Name of the Procedure:

Closed Treatment of Femoral Shaft Fracture, with Manipulation, with or without Skin or Skeletal Traction

Summary

This procedure involves the non-surgical realignment of a broken femoral shaft (the long, straight part of the thigh bone). The bone is manipulated back into place without the need for an incision. Traction, either by skin or skeletal means, may be used to help in aligning the bone properly.

Purpose

The procedure addresses fractures of the femoral shaft, which can result from traumatic events like car accidents or falls. The goal is to restore the alignment and function of the thigh bone, promoting proper healing and minimizing discomfort and complications.

Indications

• Severe pain and inability to bear weight on the affected leg.
• X-rays showing a fracture along the femoral shaft.
• Swelling, bruising, or deformity of the thigh.
• Patients who are candidates for non-surgical management, often due to either the nature of the fracture or patient-specific factors like age, health status, or preference.

Preparation

• Patients may be asked to fast for a certain period before the procedure if anesthesia or sedation is used.
• Diagnostic imaging, such as X-rays or CT scans, is required to assess the fracture.
• Pre-procedure assessments might include blood tests and a physical examination.

Procedure Description

1. The patient is positioned, usually lying flat on their back.
2. Anesthesia or sedation is administered to ensure comfort.
3. The medical team applies traction to the leg, gently pulling to align the bones.
4. Manual manipulation is performed to achieve proper alignment of the femoral shaft.
5. X-rays are taken during the procedure to confirm correct alignment.
6. Immobilization is achieved through casts, splints, or external fixation devices.
7. Skin or skeletal traction may be applied to maintain proper bone alignment during healing.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the fracture and the patient's condition.

Setting

It is usually performed in a hospital setting, either in an operating room or a specialized procedure suite.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants
• Radiology technician for imaging support

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve or blood vessel injury
• Malalignment or failure of the bone to heal properly
• Complications from traction, such as skin irritation or pressure sores

Benefits

• Alignment and stabilization of the fractured femur.
• Relief of pain and discomfort.
• Prevents further damage and complications.
• Promotes proper healing and return to function.

Recovery

• Patients may need to stay in the hospital for observation.
• Pain medications and anti-inflammatory drugs may be prescribed.
• Physical therapy to regain strength and mobility.
• Follow-up appointments for X-rays to monitor healing.
• May require the use of crutches or a walker temporarily.
• Full recovery typically takes several months, with some restrictions on weight-bearing activities.

Alternatives

• Open reduction and internal fixation (surgical option with plates or rods).
• External fixation involving a frame outside the leg.
• Pros include potentially faster recovery and better alignment with surgical options, but they come with higher risks and longer hospital stays.

Patient Experience

• During the procedure, the patient is sedated or under anesthesia, so they should not feel pain.
• After the procedure, there may be discomfort or pain, which is managed with medications.
• Temporary restrictions on leg movement and weight-bearing are likely.
• Regular follow-up appointments are crucial to ensure proper healing and adjust treatment as needed.