27227 Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation

Name of the Procedure:

Open Treatment of Acetabular Fracture(s) with Internal Fixation
Common name: Open Reduction and Internal Fixation (ORIF) of Acetabular Fracture

Summary

Open treatment of acetabular fractures involves surgically exposing the hip joint to realign and stabilize broken bones using internal fixation devices, such as screws and plates. This procedure is often required when fractures are complex or involve significant displacement.

Purpose

The procedure addresses acetabular fractures, which are breaks in the socket portion of the hip joint. The goal is to restore proper alignment and stability to the hip joint, allowing for normal function and reducing the risk of arthritis and other complications.

Indications

• Severe hip pain and inability to bear weight
• Displaced fractures evident on imaging studies
• Failure of conservative treatments (e.g., physical therapy, pain medication)
• Young or active patients where joint function preservation is crucial

Preparation

• Fasting for 8-12 hours prior to surgery
• Discontinuation or adjustment of certain medications (e.g., blood thinners) as directed by the surgeon
• Pre-operative imaging studies (e.g., X-rays, CT scans) to assess fracture pattern
• Blood tests and general health assessment

Procedure Description

1. Administration of general or regional anesthesia to ensure patient comfort.
2. Making an incision over the hip to access the acetabulum.
3. Visualizing and cleaning the fracture site.
4. Realigning the bone fragments to their proper anatomical position.
5. Securing the fragments with internal fixation devices such as screws and plates.
6. Closing the incision with sutures or staples and applying a sterile dressing.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Blood clots (deep vein thrombosis or pulmonary embolism)
• Nerve or blood vessel injury
• Implant failure or malposition
• Hip stiffness or loss of motion
• Need for additional surgery

Benefits

• Restoration of hip joint alignment and stability
• Improved mobility and function
• Reduced pain
• Decreased risk of future arthritis

Recovery

• Hospital stay for 2-5 days post-surgery
• Pain management with medications
• Physical therapy to aid in mobility and strength recovery
• Use of crutches or walker for several weeks
• Follow-up appointments to monitor healing
• Full recovery may take 3-6 months, with gradual return to normal activity

Alternatives

• Non-surgical management (traction, bracing): less effective in ensuring proper alignment
• Percutaneous fixation: less invasive but suitable only for specific fracture types
• Total hip replacement: indicated for severe fractures in elderly or those with pre-existing joint disease

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, there may be pain and discomfort managed with medications. The patient will need assistance with mobility initially and will work with a physical therapist to regain strength and function. Pain and swelling are expected but should gradually improve with care and rehabilitation.