Name of the Procedure:

Prophylactic Treatment (Nailing, Pinning, Plating, or Wiring) with or without Methylmethacrylate for Femoral Neck and Proximal Femur

Summary

This procedure involves reinforcing the femoral neck and proximal femur by inserting devices such as nails, pins, plates, or wires. It may also include the use of methylmethacrylate, a type of bone cement. The goal is to prevent fractures in at-risk bones.

Purpose

This procedure aims to prevent fractures in the femoral neck and proximal femur, especially in patients with conditions that weaken these bones. It's designed to stabilize the bone and reduce the risk of breakage, thereby improving the patient’s mobility and overall quality of life.

Indications

• Osteoporosis
• Bone tumors or metastasis to the femur
• Previous fractures in the femur or other bones
• Conditions leading to bone weakness (e.g., Paget's disease)
• High-risk patients for femoral neck and proximal femur fractures

Preparation

• The patient may be required to fast for 8 hours before the surgery.
• Adjustments to medications, especially blood thinners, may be necessary.
• Preoperative imaging studies like X-rays, CT scans, or MRIs to assess bone integrity.
• Blood tests and a complete medical evaluation to ensure fitness for surgery.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made to access the femoral neck and proximal femur.
3. Insertion: Nails, pins, plates, or wires are inserted to stabilize the bone.
4. Cement Application: If needed, methylmethacrylate is applied to reinforce the bone structure.
5. Closure: The incision is closed with sutures or staples.
6. Imaging: Post-procedure X-rays verify the proper placement of the hardware.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and specific requirements.

Setting

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

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Radiologic Technologist (for intraoperative imaging)

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Hardware failure or misplacement
• Allergic reaction to anesthesia or materials used

Benefits

• Significantly reduced risk of femoral fractures
• Improved bone stability and strength
• Enhanced mobility and physical activity
• Reduction in pain associated with bone weakness

Recovery

• Hospital stay for 1-3 days post-procedure.
• Pain management with medications.
• Physical therapy to restore mobility and strength.
• Avoidance of high-impact activities for several weeks.
• Follow-up appointments for monitoring healing and hardware placement.

Alternatives

• Non-surgical management with medications and lifestyle modifications
• Use of external braces or supports
• Regular physical therapy and exercise regimes
• Bone-strengthening medications

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, patients might feel discomfort or pain at the surgical site, which can be managed with pain relief medications. Physical therapy will help regain strength and mobility. Mild swelling and bruising around the incision site are common initially.