Clinical Context
A typical patient is an adult who sustains a displaced fracture of the femoral shaft or subtrochanteric region after a fall from standing, a motor vehicle collision, or a high-energy mechanism. The patient presents to the emergency department with acute thigh pain, deformity, swelling, and inability to bear weight. Initial evaluation includes focused trauma assessment, AP and lateral radiographs of the femur and hip, and CT if needed for complex patterns.
The clinical workflow: the patient is admitted, given analgesia and, if indicated, thromboembolism prophylaxis and tetanus update. Preoperative planning includes review of imaging, determination that open reduction and internal fixation (ORIF) with plate and screws (and optional cerclage wiring) is the optimal fixation strategy (for fractures between, around, or below the trochanters). Informed consent is obtained. The procedure is performed in an operating room under general or regional anesthesia. Intraoperative steps include exposure of the fracture, debridement of soft tissues as needed, reduction of the fragments, temporary fixation (clamps, Kirschner wires), application of an anatomic or locking plate with screws to stabilize the femur, and optional cerclage wiring for fragment control. Fluoroscopy is used to confirm reduction and hardware position. Postoperative care includes pain control, neurovascular checks, weight-bearing status per fixation stability, outpatient or inpatient physical therapy, and follow-up radiographs to monitor healing.
Typical site of service: Hospital inpatient or Hospital outpatient/ambulatory surgery center depending on patient stability and comorbidities.
Service type: Open surgical fracture fixation (ORIF) of proximal/mid/distal femur with plate and screws, possibly including cerclage wiring.
Common patient scenario: a 68-year-old with osteoporosis who slips at home and sustains a subtrochanteric femoral fracture requiring open reduction and internal fixation with a locking plate and supplemental cerclage wires. The procedure is billed with 27244 and performed under general anesthesia with intraoperative fluoroscopy in the OR; the patient is admitted for pain control and early mobilization.