27509 Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation

Name of the Procedure:

Percutaneous Skeletal Fixation of Femoral Fracture, Distal End (Condyle or Supracondylar/Transcondylar Region), with or without Intercondylar Extension, or Distal Femoral Epiphyseal Separation.

Summary

This medical procedure involves inserting pins or screws through the skin to stabilize a fractured femur at its distal end. This approach can treat fractures near the knee joint, including those involving the medial or lateral condyle, or the area just above the knee (supracondylar or transcondylar fractures), with or without extension into the knee joint space, or fractures involving the growth plate in children.

Purpose

The goal of this procedure is to stabilize the fractured bone parts to promote proper healing, restore alignment, and maintain knee joint function. It addresses fractures commonly resulting from high-impact injuries such as falls, sports accidents, or vehicle collisions.

Indications

• Significant pain and inability to bear weight on the affected leg.
• Visible deformity or abnormal movement at the distal end of the femur.
• X-ray or imaging confirmation of a fracture involving the distal femoral condyle, supracondylar/transcondylar region, or distal femoral epiphyseal separation.
• Patients who have not responded to conservative treatments or when immediate stabilization is necessary.

Preparation

• Patients may be instructed to fast for 8-12 hours prior to the procedure.
• Medication adjustments may be necessary, especially for blood thinners.
• Pre-operative imaging studies (X-rays, MRI, CT scans) are conducted to assess the fracture.
• Blood tests and medical history review are performed to ensure patient suitability for surgery.

Procedure Description

1. The procedure is usually performed under general anesthesia or regional anesthesia such as spinal or epidural blocks.
2. The surgical area is cleaned and sterilized.
3. Using imaging guidance (fluoroscopy or X-rays), small incisions are made to allow the insertion of pins or screws.
4. These pins or screws are carefully maneuvered to align and stabilize the fractured bone parts.
5. The incisions are then closed with sutures or staples.
6. A dressing is applied to keep the area sterile.

Duration

This procedure typically takes 1 to 2 hours, depending on the complexity of the fracture.

Setting

The procedure is performed in a hospital operating room, where specialized imaging equipment is available.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist

Risks and Complications

• Infection at the incision sites.
• Blood clots (deep vein thrombosis).
• Damage to blood vessels or nerves near the femur.
• Improper healing or misalignment of the bone.
• Need for additional surgeries if fixation does not hold.

Benefits

• Faster healing and recovery compared to non-surgical treatments.
• Reduced pain and improved leg function.
• Enhanced ability to return to daily activities and physical therapy sooner.

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Physical therapy begins soon after the procedure to promote mobility and strength.
• Pain management will be provided through medications.
• Patients should avoid putting weight on the leg as per the surgeon's instructions until healing is confirmed.
• Follow-up appointments are necessary to monitor healing progress through physical exams and imaging tests.

Alternatives

• Conservative treatment with casting or bracing.
• Open reduction and internal fixation (ORIF), which involves a larger incision and direct access to the fracture.
• Each alternative has its own risks and benefits, with percutaneous fixation often offering a less invasive option and faster recovery.

Patient Experience

Patients will be asleep if under general anesthesia, or will feel numbness in the lower body if under regional anesthesia during the procedure. Post-operatively, there will be some pain and discomfort managed with medications. Physical therapy will be crucial for recovery, and adherence to post-procedure instructions will significantly influence healing outcomes.