Internal Fixation of the Hip
Definition
- Stabilization of an intracapsular fracture of the femoral neck or an extracapsular fracture of the intertrochanteric region.
Discussion
- The procedure is indicated for the patient when early postoperative mobilization may not be feasible.
- The procedure could be performed under local anesthesia if necessary because of poor physiologic status.
- Fixation can be achieved with a variety of fixation devices, including nails, pins, or compression screws across the fracture site, or sometimes in conjunction with a plate along the femoral shaft.
Position
- Supine, either on a fracture table or regular operating table that can accommodate fluoroscopy.
Packs/ Drapes
- Total hip extremity pack
- Folded towels
- Stockinette cuff
- Image intensifier drape
Instruments
- Basic orthopedic tray
- Power drill, cord, drill bits
- Fixation device, guide pins
Supplies/Equipment
- Basin set
- Suction
- Blades
- Power source for drills
- Asepto syringe
- Stockinette
- Solutions
- Medications
- Sutures
Procedure
- After the patient is asleep, the fracture is reduced and checked by x-ray film.
- The incision is made, exposing the fracture site, and the appropriate fixation device is placed after guide wires are inserted temporarily to check alignment.
- A drill is used to assist a placement or fixation device, and an x-ray film is taken to reaffirm placement.
- The wound is irrigated with antibiotic solution and closed.
Perioperative Nursing Considerations
- Have x-ray capabilities in the room.
- Notify x-ray department when patient is being positioned on the table. Observe radiologic precautions.
- The extremity may be supported postoperatively in a cast, depending on the location/ severity of the fracture.
