28605 Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia

Name of the Procedure:

Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia (Commonly known as: Non-surgical correction of Lisfranc joint dislocation)

Summary

This procedure involves manually realigning a dislocated tarsometatarsal joint, which is located in the midfoot, without any surgical incision. Anesthesia is administered to ensure the patient remains comfortable and pain-free during the manipulation.

Purpose

Medical Condition:

• Tarsometatarsal joint dislocation, also known as Lisfranc injury. ##### Goals and Expected Outcomes:
• To realign the dislocated joint, relieve pain, restore normal foot function, and prevent further complications like chronic pain or arthritis.

Indications

Symptoms:

• Severe pain in the midfoot area, swelling, bruising, and an inability to bear weight on the affected foot. ##### Patient Criteria:
• Persistent dislocation of the tarsometatarsal joint confirmed through physical examination and imaging studies such as X-rays or MRI.

Preparation

Pre-procedure Instructions:

• Fasting for 6-8 hours before the procedure if general anesthesia will be used.
• Adjusting or halting certain medications as advised by the healthcare provider. ##### Diagnostic Tests:
• X-rays or MRI of the foot to assess the extent of the dislocation.

Procedure Description

1. Anesthesia Administration: General anesthesia or local/regional anesthesia is administered to ensure the patient is pain-free.
2. Joint Manipulation: The orthopedic specialist manually manipulates the dislocated joint, using precise techniques to realign the bones.
3. Immobilization: Once the joint is properly realigned, a cast or splint is applied to stabilize the foot and maintain the correction.

Tools and Technology:

• Anesthesia equipment.
• Radiographic imaging (for guidance if needed).
• Casting or splinting materials.

Duration

Typically, the procedure takes about 30 minutes to 1 hour, depending on the severity of the dislocation.

Setting

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

Personnel

• An orthopedic surgeon or foot and ankle specialist.
• An anesthesiologist or nurse anesthetist.
• Surgical nurses and support staff.

Risks and Complications

Common Risks:

• Swelling, bruising, and pain at the site. ##### Rare Complications:
• Nerve damage, blood clots, infection, or improper alignment which might necessitate further treatment.

Benefits

• Immediate reduction of pain and discomfort.
• Restoration of normal foot alignment and function.
• Prevention of long-term complications such as arthritis.

Recovery

Post-procedure Care:

• Keeping the foot elevated and iced to reduce swelling.
• Using crutches or a walker to avoid weight-bearing on the affected foot. ##### Recovery Time:
• Immobilization in a cast or splint for 4-6 weeks.
• Physical therapy may be needed to restore strength and mobility. ##### Follow-up:
• Regular follow-up appointments to monitor healing progress.

Alternatives

• Surgical Correction: Involves open reduction and internal fixation with screws or plates.
• Pros: May be necessary for more severe injuries, allows for direct visualization and correction of the dislocation.
• Cons: Higher risk of complications, longer recovery time.

Patient Experience

During the Procedure:

• The patient will be under anesthesia and should not feel any pain. ##### After the Procedure:
• Pain and discomfort managed with prescribed medications.
• Instructions for care will be provided, including how to manage the cast/splint and when to follow up with the healthcare provider.