Name of the Procedure:

Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area
Common name(s): Bone graft surgery for femur fractures, Femoral bone grafting

Summary

Bone grafting in the femoral head, neck, intertrochanteric, or subtrochanteric area involves transplanting bone tissue to repair and rebuild diseased or damaged bones in the upper part of the thigh bone (femur). The procedure includes obtaining a bone graft from another part of the patient's body or a donor.

Purpose

This procedure addresses fractures and bone defects in the upper femur that cannot heal properly on their own or require additional support. The goals are to promote bone healing, restore proper bone structure, and improve function and mobility.

Indications

• Non-union or delayed union of femoral neck fractures
• Bone defects or gaps due to injury or disease
• Avascular necrosis of the femoral head
• Pathological fractures
• Congenital bone malformations

Preparation

• Patients may need to fast for a specified period before the surgery.
• Medication adjustments, including stopping blood thinners, may be required.
• Preoperative imaging studies such as X-rays, CT scans, or MRIs.
• Blood tests and overall health assessment.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered for pain control and patient comfort.
2. Incision: A surgical incision is made to access the affected femoral area.
3. Bone Graft Harvesting: Bone graft material is obtained from a donor site (e.g., pelvis) or using synthetic substitutes.
4. Preparation: The area receiving the graft is prepared by cleaning and debriding any damaged tissue.
5. Grafting: The harvested bone graft is shaped and placed into the affected area.
6. Stabilization: The graft may be secured with screws, plates, or rods to ensure stability.
7. Closure: The incision site is closed with sutures or staples and bandaged.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the damage.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technician

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Graft rejection or failure
• Damage to surrounding tissues or nerves
• Anesthesia-related complications

Benefits

• Enhanced bone healing and structural support
• Restoration of function and mobility
• Reduction in pain and improvement in quality of life
• Prevention of further bone damage or complications

Recovery

• Post-procedure monitoring in the recovery room followed by hospital stay.
• Pain management with medications.
• Instructions on wound care and activity restrictions.
• Physical therapy to restore mobility and strength.
• Follow-up appointments for monitoring bone healing and graft integration.

Alternatives

• Non-surgical options such as bone stimulators, physical therapy, and medications.
• Other surgical procedures like internal fixation with metal hardware without bone grafting.
• Conservative management if the condition allows.

Patient Experience

Patients may experience post-operative pain, swelling, and limited mobility initially. Pain management includes medications and comfort measures like elevation and ice. Gradual improvement in movement and strength is expected with adherence to rehabilitation protocols.