Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws
CPT4 code
Name of the Procedure:
Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws.
Summary
This is a surgical procedure used to treat a broken thigh bone (femur). The surgery involves making an incision to align the bone fragments and stabilizing them with an intramedullary rod inserted into the bone marrow canal. Additional hardware like cerclage wires or locking screws may be used to secure the bone fragments further.
Purpose
This procedure is performed to repair fractures of the femoral shaft, which can occur due to trauma like car accidents or falls. The main goal is to restore the normal alignment and strength of the femur, allowing the bone to heal correctly and enabling the patient to regain normal leg function.
Indications
- Severe femoral shaft fractures where the bone segments are misaligned.
- Open fractures where the bone pierces the skin.
- Fractures that have not healed properly with conservative treatment (e.g., casting).
- Multiple fractures or complex injuries.
Preparation
- Fasting for at least 8 hours prior to surgery.
- Adjustments to medications as advised by the healthcare provider.
- Pre-operative blood tests, imaging (X-rays, MRI, or CT scans), and physical examination.
- Discussion about the procedure, risks, and consent form signing.
Procedure Description
- Anesthesia is administered, typically general anesthesia.
- An incision is made in the skin over the fracture site.
- The bone fragments are realigned (reduction).
- An intramedullary rod is inserted through the bone marrow cavity of the femur.
- Cerclage wires or locking screws may be placed to further secure the bone fragments.
- The incision is closed with sutures or staples.
- A sterile dressing is applied to the wound.
- The patient is monitored in the recovery room.
Duration
The procedure typically takes about 2 to 3 hours.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Orthopedic surgeon
- Surgical nurse
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection
- Blood clots
- Nerve or blood vessel damage
- Non-union or delayed healing of the bone
- Hardware irritation or failure
- Anesthetic complications
Benefits
- Proper alignment and stabilization of the femur.
- Improved chances of the bone healing correctly and more quickly.
- Restoration of normal leg function and reduced pain.
- Shorter immobilization period compared to non-surgical treatments.
Recovery
- Hospital stay for a few days to monitor recovery.
- Pain management with medications.
- Physical therapy to regain strength and mobility.
- Restrictions on weight-bearing activities for several weeks.
- Follow-up appointments with the surgeon to monitor healing.
Alternatives
- Non-surgical treatment with casting or bracing (less effective for severe fractures).
- External fixation without internal rods (used in specific cases).
- Each alternative has its own pros and cons in terms of recovery time, stability, and risk of complications.
Patient Experience
- During the surgery, the patient will be under anesthesia and will not feel pain.
- Post-operatively, pain can range from moderate to severe but is managed with medications.
- Swelling, bruising, and discomfort at the surgical site are common.
- Gradual improvement in pain and function is expected over weeks to months with physical therapy support.