Name of the Procedure:

Closed Treatment of Intertrochanteric, Peritrochanteric, or Subtrochanteric Femoral Fracture with Manipulation, with or without Skin or Skeletal Traction

Summary

This procedure involves the non-surgical realignment of a fractured femur near the hip joint, commonly referred to as the upper thigh bone. The bones are manually manipulated back into place, and traction may be used to assist in proper alignment, all while avoiding surgical incisions.

Purpose

This procedure aims to stabilize a broken femur in the upper thigh area near the hip, which is often due to falls or traumas. The goal is to allow the bone to heal correctly, restore function, and alleviate pain.

Indications

• Severe pain in the thigh or hip area
• Inability to stand or walk
• X-rays or other imaging confirming an intertrochanteric, peritrochanteric, or subtrochanteric fracture
• Patients for whom surgical treatment is not suitable due to other medical conditions

Preparation

• Fasting may be required if sedation is planned.
• Medication adjustments might be needed, especially blood thinners.
• Pre-procedure imaging (e.g., X-rays, MRI) to assess the extent of the fracture.

Procedure Description

1. The patient is positioned appropriately, often on a traction table.
2. Anesthesia or sedation is administered to ensure comfort.
3. The physician manually manipulates the bone fragments back into alignment.
4. Skin or skeletal traction devices may be attached to maintain proper bone positioning.
5. Post-procedure imaging is done to confirm correct alignment.

Duration

Approximately 1 to 2 hours, including preparation and post-procedure imaging.

Setting

Usually performed in a hospital setting, particularly in an emergency room or orthopedic department.

Personnel

• Orthopedic surgeon or trained physician
• Nurses
• Anesthesiologist (if sedation is used)
• Radiology technician for imaging support

Risks and Complications

• Risks: Pain during manipulation, reaction to anesthesia, bleeding, or infection
• Complications: Hindered bone healing, misalignment requiring surgical intervention, blood clots, or pressure sores from traction

Benefits

• Non-invasive approach to fracture treatment
• Accelerated bone healing due to proper alignment
• Reduced risk of infection compared to open surgical methods
• Pain relief and restoration of mobility

Recovery

• Patients may need to stay in the hospital briefly for observation.
• Pain management with medications.
• Gradual resumption of activities as advised by the healthcare team.
• Physical therapy may be required.
• Regular follow-up appointments to monitor healing progress.

Alternatives

• Open surgical fixation using screws, plates, or rods.
• Pros: Potential for more accurate alignment and faster recovery.
• Cons: Higher risk of infection, longer recovery time, and potential surgical complications.

Patient Experience

During the procedure, the patient may feel some discomfort due to manipulation, but this is minimized with anesthesia or sedation. Post-procedure, there may be pain or discomfort at the fracture site. Pain management strategies, including medications, will be used to ensure patient comfort. The patient will need to follow specific instructions to aid recovery, including restrictions on weight-bearing activities and adherence to physical therapy recommendations.