Open Surgery
For some conditions, minimally invasive procedures are not effective. For these more complex joint problems, the surgeon must use open surgery.
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In most cases, you will be positioned lying on your back with the affected arm extended on a hand platform.
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Your hand will be shaved and washed with an antiseptic for several minutes.
- A tourniquet, usually special inflation cuffs, may be placed on your arm to minimize blood loss during the surgery.
- If appropriate, the anesthesiologist will administer a regional nerve block to keep you comfortable during the procedure.
- If a more extensive surgery is being performed, you'll be given a general anesthesia.
Common hand and wrist surgeries
- Closed reduction and fixation attempts to realign a fractured bone and then immobilize the area with internal fixtures such as wires and rods or external devices such as splints and casts.
- Surgical drainage and/or debridement is used to surgically treat hands that are infected, usually from an injury such as an animal bite. About 25% of people treated by hand surgeons have infections. Surgical drainage may be used if there is an abscess in the hand. Debridement, or cleansing of a severe hand wound is performed to prevent further infection.
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Arthroplasty is surgery performed to restore the range of motion and relieve painby realigning or reconstructing a dysfunctional joint.
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Microsurgery is surgery that is performed on very small structures, such as blood vessels and nerves, with specialized instruments under a microscope.
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Nerve repair surgery is used if one of the three main nerves of the hand are damaged or severed.
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Re-plantation uses microsurgery to replace fingers or hands that have been amputated by accident or trauma.
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Arthoplasty
Arthritis is usually the underlying condition causing the pain and immobility. Finger joints are usually treated with joint resection or inter-positional reconstructions. Wrists can be treated with all three types of arthroplasty. Whenever possible, these surgeries are done on an out patient basis.
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Joint resection involves increasing the space between the bone and socket by removing a portion of the bone from a painful joint. Scar tissue eventually fills the gap, narrowing joint space again. Pain is relieved and motion is restored, but the joint is less stable.Your surgeon makes an incision at the joint, then carefully removes the minimum amount of bone necessary to allow free motion. The more bone that remains, the more stable the joint. Ligament attachments are preserved as much as possible.
- Inter-positional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint. Both bones of the joint are reshaped, and a disk of material is placed between the bones to prevent their rubbing together.
- Total joint replacement is a procedure where the wrist joint is removed completely and replaced by a prosthetic joint. Wrist replacement requires a hospital stay.
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