Case Study: Close reduction and internal fixation
with bone-nail fixation unit x 2 Biomet in a 44-year-old male
The process of physically reuniting your bones is known as internal fixation. The parts of a shattered bone are inserted back into the proper position indirectly using wires, pins, or metal plates during a closed reduction and internal fixation surgery treatment. Your bones’ regular mending process is halted by doing this.
Verbal consent with regards to consultation was taken from a 44-year-old patient. The patient had an injury to the right during a scuffle 2 weeks back, for which he was brought to the Peconic Bay Medical Center by the law enforcement agency. He was found to have a displaced fracture of the 5th metacarpal.
He was followed in the office and planned to have surgery. The patient was brought to the Peconic Hospital today back to the holding area. We discussed treatment options including surgical and nonsurgical. The patient opted for surgical management.
We discussed risks, benefits, and complications of surgery including infection, bleeding, nonunion, malunion, failure of implant, residual deformity, stiffness of the finger, weakness of the finger, tingling and numbness due to the injury to adjacent nerves and vessels among others. The patient understood and signed an informed consent.
The patient was taken to the operating room, where general anesthesia was induced. The right upper extremity was prepped and draped aseptically. Preoperative antibiotic was given. Manipulation of the 5th metacarpal head was done.
A pin hole incision was given at the base of the 5th metacarpal. The awl was used to insert the nail. Once the nail was inserted, the awl was removed. The nail was negotiated along the shaft through the neck.
The fracture was reduced, and the nail was passed onto the hand. The second nail was inserted using an awl by the side of the first nail into the shaft and the head. Finding it in an acceptable position in AP, lateral, and oblique views, the wound was closed. Pictures were saved.
After a dressing by 4×4, a short arm lateral gutter splint was applied in Jones’ position. The patient was extubated and moved to Recovery in a stable condition. A shoulder sling was applied.
For post operative, the patient had a fracture of the neck of 5th metacarpal about 2 months back. The patient was operated on 6 weeks back with closed reduction and fixation of the main fracture using intramedullary pins x2. The patient was put in ulnar gutter splint. The patient is in jail.
The patient was brought to the hospital from the jail where we discussed treatment options and discussed removal of the pins today. We also discussed post rehabilitation and physical therapy. We also discussed the use of ulnar gutter splint. The patient signed informed consent.
The patient was taken to the operating room general where he was placed on the well-padded operating table. sedation was induced. The splint was removed from the right upper extremity. The right upper extremity was prepped and draped aseptically in the usual fashion. Time-out was called.
Preoperative antibiotics were given. The suture was removed. The pins were visible. Pins were removed using Plier. The wound was cleaned with Betadine and dressed in 4 x 4, Webril, and Ace wrap.
The patient was taken to the post-op recovery unit in a stable condition. A verbal postoperative follow up with the patient was done. He is doing well. No fever, chills. He is wearing the splint and moving his fingers.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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