27238 Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation

Name of the Procedure:

Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation

Summary

This non-surgical procedure involves stabilizing a fracture in the upper part of the femur (thigh bone) without physically realigning the bone fragments. It includes immobilization techniques such as casting or using braces to promote natural healing.

Purpose

This procedure treats fractures that occur in the regions around the hip without needing invasive surgery. The goal is to immobilize the fracture site to ensure proper healing and to relieve pain.

Indications

• Patients with fractures in the intertrochanteric, peritrochanteric, or subtrochanteric regions of the femur.
• Individuals for whom surgery presents too high a risk due to medical conditions.
• Stable fractures where bone fragments are in acceptable alignment and can heal without manipulation.

Preparation

• Patients may need to undergo imaging tests such as X-rays or an MRI to assess the fracture.
• Pre-procedure instructions might include fasting if any sedation is to be used.
• Patients should inform their doctor about any medications or allergies.

Procedure Description

1. Imaging studies are reviewed to confirm fracture type and alignment.
2. The affected limb is immobilized using an appropriate stabilization device such as a cast or brace.
3. The patient is instructed to avoid weight-bearing activities depending on the severity of the fracture.
4. Regular follow-ups with imaging studies are scheduled to monitor healing progress.

Duration

The initial procedure to immobilize the fracture typically takes about 30 minutes. The total healing process can take several weeks to months, depending on the patient’s age, health, and fracture severity.

Setting

This procedure is generally performed in a hospital or an outpatient clinic.

Personnel

• Orthopedic surgeon or a trained physician
• Nurses or medical assistants
• Radiology technicians for imaging

Risks and Complications

• Minor risks include skin irritation from casting or braces.
• Rare risks include improper healing or malunion of the fracture.
• Complications such as deep vein thrombosis (DVT) could arise from prolonged immobilization and need to be managed proactively.

Benefits

• Provides pain relief and stabilization of the fracture.
• Avoids the risks associated with surgical procedures.
• Allows for natural healing of the bone without invasive techniques.

Recovery

• Patients are generally advised to avoid putting weight on the injured leg.
• Follow-up appointments are necessary to monitor the fracture healing.
• Physical therapy may be recommended once the bone has partially healed to restore mobility and strength.
• Full recovery might take several months, with progressively fewer restrictions.

Alternatives

• Open reduction and internal fixation (surgical option) which involves realigning the bone fragments and fixing them in place internally with screws or plates.
• Skeletal traction which involves the use of weights and pulleys to maintain fracture alignment.
• Pros of closed treatment: Non-invasive, lower infection risk, quicker initial recovery.
• Cons: Longer immobilization period, potential for bone fragments not to align well.

Patient Experience

• During the procedure, patients might feel pressure but should not experience significant pain, particularly if sedation is used.
• Post-procedure, patients may experience discomfort around the immobilization device.
• Pain can be managed with prescribed pain medication, and comfort measures include using pillows for elevation and cold packs to reduce swelling.