Name of the Procedure:

Closed Treatment of Femoral Fracture, Distal End, Medial or Lateral Condyle, with Manipulation

Summary

The closed treatment of a distal femoral fracture with manipulation is a medical procedure where a broken lower end of the thigh bone (near the knee) is realigned without the need for surgical incisions. This procedure aims to restore proper bone alignment and promote healing.

Purpose

The procedure is used to address fractures at the distal (lower) end of the femur, specifically at the media or lateral condyle, which are the rounded projections of the bone that form part of the knee joint. The primary goal is to realign the broken bone fragments to ensure proper healing and restore function, thereby minimizing complications such as mal-union or joint dysfunction.

Indications

• Acute pain, swelling, and immobility in the knee area following trauma or injury.
• X-ray or imaging studies showing a fracture in the distal femur.
• Patients who do not require open surgery.

Preparation

• The patient may be advised to fast for several hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners.
• Pre-procedure imaging (e.g., X-rays or CT scans) to assess the extent of the fracture.

Procedure Description

1. Anesthesia: The patient will receive general anesthesia or regional anesthesia (such as a nerve block) to ensure comfort during the procedure.
2. Manipulation: Using manual force and traction, the orthopedic surgeon will carefully realign the fractured bone fragments without making any incisions.
3. Immobilization: After correct alignment is achieved, the leg will be immobilized using a cast, brace, or splint to maintain proper positioning during the healing process.
4. Imaging Confirmation: Post-manipulation X-rays to confirm the bone is properly aligned.

Duration

The procedure typically takes between 30 minutes to an hour, depending on the severity of the fracture and the specifics of the case.

Setting

This procedure is usually performed in a hospital or surgical center with a sterile environment and modern imaging facilities.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or assistants
• Radiologic technologist

Risks and Complications

• Infection
• Blood clots
• Nerve or blood vessel damage
• Mal-union or nonunion of the fracture
• Stiffness or reduced range of motion in the knee joint
• Complications from anesthesia

Benefits

• Less invasive compared to open surgery.
• Reduced recovery time and potential for fewer complications.
• Restoration of normal bone alignment and function.
• Relief from pain and enhanced mobility.

Recovery

• Immobilization for several weeks to months, depending on the healing process.
• Follow-up appointments to monitor healing and possibly adjust the immobilization device.
• Physical therapy may be recommended to restore strength and mobility.
• Pain management with prescribed medications.
• Avoidance of weight-bearing activities until the bone has sufficiently healed.

Alternatives

• Open reduction and internal fixation (surgical intervention with metal plates and screws).
• External fixation with a metal frame outside the body.
• Conservative management with prolonged immobilization if surgery or manipulation is not feasible.
• Each alternative has its pros and cons related to invasiveness, recovery time, and risk of complications.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there might be discomfort or pain managed by medications. Swelling and stiffness in the knee area are common. Adhering to rehabilitation protocols will help in achieving a smooth and effective recovery process.