into the joint.
6. Fusion: The bones are set to fuse together over time as they heal.
7. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes about 1 to 2 hours, depending on the number of joints being treated and the complexity of the case.

Setting

Arthrodesis is performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Non-union or delayed union where bones do not fuse as expected
• Nerve damage
• Blood clots
• Graft rejection or complications from the graft harvest site
• Pain and swelling

Benefits

• Significant pain reduction or elimination
• Improved joint stability and function
• Enhanced quality of life by allowing more normal use of the hand or foot

Recovery

• Immediate post-operative care includes monitoring for infection and ensuring proper pain management.
• The limb may need to be immobilized with a cast or brace.
• Physical therapy may be recommended to maintain flexibility in adjacent joints.
• Recovery time typically spans several weeks to a few months, with possible restrictions on weight-bearing or certain activities.
• Follow-up appointments to monitor the healing process and remove any fixation devices if necessary.

Alternatives

• Joint replacement or arthroplasty
• Conservative treatments like physical therapy, orthotics, and pain management with medications or injections
• Pros and cons:
  • Joint replacement allows for retained joint movement but might not be suitable for all patients.
  • Conservative treatments are less invasive but may not provide lasting relief for severe conditions.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, there may be discomfort at the surgical site, and effective pain management will be provided. The patient might experience swelling and temporary immobility. Physical therapy will aid in recovery, and most patients can gradually return to normal activities with appropriate precautions.