DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left hip intertrochanteric fracture.
POSTOPERATIVE DIAGNOSIS: Left hip intertrochanteric fracture.
OPERATION PERFORMED: Intramedullary nailing, left hip intertrochanteric fracture.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Spinal.
ESTIMATED BLOOD LOSS: 50 mL.
COMPLICATIONS: None.
CONDITION: Stable to recovery room.
DESCRIPTION OF OPERATION: The patient was brought to the operating room, lying supine in his hospital bed. A spinal anesthetic was administered. Once the patient was comfortable, he was transferred over to the fracture table. A Foley catheter was placed. IV antibiotics were administered preoperatively. The patient was secured onto the fracture table with a belt and tape across the arms and upper chest area, and both feet were secured distally. A perineal post had been placed. The left lower extremity was secured down and longitudinal traction applied through the post. The right lower extremity hip and knee were flexed and externally rotated to keep them out of the operative field. C-arm fluoroscopy was then brought in to check fracture alignment, and it was found to be acceptable on AP and lateral views.
The lateral hip region was then prepped with DuraPrep and then draped out in the usual sterile fashion. A stab wound incision was made proximal to the tip of the greater trochanter and a Steinmann pin placed on the tip of the greater trochanter, localizing it on AP and lateral views to be in the center. This was placed down into the femur to the level of the lesser trochanter. The knife was used to enlarge the opening proximally and a guide placed over the pin down to the tip of the greater trochanter. The drill was used through the guide to open the greater trochanter. The guide pin was then removed and the actual Synthes trochanteric fixation nail with 130 degree angle x 11 mm diameter was placed down into canal on the insertion device. It was tapped down until it was at the appropriate level for the hip helical blade.
The placement was checked on AP and lateral views. The hip helical blade cannula was then placed through the 130 degree guide connected onto the insertion handle. This was placed against the skin and then an incision made through the skin and fascia down onto bone. The cannula was then placed down until it was flush on the bone. The guide pin was drilled up into the center of the femoral head on AP and lateral views. The inner sleeve was then removed, and the length of the blade was measured to be 110 mm. The outer cortex was then drilled, and then, on the insertion handle, the 110 mm helical blade tapped up into position. Again, this was done under C-arm fluoroscopy to ensure correct placement.
Attention was then turned proximally, and the flexible screwdriver was used to tighten down the proximal screw to the helical blade. The distal screws and cannulas were then placed through the targeting device and a small incision made through the skin and fascia allowing it to be placed flush against bone. Drill was used to drill through both cortices. The length of the screw was measured with the depth gauge and a 40 mm length distal interlocking screw placed.
The fracture was well reduced. All the metal was in good position. The fracture moved as one unit. All the wounds were then irrigated with antibiotic solution. The fascial layer proximally was repaired with 0 Vicryl stitches. Subcutaneous tissue was closed with inverted 2-0 Vicryl, and the skin was closed with a running 3-0 PDS stitch. Steri-Strips were applied. A sterile compressive dressing and Betadine-soaked Adaptic, 4 x 4’s, and ABD were placed over the wounds. The patient was then carefully transferred off the fracture table onto his hospital bed. The patient tolerated the procedure well and was brought to the recovery room in stable condition.
