Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femur
CPT4 code
Name of the Procedure:
Prophylactic Treatment of Femur (Nailing, Pinning, Plating, or Wiring) with or without Methylmethacrylate
Summary
Prophylactic treatment of the femur involves the insertion of hardware such as nails, pins, plates, or wires to stabilize the bone. Methylmethacrylate (a type of bone cement) may be used to enhance stability. This procedure helps to prevent fractures in patients at high risk.
Purpose
The procedure addresses weakened or compromised femoral bones, often due to conditions like osteoporosis, metastatic cancer, or other bone-weakening diseases. The goal is to prevent fractures, ensure stability, and enhance the patient's mobility and quality of life.
Indications
- Severe osteoporosis
- Metastatic bone disease
- Previous bone fractures indicating high risk of new fractures
- Conditions causing significant bone weakening
Patient criteria include those with high fracture risk and patients requiring preventative measures to maintain bone integrity.
Preparation
- Fasting typically required for 8-12 hours before the procedure.
- Adjustments to medications may be necessary (e.g., blood thinners).
- Preoperative imaging studies (e.g., X-rays, MRI, CT scans).
- Blood tests to evaluate overall health and suitability for surgery.
Procedure Description
- Anesthesia: The patient is given general or regional anesthesia.
- Incision: A small incision is made over the site.
- Hardware Insertion:
- Nailing: A nail is inserted through the marrow canal of the femur.
- Pinning: Pins are placed to stabilize bone fragments.
- Plating: A metal plate is screwed to the outside of the bone.
- Wiring: Wires are used to hold bone fragments together.
- Methylmethacrylate: Applied if necessary, to fill gaps and provide additional stability.
- Closure: The incision is closed with sutures or staples.
Tools/Equipment: Surgical drill, screws, plates, nails, bone cement applicator.
Duration
The procedure typically takes between 1 to 3 hours, depending on complexity.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic Surgeon
- Surgical Nurse
- Anesthesiologist
- Surgical Technologist
Risks and Complications
- Infection at the site
- Bleeding or blood clots
- Nerve or blood vessel damage
- Non-union (bone not healing properly)
- Hardware failure or need for revision surgery
Benefits
- Prevents bone fractures
- Enhances stability and mobility
- Reduces pain related to weakened bone structure
- Immediate benefits include stabilization, with full benefits realized over weeks as healing progresses.
Recovery
- Hospital stay of 1-3 days post-procedure.
- Pain management with prescribed medications.
- Physical therapy starting as early as the day after surgery.
- Avoiding weight-bearing activities for a specified period.
- Follow-up appointments for monitoring bone healing with imaging.
Alternatives
- Conservative management with medications (e.g., bisphosphonates).
- Physical therapy alone.
- Radiotherapy for bone metastases.
- Lifestyle modifications to reduce fracture risk.
Pros and cons must be discussed with the healthcare provider to choose the most suitable option.
Patient Experience
- The patient may feel groggy from anesthesia post-surgery.
- Pain and discomfort managed with medication.
- Increased mobility and reduction in pain after initial recovery phase.
- Physical therapy aids in faster recovery and return to normal activities.