The surgeon who operated on my thumb fracture gave me a DVD movie afterwards to watch the whole procedure. I was wondering why they suspended my thumb and hand up in the air. Is that to help with circulation or something?
After the patient is anesthetized and asleep, the affected arm is held in traction to separate the bones at the fracture site. This is done when the X-ray shows that the fractured piece is compressed up against the rest of the bone or if the fractured fragment has rotated and must be freed, turned, and put back in place.
A special traction unit is used that holds the hand, wrist, and arm steady while the surgeon works on it. The thumb is placed in a finger trap that is much like the Chinese finger traps we played with as children. The more pressure that is applied, the tighter the trap becomes. In the case of a surgical finger trap, the tension applied is just enough to stabilize the thumb without compromising circulation.
As you will probably see from the video of the procedure, the surgeon can use a small-joint arthroscope to work inside the thumb. The availability of this surgical tool makes it possible now to reduce the fracture in an anatomically correct position. Reduction refers to putting the broken pieces of bone back together so that the bone surfaces line up exactly and the carpometacarpal joint is fully restored.
Before thumb arthroscopy was available, traction and fluoroscopy (real-time 3-D X-rays) were used to make sure the bones was reduced properly. But it turns out that this method wasn't always reliable. Sometimes it looked like the bone was reduced and properly in place when it wasn't.
Even a slight rotation of the bone can make a difference. Without an exact anatomic reduction, patients can end up with a painful, arthritic thumb. Combining arthroscopy with the fluoroscopy has changed all that. Now the hand surgeon can replace the bone fragments where they belog, apply the appropriate fixation, and make sure everything is lined up perfectly before putting the hand in a splint.
Randall W. Culp, MD, and Jeff W. Johnson, MD. Arthroscopically Assisted Percutaneous Fixation of Bennett Fractures. In The Journal of Hand Surgery. January 2010. Vol. 35A. No. 1. Pp. 137-140.
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