Name of the Procedure:

Percutaneous Skeletal Fixation of Metatarsophalangeal Joint Dislocation, with Manipulation

Summary

Percutaneous skeletal fixation of metatarsophalangeal (MTP) joint dislocation with manipulation is a minimally invasive procedure used to correct joint dislocations in the toes, specifically where the metatarsal bones meet the phalanges (toe bones).

Purpose

This procedure aims to realign a dislocated MTP joint to its proper anatomical position, relieve pain, restore function, and prevent long-term joint damage.

Indications

• Acute or chronic dislocation of the MTP joint
• Severe pain and swelling in the affected joint
• Inability to move the affected toe
• Pain and difficulty in walking or bearing weight on the foot

Preparation

• Fasting for at least 6-8 hours before the procedure, if general anesthesia is planned
• Adjusting or stopping certain medications, as advised by your doctor
• Pre-procedure imaging tests, such as X-rays or MRIs, to assess the extent of dislocation and tissue damage

Procedure Description

1. Local or general anesthesia is administered to ensure the patient is comfortable.
2. A small incision is made near the affected joint.
3. Using X-ray guidance, the surgeon manually realigns the dislocated MTP joint.
4. Pins, screws, or wires (percutaneous skeletal fixation devices) are inserted through the skin to hold the bones in their correct position.
5. The incision is closed and bandaged to protect the area.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

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

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist
• Radiologic technician

Risks and Complications

• Infection at the site of incision or within the joint
• Bleeding or blood clots
• Damage to surrounding nerves or blood vessels
• Failure to correct the dislocation or recurrence of dislocation
• Pain or stiffness in the joint
• Complications from anesthesia

Benefits

• Immediate relief from pain and discomfort caused by the dislocation
• Restoration of normal toe alignment and function
• Improved ability to walk and bear weight on the foot
• Prevention of long-term joint damage and deformity

Recovery

• Keeping the foot elevated and applying ice to reduce swelling
• Keeping the bandage dry and clean
• Avoiding weight-bearing activities for several weeks
• Gradually returning to normal activities under the guidance of your doctor
• Follow-up appointments for removal of fixation devices and evaluation of joint healing

Alternatives

• Non-surgical treatments, such as splinting or casting, may be considered for less severe dislocations
• Open surgical correction if percutaneous fixation is not suitable
• Physical therapy to strengthen the joint and prevent future dislocations

Patient Experience

During the procedure, the patient will either be asleep or numb in the affected area. Post-procedure, some pain and swelling are expected, managed with pain relievers and proper care. Discomfort typically decreases significantly within the first week, and most patients start to experience improved function and relief soon after.