Local Anesthesia Approach for Percutaneous Screw Fixation of an Impacted Subcapital Femoral Neck Fracture: A Technique for High-Risk Patients

Figures

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  Figure 1. Localizing the trajectory and position of the femoral neck utilizing AP fluoroscopy AP: Anterior-posterior (A) Grossly assess the level prior to prepping the skin by placing the needle anterior on the proximal femur. (B) Fluoroscopic image visualizing the needle at the level of the lesser trochanter overlying the lateral cortex.

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  Figure 2. Local anesthesia application procedure images (A) After prepping the site, the skin, subcutaneous, and fatty layers were infiltrated with local anesthetic under sterile technique in the areas where skin incisions will be made. The insertion site was determined with fluoroscopy, and the anterior and posterior borders of the femur were palpated with the contralateral hand. (B) The needle was advanced under fluoroscopic view to the planned insertion site of the drill pins on the lateral cortex of the femur, beginning inferiorly and progressively moving proximally to infiltrate the entire periosteum of the targeted lateral femur. A 1.5-inch 22 gauge needle was used in this case.

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  Figure 3. Treatment site images after preparation After scrubbing, gowning, prepping, and draping, plenty of time should have elapsed to allow for the full anesthetic effect. (A) Fluoroscopic AP image showing guide pin placed percutaneously through the skin onto the lateral cortex at the level of the lesser trochanter. (B) Lateral fluoroscopic image after all three pins were placed percutaneously in a triangular and parallel fashion.

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  Figure 4. Intraoperative images (A) Gross visualization of three pins placed percutaneously in a triangular, parallel fashion. Small incisions were then made in the skin and the guide pins were measured. A cannulated drill was used over each guide pin to drill the lateral cortex, and screws were then inserted over each guide pin. (B) Fluoroscopic anterior-posterior (AP) image showing placement of the inferior 7.3 cannulated screw over the guide pin.

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  Figure 5. Post-operative images (A) Anterior-posterior (AP) and (B) lateral fluoroscopic images showing screw placement after guide pin removal.

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  Figure 6. Three weeks post-operative AP radiograph Anterior-posterior (AP) radiograph of the right hip taken three weeks post-operatively shows no displacement or loss of fixation.