CPT® Code 25685

1. Indications

The open treatment of a trans-scaphoperilunar type fracture dislocation is indicated in specific circumstances where the injury presents significant complications or where closed treatment methods have failed. The following conditions warrant this procedure:

• High-energy wrist trauma A trans-scaphoperilunar fracture dislocation typically results from a high-energy impact, necessitating surgical intervention for proper alignment and stabilization.
• Scaphoid fracture The presence of a fracture in the scaphoid bone, which is critical for wrist function, indicates the need for surgical treatment to ensure proper healing and prevent complications.
• Lunate dislocation The dislocation of the lunate bone, which can lead to significant functional impairment, requires reduction and stabilization through open surgical techniques.
• Failed closed treatment If initial closed treatment methods, such as manual manipulation, do not achieve adequate anatomical alignment, an open approach becomes necessary.

2. Procedure

The procedure for the open treatment of a trans-scaphoperilunar type fracture dislocation involves several critical steps to ensure successful outcomes. Each step is designed to address the specific components of the injury effectively.

• Step 1: Incision An incision is made on the volar aspect of the wrist, providing direct access to the fracture site. This approach allows the surgeon to visualize and address the injury accurately.
• Step 2: Irrigation and Debridement Once the incision is made, the fracture site is thoroughly irrigated to remove any bone fragments and debris. This step is crucial for preventing infection and ensuring a clean surgical field.
• Step 3: Reduction of the Scaphoid Fracture The scaphoid fracture is then reduced, meaning it is manipulated back into its proper anatomical position. This is a critical step to restore function and stability to the wrist.
• Step 4: Stabilization After achieving proper alignment, the scaphoid fracture is stabilized using various fixation methods, which may include screw fixation, K-wires, and/or anchor sutures. This stabilization is essential for promoting healing.
• Step 5: Reduction of the Lunate Dislocation The dislocated lunate is then reduced back into its correct position. This step is vital for restoring the normal anatomy of the wrist and preventing long-term complications.
• Step 6: Verification of Anatomic Alignment Following the reduction of both the scaphoid fracture and lunate dislocation, radiographic imaging is performed to verify that anatomic alignment has been achieved. This confirmation is crucial before closing the incision.
• Step 7: Closure and Immobilization Once proper alignment is confirmed, the incisions are closed, and the wrist is immobilized in a cast to protect the surgical site and facilitate healing.

3. Post-Procedure

Post-procedure care following the open treatment of a trans-scaphoperilunar type fracture dislocation is essential for optimal recovery. Patients are typically advised to keep the wrist immobilized in a cast for a specified duration to ensure proper healing of the fracture and stabilization of the lunate. Regular follow-up appointments are necessary to monitor the healing process through radiographic evaluations. Patients may also be instructed on pain management strategies and rehabilitation exercises to restore mobility and strength once the cast is removed. It is important to adhere to the surgeon's guidelines regarding activity restrictions and rehabilitation protocols to prevent complications and ensure a successful recovery.