Alternative Names surgical pinning of the hip, open reduction and internal fixation of a hip fracture
Definition Hip pinning is a procedure used to repair a hip fracture, or broken hip. Pinning means that one or more special metal pins are inserted into a bone or bones. Many people with hip fractures need to have this procedure. Often, it enables the hip to begin functioning and the person to move around earlier than if the bone had to heal on its own. Also, it can help reduce complications.
Who is a candidate for the procedure? A hip fracture is actually a break in the top part of the thighbone, also called the femur. Only some hip fractures need pinning. A bone surgeon known as an orthopaedist will determine if a fracture needs pinning. The decision is usually based on the location, type, and severity of the hip fracture.
How is the procedure performed? Hip pinning is done under general anaesthesia or regional anaesthesia. General anaesthesia means the person is put to sleep with medications. Regional anaesthesia usually means the person will be awake, but numb below the waist. A medication may be given to make the person drowsy.
Once the numbing medication has started to work, the hip is area is cleaned. An incision is usually made on the outside of the hip. In rare cases, an incision is not made into the skin, and the bones are manipulated into the right position from the outside of the body. Joint X-rays are used to confirm that the bone pieces are in the right position. Special metal pins are then inserted into the bone pieces to hold them together. In most cases, these pins are underneath the skin and cannot be seen after the operation. In some cases, the pins are inserted through the skin.
Other devices such as metal plates may also be needed to help hold the broken bone together. After the bone is repaired, the incision is sewn closed. Special plastic tubes may be put through the skin incision and into the area of surgery. These act as drains to collect blood and other fluid that can build up after surgery. A dressing is then applied to the incision. The person is taken to the surgery recovery room. This procedure usually takes a total of 1 to 3 hours.
What happens right after the procedure? After the surgery, the person will stay in the surgery recovery room for close observation. Blood pressure, pulse rate, breathing rate and other body functions will be checked. Close attention will be paid to the circulation and sensation in the legs and feet. The person will receive fluids through an intravenous tube to replace fluids lost during surgery. The individual may have a drain inserted in the body near the incision. He or she may also have a urinary catheter to drain urine from the bladder.
After a short time, the person is taken to a hospital room on the orthopaedic floor or to the surgical inpatient unit. Drugs for pain are given as needed. Antibiotics may be given to prevent or treat infections. While in the hospital, the individual will have physiotherapy. This involves learning to perform exercises to strengthen the hip. Most people will be able to leave the hospital within 5 to 7 days.
What happens later at home? Before going home, a person should be able to get around using crutches or a walker. Physiotherapy may still be needed after the person goes home. Sometimes, some people need to go to a rehabilitation centre after leaving the hospital. This helps a person gain the independence needed to be able to get around at home. Full recovery from this surgery may take 3 to 6 months.
What are the potential complications after the procedure? There are complications with any surgery or anaesthesia. These include bleeding, infection, and allergic reactions to the medications used for pain. Other possible complications include blood clots in the leg or the lung. Medications may cause stomach upset, allergic reactions, and other side effects. Specific side effects depend on the medications used. Poor healing of the fracture is also a possible complication.
Author: Gail Hendrickson, RN, BS Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 17/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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