Name of the Procedure:

Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft)

Summary

In this surgical procedure, doctors repair a broken or improperly healed femur (thigh bone) using a graft taken from the patient's own bone, typically the iliac crest (part of the pelvis). The procedure involves realigning the femur and using the bone graft to facilitate proper healing.

Purpose

This procedure addresses nonunion or malunion of the femur, which occurs when a broken femur does not heal properly or fails to heal at all. The goal is to realign the bone correctly, promote healing, and restore function to the affected leg.

Indications

• Persistent pain and disability from a femur that hasn't healed properly.
• Visible deformity or shortening of the leg.
• Mobility issues due to the malformed bone.
• X-ray or imaging studies showing nonunion or malunion.

Preparation

• Fasting for at least 8-12 hours prior to surgery.
• Adjustments to medications, especially blood thinners and other specific prescriptions.
• Preoperative imaging studies such as X-rays, CT scans, or MRIs.
• Preoperative medical evaluation and discussions about anesthesia.

Procedure Description

1. Anesthesia: Administer general anesthesia to the patient.
2. Incision: Make an incision over the affected area of the femur.
3. Exposure: Expose the nonunion or malunion site.
4. Realignment: Realign the bone fragments correctly.
5. Bone Graft Harvesting: Make a second incision over the iliac crest or other suitable site to harvest the bone graft.
6. Graft Placement: Place the harvested bone graft at the site of the fracture.
7. Fixation: Use surgical plates, screws, or rods to secure the bone and graft in place.
8. Closure: Close the incisions with stitches or surgical staples.
9. Dressing: Apply a sterile dressing to the wound.

Duration

The procedure typically takes around 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Surgical technologist

Risks and Complications

• Infection
• Blood clots
• Nerve or blood vessel damage
• Failure of the bone graft to incorporate or heal
• Anesthetic complications
• Postoperative pain and swelling
• Possible long-term need for further surgery

Benefits

• Proper bone healing and alignment
• Improved leg function and mobility
• Reduced pain and discomfort
• Potential return to normal activities within a few months

Recovery

• Pain management with medications prescribed by the doctor.
• Physical therapy starting within a few days to weeks post-surgery.
• Instructions on weight-bearing and mobility limitations.
• Follow-up appointments for X-rays and progress checks.
• Complete recovery and return to normal activities typically take several months.

Alternatives

• Non-surgical management with braces or casting (less effective for severe cases).
• External fixation devices.
• Usage of bone stimulators.
• Revision surgery or specialized orthopedic procedures for complex cases.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the surgery. Postoperatively, expect some pain and swelling, managed with medication. Physical therapy may be uncomfortable initially but is crucial for recovery. Most patients return to normal activities within several months, experiencing improved mobility and function.