27269 Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed

Name of the Procedure:

Open Treatment of Femoral Fracture, Proximal End, Head (Open Reduction Internal Fixation - ORIF)

Summary

Open treatment of a femoral fracture at the proximal end involves a surgical procedure to align and stabilize the broken bones in the upper part of the thigh near the hip joint. This procedure includes internal fixation, where metal rods, screws, or plates are used to keep the bones in place during healing.

Purpose

This procedure is used to address fractures in the proximal end of the femur (thigh bone), specifically when the femoral head is involved. The goals are to realign the fractured bone, ensure proper healing, and restore normal function and mobility to the hip and leg.

Indications

• Severe fracture of the proximal femur that cannot heal properly with non-surgical methods.
• Displaced fractures where the bone ends are out of alignment.
• Fractures that involve the hip joint.
• Patients experiencing significant pain, loss of function, or inability to bear weight on the affected leg.

Preparation

• Patients may be instructed to fast for at least 8 hours before the procedure.
• Medication adjustments may be necessary, especially blood thinners.
• Preoperative tests might include X-rays, MRI, or CT scans to assess the fracture.
• Blood tests and a general health assessment will be conducted.

Procedure Description

1. The patient is typically placed under general anesthesia.
2. An incision is made over the hip area to expose the fractured bone.
3. The surgeon realigns the bone fragments (open reduction).
4. Metal implants such as screws, plates, or rods are inserted to secure the bone fragments (internal fixation).
5. The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure usually takes about 2-4 hours, depending on the complexity of the fracture.

Setting

This surgery is typically performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Recovery room nurses

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Implant failure or loosening
• Delayed healing or nonunion of the fracture
• Postoperative pain and stiffness
• Anesthesia-related risks

Benefits

• Proper alignment and stabilization of the femur
• Improved chances of full functional recovery
• Reduced pain and improved mobility

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Physical therapy will be initiated to regain strength and mobility.
• Pain management may include medications and ice packs.
• Weight-bearing restrictions and activity limitations will be advised for several weeks.
• Follow-up appointments are necessary to monitor healing and implant position.

Alternatives

• Non-surgical treatment may include casting or bracing, but it is generally less effective for complex fractures.
• Traction might be used in some cases but also has limitations.
• Pros and cons should be discussed with the medical team to determine the best approach.

Patient Experience

• Patients will be under general anesthesia during the procedure, so they won't feel any pain.
• Postoperative pain and discomfort can be managed with medication.
• Physical therapy and rehabilitation are crucial for recovery.
• Full recovery and return to normal activities may take several months.