Caleb Foster
Hip nailing is a procedure used to treat hip fractures, specifically intertrochanteric femur fractures. The procedure involves placing a large-diameter rod inside the bone, along with screws that connect to the rod and support the hip joint. The surgery typically requires a hospital stay of 1-2 days, and patients are encouraged to move their hip, knee, and ankle to aid in recovery. The AFFIXUS® Hip Fracture Nail System is one example of a hip nailing system that utilizes goal post technology and anti-rotation screws to facilitate accurate placement and stabilization. The average age of patients requiring this procedure is 70 years old, and the type of nail used may vary depending on surgeon preference and fracture patterns.
| Characteristics | Values |
|---|---|
| Hospital stay | 1-2 days |
| Postoperative follow-up appointment | 10-14 days after surgery |
| Average age of patients | 70 years |
| Range of patient ages | 19-96 years |
| Patient gender | 58.5% female |
| Type of break | Intertrochanteric femur fracture |
| Type of nail | Cephalomedullary nails |
| Number of patients with cephalomedullary nails | 176 |
| Number of patients with reconstruction nails | 17 |
| Intra-operative complications | 9 fractures without consequences |
| Rate of fixation | Good in 66% of cases |
| Rate of acceptable fixation | 27% |
| Rate of anatomical preoperative reduction | 72% |
| Rate of weight-bearing resumption | 83.4% during the first week |
| Mortality rate | 12.3% at three months |
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What You'll Learn
- Hip nailing is used to treat intertrochanteric femur fractures
- The average hospital stay after hip surgery is 1-2 days
- Patients are advised to move their hip, knee and ankle to avoid stiffness
- The type of nail used depends on the type of fracture
- Weight-bearing is usually allowed immediately after surgery
Hip nailing is used to treat intertrochanteric femur fractures
Hip nailing is a surgical procedure used to treat intertrochanteric femur fractures. This type of fracture involves a break in the top part of the thigh bone, which is part of the hip. The hip nailing procedure typically involves the placement of a titanium rod, known as a cephalomedullary nail, inside the bone where the bone marrow is located. This rod is connected to a large screw that extends towards the hip joint and a smaller screw near the knee. The metal construct does not cross the hip or knee joints, allowing for a full range of motion during the healing process.
The AFFIXUS® Hip Fracture Nail System is an innovative system used in hip nailing procedures. This system offers unique features such as optimal nail geometry, distal bend aid, and an anti-rotation hole. The anti-rotation hole helps stabilize the fractured femoral neck and head segment during the procedure. The AFFIXUS® system also includes GOAL POST™ technology, which assists surgeons in visualising the femoral neck to accurately place the guide pin for the lag screw.
Following hip nailing surgery, patients typically stay in the hospital for 1-2 days. Some individuals may be discharged home without assistance, while others may require support from a Home Health Agency for tasks such as bathing and therapy. During the hospital stay, patients will meet with various specialists, including physical therapists, occupational therapists, and social workers, to determine the best course of treatment for their recovery.
The recovery process after hip nailing surgery involves physical therapy and weight-bearing exercises. Patients are encouraged to move their hip, knee, and ankle joints as much as possible to prevent stiffness. The wound care instructions include keeping the surgical site clean and dry, and the sutures or staples are typically removed during the first postoperative follow-up appointment, which occurs 10-14 days after surgery. The bone usually takes about three months to heal completely, and the intramedullary nail often remains in place for life.
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The average hospital stay after hip surgery is 1-2 days
During their hospital stay, patients work with physical therapists and occupational therapists to ensure they can move around and perform basic day-to-day functions. They will be instructed on how to care for their wound and manage their pain. Patients will also receive guidance on weight-bearing and will be advised to move their hip, knee, and ankle as much as possible to prevent stiffness.
In addition to the surgical approach and incision length, patient-specific factors such as age, medical co-morbidities, and the duration of the operation can influence the length of the hospital stay. Older patients above 70 years of age and those with prolonged operations are more likely to have hospital stays of over 2 weeks.
After discharge from the hospital, patients will continue their recovery at home or in a rehabilitation facility, depending on their needs and support systems. Follow-up appointments with the surgeon or at an orthopedic clinic are typically scheduled for 2 to 4 weeks after surgery to monitor the patient's progress and address any concerns.
It is important to note that the information provided here is general, and the duration of hospital stay after hip surgery can vary depending on individual circumstances and the recommendations of the treating medical team.
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Patients are advised to move their hip, knee and ankle to avoid stiffness
Patients who have undergone hip nail placement surgery are typically advised to move their hip, knee, and ankle as much as possible to prevent stiffness and promote blood flow. While it is safe to walk on the leg, patients should expect to experience pain during the healing process.
On the second day after surgery, patients are encouraged to perform tasks independently, such as using the bathroom and taking walks with assistance. During their hospital stay, patients are given shots of Lovenox and provided with pneumatic compression devices to prevent blood clots. They may also be prescribed blood-thinning medications and antibiotics to prevent infection.
Once discharged, patients may continue their recovery at home, with some requiring assistance from a Home Health Agency for bathing and therapy. Others may need to transition to a rehabilitation hospital or skilled nursing facility if they are deemed unsafe to recover at home.
During recovery, patients are advised to perform leg exercises, such as moving their ankles up and down while in bed, to prevent blood clots. Additionally, walking and moving as much as possible can help reduce the risk of blood clots and promote overall healing. Most patients with hip fractures do not require extensive physical therapy beyond gait training to ensure they can correctly use assistive devices like a walker or cane.
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The type of nail used depends on the type of fracture
The type of nail used for hip fracture surgery depends on the type of fracture. Hip fractures are a common problem, with around 296,000 cases annually in the United States. The choice of surgery is often influenced by the location of the fracture.
Internal fixation is a common approach, where pins, screws, or a rod is inserted into the fractured bone to stabilise it while healing occurs. For fractures along the neck of the femur, metal pins or large screws may be used for repair. In the case of an intertrochanteric femur fracture, a titanium rod called a cephalomedullary nail is used. This is a type of intramedullary nail (IMN) that is placed inside the bone, along with a large screw connecting to the rod towards the hip joint, and a smaller screw near the knee. The AFFIXUS® Hip Fracture Nail System is an example of a product used in such procedures, featuring an anti-rotation hole and GOAL POST™ technology for accurate placement.
Another method is the use of a sliding hip screw (SHS), which has historically been the preferred implant for stabilisation. However, intramedullary hip screw devices are gaining popularity due to their mechanical and theoretical clinical advantages. Intramedullary nails are placed closer to the mechanical axis of the lower extremity, reducing bending moments on the implant. They can also be inserted percutaneously, resulting in lower blood loss and less periosteal disruption compared to SHS.
In some cases, the fracture may require a dynamic hip screw (DHS) or even a full or partial hip replacement if internal fixation is not suitable or advised. This may be necessary when there is a lack of blood supply to the head of the femur. The choice between IMN and DHS can depend on various factors, with studies evaluating the functional outcomes, complications, and relative parameters between the two methods.
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Weight-bearing is usually allowed immediately after surgery
Weight-bearing is usually allowed immediately after hip nail placement surgery. Hip nailing is a procedure used to treat intertrochanteric femur fractures. This type of break involves the top part of the thigh bone, which is part of the hip. During the surgery, a titanium rod, known as a cephalomedullary nail, is placed inside the bone. This metal construct does not cross the hip or knee joint to avoid restricting the range of motion during the healing process.
Following hip nail placement surgery, patients typically stay in the hospital for 1-2 days. Some individuals are able to return home unassisted, while others may require assistance from a Home Health Agency or transition to a skilled nursing facility or rehabilitation hospital. It is safe for patients to walk on their leg following surgery, although they will experience pain during the healing process. To promote recovery, patients are encouraged to move their hip, knee, and ankle joints as much as possible to avoid stiffness.
The ability to bear weight immediately after surgery is a significant advantage of hip nail placement procedures. This allows patients to regain mobility and resume their daily activities sooner. However, it is important to follow the surgeon's instructions for weight-bearing, wound care, physical therapy, medication, and diet to ensure optimal healing.
In addition to weight-bearing capabilities, hip nail placement surgery offers other benefits. The procedure aims to provide stability and support to the fractured bone, allowing it to heal properly. The metal construct used during surgery helps bear the load and facilitate bone union. This is particularly important for individuals with unstable fractures, as it provides the necessary stability for the bone to mend.
The type of nail used in hip nail placement surgery can vary depending on the fracture pattern and surgeon preference. Cephalomedullary nails are the most commonly used, but reconstruction nails are also an option. The choice of nail length and diameter can also be customized to fit the patient's specific needs and fracture characteristics. Overall, hip nail placement surgery offers a promising approach to treating intertrochanteric femur fractures, with weight-bearing typically permitted immediately post-surgery to enhance the recovery process.
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