28606 Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation

Name of the Procedure:

Percutaneous Skeletal Fixation of Tarsometatarsal Joint Dislocation, with Manipulation

Summary

This procedure involves correcting a dislocated tarsometatarsal (midfoot) joint using minimally invasive techniques. A combination of manual manipulation and percutaneous (through the skin) screws or wires is used to stabilize the bones.

Purpose

The procedure addresses dislocations of the tarsometatarsal joint, which can cause severe pain, deformity, and difficulty walking. The goal is to realign and stabilize the bones to restore normal foot anatomy and function, alleviating pain and preventing chronic instability or arthritis.

Indications

• Severe pain and visible deformity in the midfoot.
• Inability to bear weight on the affected foot.
• X-rays or other imaging confirming dislocation of the tarsometatarsal joint.
• Non-responsive to conservative treatments such as casting or splinting.

Preparation

• Patients are typically advised to fast starting midnight before the procedure.
• Adjustments to certain medications, especially blood thinners.
• Pre-procedure evaluations, including physical exams, blood tests, and imaging studies like X-rays or CT scans.

Procedure Description

1. The patient is placed under general anesthesia or regional anesthesia (like a spinal block).
2. The surgeon performs a closed reduction, manipulating the foot to align the dislocated joints.
3. Using fluoroscopy (real-time X-ray), the surgeon inserts percutaneous screws or wires through small skin incisions to hold the bones in place.
4. Once satisfactory alignment is confirmed, the incisions are closed and sterile dressings are applied.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Radiology technician (for fluoroscopy guidance)

Risks and Complications

• Infection at the incision sites
• Nerve or blood vessel damage
• Nonunion or malunion of the bones
• Stiffness or decreased range of motion
• Complications from anesthesia
• Risks associated with hardware, such as loosening or breakage

Benefits

• Immediate relief from severe pain caused by dislocation
• Restored foot alignment and function
• Prevention of long-term complications like chronic pain or arthritis
• Improved ability to walk and engage in daily activities

Recovery

• The foot is usually immobilized with a cast or boot for several weeks.
• Non-weight-bearing on the affected foot initially, gradually progressing to partial and full weight-bearing.
• Physical therapy may be recommended to restore strength and mobility.
• Follow-up appointments to monitor healing and remove hardware if necessary.

Alternatives

• Conservative treatments like casting, splinting, or physical therapy.
• Open surgical reduction and fixation if percutaneous methods are not suitable.
• Pros of alternatives: less invasive, may avoid surgical risks.
• Cons: possibly less effective for severe dislocations or if conservative methods fail, longer recovery time.

Patient Experience

• During the procedure, the patient will be sedated and should feel no pain.
• Post-procedure, pain management includes medications and ice.
• Some swelling and discomfort are common initially.
• Full recovery can take several months, but pain relief and improved function are typically noticed within weeks.