27470 Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique)

Name of the Procedure:

Repair, Nonunion or Malunion, Femur, Distal to Head and Neck; Without Graft (e.g., Compression Technique)
Common Name(s): Femoral Nonunion/Malunion Repair
Technical Medical Terms: Nonunion femoral repair, Malunion femoral repair, Compression plating of femur

Summary

Repairing a nonunion or malunion of the femur involves realigning and stabilizing the bone to ensure proper healing. This procedure corrects improperly healed fractures and does not use grafting material, often employing techniques like compression plating to achieve bone stability.

Purpose

This procedure addresses improper healing of a femoral fracture where the bone has not unified correctly (nonunion) or has healed in a misaligned position (malunion). The goal is to restore proper alignment and stability to the femur, thus improving function and alleviating pain.

Indications

• Symptoms: Persistent pain or discomfort, limited mobility, visible or palpable deformity
• Conditions: Diagnosed nonunion or malunion of the femur distal to the head and neck
• Criteria: Inadequate healing observed in follow-up imaging and assessments, failure of conservative treatments like bracing or physical therapy

Preparation

• Fasting: Typically required the night before the surgery
• Medication Adjustments: Potentially stopping blood thinners or certain medications as instructed by a physician
• Diagnostic Tests: Preoperative imaging (X-rays, CT scans) to assess bone structure and alignment, blood tests to evaluate overall health

Procedure Description

1. Anesthesia: Administered general anesthesia.
2. Incision: A surgical cut is made over the affected area.
3. Realignment: The bone fragments are realigned correctly.
4. Stabilization: Compression plating or screws are used to stabilize the bone.
5. Wound Closure: The incision is closed with sutures or staples.

Tools & Equipment:

• Compression plates, screws, surgical drill
• Imaging equipment for intraoperative assessment
• Standard surgical instruments

Duration

The procedure typically lasts 2 to 4 hours, depending on the complexity of the bone misalignment.

Setting

The procedure is performed in a hospital or a surgical center with specialized orthopedic facilities.

Personnel

• Surgeon: An orthopedic surgeon performs the procedure.
• Anesthesiologist: Manages anesthesia and patient vitals.
• Nursing Staff: Prepares the operating room, assists during surgery, and provides post-operative care.

Risks and Complications

• Common Risks: Infection, bleeding, pain at the surgical site
• Rare Risks: Nerve or blood vessel damage, blood clots, complications from anesthesia
• Management: Immediate medical attention, antibiotics for infections, pain management strategies

Benefits

• Corrects bone alignment, restoring function and reducing pain
• Expected outcomes usually realize a significant improvement within few weeks to months after surgery.

Recovery

• Post-Procedure Care: Wound care, pain medication, physical therapy
• Recovery Time: Partial weight-bearing may begin a few weeks post-surgery, with gradual return to full activity over several months
• Restrictions: Limited weight-bearing initially, avoid strenuous activities
• Follow-Up: Regular outpatient visits for X-rays and surgeon assessments

Alternatives

• Non-Surgical: Physical therapy, bracing, and electric bone stimulation
• Pros and Cons: Non-surgical options are less invasive but may be less effective for severe malunions or nonunions compared to surgical intervention.

Patient Experience

• During Surgery: Under anesthesia, the patient should not feel pain or be aware of the procedure.
• After Surgery: Post-operative pain managed with medications; some discomfort is expected during healing.
• Comfort Measures: Ice packs, elevation, and pain relief medication help manage post-op symptoms.

This comprehensive overview aims to provide a clear understanding of the femoral nonunion/malunion repair procedure, its purposes, and what you can expect throughout the process.