Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage
CPT4 code
Name of the Procedure:
Treatment of Intertrochanteric, Peritrochanteric, or Subtrochanteric Femoral Fracture; with Intramedullary Implant, with or without Interlocking Screws and/or Cerclage
Summary
This surgical procedure involves the stabilization of a fractured femur (thigh bone) using an intramedullary implant, which may include interlocking screws or cerclage. The implant is placed inside the bone's central canal to help align and secure the fracture, facilitating proper healing.
Purpose
The procedure is designed to treat fractures in the upper part of the femur, specifically around the trochanters or just below them. The goals are to stabilize the fracture, ensure proper alignment, promote healing, and restore the patient's ability to bear weight and function normally.
Indications
- Severe pain and inability to bear weight due to a femoral fracture.
- Fractures of the intertrochanteric, peritrochanteric, or subtrochanteric regions.
- Patients who have sustained fractures from trauma, falls, or osteoporosis.
- Cases where conservative treatments (e.g., casting or traction) are not feasible.
Preparation
- Fasting for at least 8 hours prior to surgery.
- Adjustment or cessation of certain medications, such as blood thinners.
- Preoperative diagnostic tests, including X-rays, CT scans, or MRI to assess the fracture.
- Preoperative medical evaluation to ensure the patient is fit for surgery.
Procedure Description
- Anesthesia: The patient is given general anesthesia or regional anesthesia like spinal or epidural.
- Incision: A small incision is made near the hip.
- Fracture Alignment: The fractured femur is aligned properly.
- Intramedullary Implant Insertion: An intramedullary rod is inserted into the central canal of the femur.
- Interlocking Screws/Cerclage: Interlocking screws or cerclage wires may be used to provide additional stability.
- Closure: The incision is closed with sutures or staples and a sterile dressing is applied.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Radiologic technologist (to assist with imaging during surgery)
Risks and Complications
- Infection at the surgical site
- Blood clots
- Nerve or blood vessel injury
- Malalignment or improper healing of the fracture
- Need for additional surgeries
- Anesthetic complications
Benefits
- Stabilizes the fracture, allowing for proper healing.
- Restores function and mobility.
- Reduces pain and discomfort.
- Shorter recovery time compared to non-surgical treatments.
Recovery
- Post-surgery, the patient may need pain management and antibiotics to prevent infection.
- Physical therapy to restore mobility and strength.
- Weight-bearing activities may be limited for several weeks.
- Follow-up appointments for monitoring healing through imaging and clinical assessments.
- Full recovery typically takes several months, depending on the patient's overall health and adherence to rehabilitation protocols.
Alternatives
- Non-surgical treatments such as casting or traction (less effective for severe fractures).
- External fixation (external rods and pins).
- Pros: Less invasive options available.
- Cons: Longer immobilization, potential for improper healing and prolonged recovery.
Patient Experience
- The patient will be under anesthesia during the procedure and should feel no pain.
- Postoperative pain and swelling managed with pain medication.
- Discomfort from the incision and restricted mobility initially.
- Gradual improvement in pain and function with physical therapy and healing.