Name of the Procedure:

Percutaneous Skeletal Fixation of Femoral Fracture, Proximal End, Neck

Summary

Percutaneous skeletal fixation is a minimally invasive surgical technique used to stabilize a fracture in the neck of the femur (thigh bone) through small skin incisions. Metal hardware, such as screws, is inserted to hold the bone in place while it heals.

Purpose

This procedure addresses fractures in the femoral neck, a common injury often caused by falls, especially in older adults. The main goals are to ensure proper alignment of the bone, promote effective healing, and restore mobility as quickly as possible.

Indications

• Acute fracture of the femoral neck
• Persistent pain and instability in the hip area
• Failure of non-surgical treatments (e.g., casting, bracing)
• Healthy enough for surgery but poor candidate for more invasive procedures due to age or comorbidities

Preparation

• Patients may be asked to fast for 8-12 hours before the procedure.
• Adjustments to certain medications, especially blood thinners, may be required.
• Preoperative imaging (X-rays, CT scan) to assess the fracture.
• Blood tests and other assessments to ensure overall readiness for surgery.

Procedure Description

1. The patient is given regional or general anesthesia.
2. Small incisions are made near the hip.
3. Under fluoroscopic (X-ray) guidance, special tools are used to guide screws or pins through the small incisions into the fractured bone segments.
4. The hardware is positioned to stabilize the bone and hold it in proper alignment.
5. Incisions are closed with sutures or staples, and a sterile dressing is applied.

Duration

Typically, the procedure lasts about 1 to 2 hours.

Setting

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

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (if fluoroscopic guidance is used)

Risks and Complications

• Infection at the surgical site
• Bleeding
• Blood clots (deep vein thrombosis)
• Hardware failure or migration
• Nerve or blood vessel injury
• Nonunion or malunion of the fracture, requiring additional surgery

Benefits

• Stable fixation of the femur, allowing early mobilization
• Reduced pain and improved function in the hip
• Shorter recovery time compared to traditional open surgery
• Smaller scars due to minimal incisions

Recovery

• Pain management typically involves medications.
• Physical therapy usually begins within a few days to restore movement.
• Weight-bearing restrictions may be advised for several weeks.
• Follow-up appointments to monitor healing with X-rays and clinical assessments.

Alternatives

• Non-surgical treatment like casting or bracing (less effective for proximal femur fractures)
• Open reduction and internal fixation (more invasive but necessary for complex fractures)
• Hip hemiarthroplasty or total hip replacement (considered for severe cases or elderly patients)

Patient Experience

• During the procedure, patients are unconscious if under general anesthesia, or numb from the waist down with spinal anesthesia.
• Postoperatively, patients may experience moderate pain managed with medication.
• Some soreness around the surgical site is expected as it heals.
• Physical therapy plays a critical role in a smooth recovery process and restoring function.