27232 Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction

Name of the Procedure:

Closed Treatment of Femoral Fracture, Proximal End, Neck; with Manipulation, with or without Skeletal Traction

Summary

This procedure involves realigning (manipulating) a broken femur (thighbone) near the hip without surgical incisions. It may include the use of skeletal traction to maintain proper bone alignment during healing.

Purpose

The procedure addresses fractures of the femur's proximal end (near the hip), specifically the neck of the femur. The goal is to ensure proper alignment of the bone fragments to promote healing, restore function, and reduce pain.

Indications

• Trauma or injury resulting in a fractured femoral neck.
• Patients experiencing severe pain, inability to bear weight on the affected leg, or visible deformity.
• Suitable for patients who are unable to undergo surgery due to medical comorbidities.

Preparation

• Fasting may be required if anesthesia is involved.
• Adjustments to medications, particularly blood thinners, as advised by the doctor.
• Pre-procedure imaging tests, such as X-rays or CT scans, to assess the fracture.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure patient comfort.
2. Manipulation: The healthcare provider realigns the bone fragments by manually adjusting the leg and hip.
3. Skeletal Traction: If needed, a traction device is applied, using pins or screws to maintain bone position during healing.
4. Imaging: Further imaging may be done to confirm proper alignment post-manipulation.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center, often in an operating room or a specialized orthopedic treatment area.

Personnel

• Orthopedic surgeon or specialized physician
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians
• Radiologic technologist for imaging assistance

Risks and Complications

• Infection at the site of skeletal traction (if used)
• Improper bone alignment, requiring further intervention
• Blood clots, particularly deep vein thrombosis (DVT)
• Nerve or blood vessel damage

Benefits

• Realignment of the femoral neck to promote proper healing
• Alleviation of pain and restoration of function
• Avoidance of invasive surgery for medically compromised patients

Recovery

• Immobilization of the leg using a cast, brace, or traction device as directed.
• Pain management with prescribed medications.
• Physical therapy to regain strength and mobility.
• Follow-up appointments for X-rays to monitor healing.
• Recovery time varies; typically, several weeks to months with gradual resumption of activities.

Alternatives

• Open reduction and internal fixation (ORIF) surgery

  • Pros: Direct visualization and fixation of the fracture.
  • Cons: More invasive, longer recovery, higher surgical risk.

• Non-surgical management

  • Pros: Avoids surgical risks.
  • Cons: Risk of improper healing and limited mobility.

Patient Experience

• During the procedure, patients under anesthesia will not feel pain.
• Post-procedure, moderate pain and swelling can be managed with medications.
• Discomfort from immobilization devices and limited mobility is expected.
• Gradual improvement in pain and function with adherence to rehabilitation protocols.