Background Information:

What are the other Names for the Procedure?

• Internal Fixation of Hip Fracture
• Repair of Hip Fracture

What is Hip Nailing for Hip Fracture surgical procedure?

• Hip Nailing is a surgical procedure that involves reconnecting the loose bone fragments of the femur, close to the hip joint
• The hip joint is a ball (the head of a thigh bone/femur) and socket (called acetabulum) joint that is covered by a soft tissue envelope called capsule
• Any fracture to the socket is not considered a hip fracture. Nailing is performed for hip fracture

There are 3 types of hip fractures:

• Intracapsular fracture: Fractures at the level of head and neck of femur, within the capsule
• Intertrochanteric fracture: Fractures that occur between the greater and lesser trochanter (2 different bony prominences on the upper part of femur)
• Subtrochanteric fracture: Fractures that occur below the lesser trochanter

What part of the Body does the Procedure involve?

A Hip Nailing for Hip Fracture procedure involves the top of the femur and the pelvis socket joint.

Why is the Hip Nailing for Hip Fracture surgical procedure Performed?

A Hip Nailing for Hip Fracture surgical procedure is performed for the following reasons:

• To improve patient’s pain
• To improve the hip joint’s range of motion
• And to improve the mobility, in elderly individuals

What are some Alternative Choices for the Procedure?

• Non-surgical treatment is an option that is generally reserved for patients, who are not medically fit for surgery, or if they were unable to walk prior to injury, and may have been bedridden or wheelchair-bound
• Some fractures may be considered stable enough to be managed with non-surgical approach
• Some intertrochanteric fractures are managed with compression hip screws; this is based on the surgeon’s experience and expertise
• Percutaneous hip screw and plate insertion is now possible. It has the potential for less blood loss, an earlier bearing of full (normal) weight, and better reduction

What are the Recent Advances in the Procedure?

Percutaneous insertion technique and less invasive approaches are some of the recent advances to the procedure.

What is the Cost of performing the Hip Nailing for Hip Fracture surgical procedure?

The cost of Hip Nailing for Hip Fracture procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Hip Nailing for Hip Fracture procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://orthoinfo.aaos.org/topic.cfm?topic=A00392

http://www.hopkinsmedicine.org/gec/series/fixing_hip_fractures

Prior to Hip Nailing for Hip Fracture surgical procedure:

How is the Hip Nailing for Hip Fracture surgical procedure Performed?

The Hip Nailing for Hip Fracture surgical procedure is performed as follows:

• The procedure is performed under general or spinal anesthesia
• The approach is based on the area of the hip that is broken. It can be done, either through the front, or back of the hip. In some patients, both approaches may be required
• In cases where fracture fragments are displaced, a reduction of fragments to near normal position is obtained first, either without an incision (closed reduction) or with incision (open reduction)
• Surgery is performed only when an adequate, stable, or near-anatomic reduction, is obtained
• A cut is made in the skin on the lateral aspect of the thigh and continued down through the underlying tissues and muscles to the femur
• The lateral femur and the greater trochanter is exposed
• A nail is inserted through the greater trochanter, with a compression hip screw inserted through the upper portion of the nail, into the femoral head
• After appropriate placement of the nail, the muscles, fascia, and skin are closed

Where is the Procedure Performed?

Hip Nailing for Hip Fracture procedure is performed at a hospital.

Who Performs the Procedure?

An orthopedic surgeon performs the Hip Nailing for Hip Fracture procedure.

How long will the Procedure take?

Depending on surgeon’s experience and expertise, the surgery may take anywhere between 2-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Hip Nailing for Hip Fracture procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hip Nailing for Hip Fracture surgical procedure?

Prior to a Hip Nailing for Hip Fracture procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• X-ray of the hip
• X-ray of the lung
• CT scan
• MRI scan

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is Hip Nailing for Hip Fracture procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Hip Nailing for Hip Fracture surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia or general anesthesia is administered for this procedure.

How much Blood will you lose, during the Procedure?

An open surgical approach can sometimes involve significant blood loss, in which case, the patients are transfused blood and blood products.

What are the possible Risks and Complications during the Hip Nailing for Hip Fracture surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection around the surgical wound
• Formation of blood clots
• Anesthetic complications
• Accidental injury to the neighboring tissues

What Post-Operative Care is needed at the Healthcare Facility after the Hip Nailing for Hip Fracture surgical procedure?

• After the surgical procedure, patients will be sent to an area of the hospital, called postoperative recovery area (PACU)
• The patient’s blood pressure, heart rate, and respiration cycle, are closely monitored. Any additional pain associated with the procedure will also be treated
• Individuals are usually discharged from the hospital 4-7 days after the surgery is performed
• Medications may be given to prevent blood clot, and antibiotics administered to prevent infection
• Physical therapy is instituted early to help with patient’s ambulation
• Sometimes the patients may need walkers, crutches, or canes, as recommended by physical therapist and surgeons

After the Hip Nailing for Hip Fracture surgical procedure:

What are the possible Risks and Complications after the Hip Nailing for Hip Fracture surgical procedure?

Post Hip Nailing for Hip Fracture procedure, the following complications may arise:

• Excessive bleeding
• Infection of the surgical wound
• Formation of blood clots in the legs that can travel to the lungs (pulmonary embolism)
• Reoccurring fracture of the hip
• Non-union of fracture
• Device failure

What is the Prognosis after the Surgery?

A complete recovery from a Hip Nailing for Hip Fracture procedure is usually adequate without any complications, if properly rehabilitated.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, and constipation
• Abnormal swelling
• Signs of an infection
• Fever
• Dizziness
• Feeling sick
• Muscle aches
• Headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Hip Nailing for Hip Fracture surgical procedure?

At home, the following post-operative care is recommended, after a Hip Nailing for Hip Fracture procedure:

• Slowly resume regular/daily activities, as advised by the surgeon and physical therapist, to aid in a faster recovery
• Individuals usually begin by using a walker, followed by crutches, and then a cane, if needed
• Avoid all activities that are physically strenuous for about 12 weeks after surgery
• Avoid lifting or pulling heavy objects
• Resume driving, when advised by your physician
• Gently wash the surgical wound everyday with plain soap and water
• Elevate legs while resting, to prevent formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, advised by your physician
• Blood thinning medication may be prescribed by your physician, to help prevent the formation of blood clots
• Take stool softeners to prevent constipation, under advice by the physician
• Take antibiotic medication to help combat or prevent infection, as advised by the physician
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary
• Immediately for a few weeks after the surgery, have a high-fiber diet. As you increase your fiber intake, also increase your fluid intake, in order to prevent constipation and stress during bowel movements and urination
• Avoid sex till complete healing has taken place (or follow your physician’s advice)

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 3-6 months, to recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Hip Nailing for Hip Fracture surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The facility, physician’s office or hospital
• An anesthesiologist (if anesthesia was administered)
• Orthopedic surgeon

The patient is advised to inquire and confirm the type of billing, before the Hip Nailing for Hip Fracture procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA