Name of the Procedure:

Open Treatment of Femoral Shaft Fracture with Plate/Screws, with or without Cerclage

Summary

This procedure involves surgically aligning and stabilizing a broken femur (thigh bone) using metal plates and screws. In some cases, wires (cerclage) are also used to provide additional support.

Purpose

The procedure addresses femoral shaft fractures, aiming to realign the bone properly and ensure it heals correctly. The goals are to restore normal leg function, alleviate pain, and prevent complications associated with improper healing.

Indications

• Severe fracture of the femoral shaft
• Fractures that cannot be treated with casting or less invasive methods
• Displaced or unstable fractures
• Multiple fractures
• Patients with high physical demands that require optimal bone healing

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or stopping certain medications under healthcare provider’s guidance
• Pre-operative imaging, such as X-rays or CT scans, to assess the fracture
• Blood tests and other necessary pre-surgical evaluations

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made over the site of the fracture.
3. Fracture Alignment: The fractured bone segments are exposed and realigned.
4. Fixation: Metal plates and screws are attached to the bone to secure the segments. If needed, cerclage wires are wrapped around the bone fragments for additional stability.
5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 3 hours, depending on the complexity of the fracture.

Setting

Performed in a hospital operating room or at a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding and blood clots
• Damage to surrounding tissues or nerves
• Nonunion (failure of the bone to heal) or malunion (improper healing)
• Pain and stiffness in the leg
• Potential need for additional surgeries

Benefits

• Proper alignment and stabilization of the femur
• Enhanced healing process
• Reduced pain and improved leg function
• Shorter recovery time compared to non-surgical methods for complex fractures

Recovery

• Hospital stay of 1-3 days post-surgery
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility
• Avoid weight-bearing on the affected leg for several weeks as advised by the surgeon
• Follow-up appointments to monitor healing and remove sutures/staples if needed

Alternatives

• Non-surgical treatment (casting) for minor or stable fractures
• Intramedullary nailing (inserting a rod inside the bone)
• External fixation (using a frame outside the body to stabilize the bone)
• Pros and Cons: Non-surgical treatments may involve longer immobilization and healing times, while other surgical options like intramedullary nailing may be less invasive but suitable for different fracture types.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel pain. After surgery, they may experience discomfort, swelling, and bruising, which can be managed with pain medication and ice. Physical rehabilitation is crucial for recovery, and patients should follow their healthcare provider's instructions closely for the best outcomes.