E Hip pinning (open reduction and internal fixation)
Hip pinning involves the open reduction of a hip fracture that is maintained by the application of plates and screws (internal fixation). Bone grafting may be used to repair any defects. Hip fractures may result from high-impact trauma, but most result from minor trauma in elderly persons. If the fracture is related to high-impact trauma, a coexisting trauma should be thoroughly evaluated.
2. Preoperative assessment and patient preparation
a) History and physical examination: Obtain a verbal history from the patient or family member. Note any preexisting disease processes, social history, current medications, surgical history, and allergies.
b) Laboratory tests: Hemoglobin, hematocrit, complete blood count, prothrombin time, partial thromboplastin time, and others are obtained as indicated by the history and physical examination.
c) Diagnostic tests: 12-lead ECG, chest radiography, and others are obtained as indicated by the history and physical examination.
3. Room preparation
b) Additional equipment
(1) Positioning devices and operating table: The patient is usually placed in a lateral position. Aging skin atrophies and is prone to trauma from adhesive tape, electrocautery pads, and ECG electrodes. Arthritic joints may interfere with positioning; when possible, the elderly patient should be positioned for comfort. Meticulous padding of the axilla and all bony prominences decreases the risk of nerve injury and ischemia. Prevent pressure to the ears and eyes. Maintain the neck in neutral alignment.
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