27268 Closed treatment of femoral fracture, proximal end, head; with manipulation

Name of the Procedure:

Closed Treatment of Femoral Fracture, Proximal End, Head; with Manipulation

• Common name(s): Closed reduction of femoral head fracture
• Medical term: Closed treatment of femoral fracture with manipulation

Summary

A closed treatment of a femoral fracture at the proximal end (the femoral head) with manipulation involves realigning the broken bone segments without surgical incisions. The bone is manually adjusted into the correct position to ensure proper healing.

Purpose

• Addressed Problem: Broken femoral head (proximal end of the femur)
• Goals: Restore normal alignment and function of the femur; alleviate pain; promote proper healing of the bone

Indications

• Severe pain, swelling, or deformity in the hip area
• Inability to bear weight or walk
• X-ray confirming a femoral head fracture
• Suitable for patients without other complicating injuries or conditions that require open surgery

Preparation

• Fasting for 6-8 hours before the procedure (if anesthesia is used)
• Discontinuation of certain medications as advised by the healthcare provider
• Pre-procedure diagnostic tests such as X-rays and possibly MRI or CT scans to assess the fracture

Procedure Description

1. Anesthesia/Sedation: General anesthesia or regional anesthesia (e.g., spinal block) to ensure patient comfort.
2. Positioning: The patient is placed in a position that allows easy access and visibility of the hip area.
3. Manipulation: The orthopedic surgeon manually applies controlled force to realign the femoral head and proximal femur bones to their correct anatomical position.
4. Immobilization: The limb is then immobilized using a splint, brace, or traction to maintain alignment during the healing process.

Duration

Typically takes about 30 minutes to 1 hour.

Setting

Performed in a hospital operating room or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Nurses and surgical technologists

Risks and Complications

• Common Risks: Pain, swelling, bruising
• Rare Risks: Nerve or blood vessel damage, blood clots, improper bone healing (malunion), avascular necrosis (loss of blood supply to the bone)

Benefits

• Restores proper bone alignment without the need for surgical incisions
• Promotes effective healing
• Reduces immediate pain and improves mobility

Recovery

• Post-procedure immobilization (cast, splint, or brace)
• Follow-up appointments for X-rays to monitor healing
• Physical therapy to restore strength and range of motion
• Recovery time varies, generally 6-12 weeks before resuming full activities

Alternatives

• Open Reduction and Internal Fixation (ORIF): Surgery to insert metal rods, plates, or screws to stabilize the bone
  • Pros: More stability for severe or complex fractures
  • Cons: Involves surgical risks and longer recovery
• External Fixation: Stabilizing the bone using an external frame
  • Pros: Minimally invasive compared to open surgery
  • Cons: May be uncomfortable and require meticulous care

Patient Experience

• During the Procedure: The patient will be under anesthesia, so they should not feel pain.
• After the Procedure: Pain management with prescribed medications; some discomfort and restricted mobility initially
• Pain Management: Oral or intravenous pain medications; ice packs to reduce swelling.
• Comfort Measures: Encourage resting and elevating the limb as advised.