DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left clavicle fracture nonunion.
POSTOPERATIVE DIAGNOSIS: Left clavicle fracture nonunion.
OPERATION PERFORMED:
1. Left clavicle curettage and debridement.
2. Open reduction and internal fixation with bone grafting and platelet gel concentrate.
SURGEON: John Doe, MD
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position. General anesthesia was induced by endotracheal intubation. The patient was secured in the Schlein shoulder holder and placed in the lounge chair position. A gram of Ancef was given intravenously for prophylaxis. The arm was prepped and draped free in the normal fashion.
We made an incision over the clavicle and carried it down through the subcutaneous tissue, securing hemostasis along the way. We used Bovie throughout and got right on top of the clavicle and subperiosteally dissected around to free up the fragments. There was absolutely no union at all. This was a complete nonunion. What we did is we curetted off both ends of it. We actually used a drill and curettes to open up the canal and then we were able to use rongeurs to kind of contour to make sure we could get good apposition of the clavicle itself.
Then, we used a 6-hole Ace fibular plate; we had to contour the plate. This took time to do. We then used a Grafton platelet gel concentrate mixture and we placed it into the canal of both bones. We placed the plate on and we fixed it distally with the cancellous screws. Then, we dynamized it on the proximal level for three screws with excellent fixation. Bone graft was placed around the entire fracture at this point. We thought we had a very good construct. We then used 0 Vicryl to close the sleeve over the top two on the subcu and then we used Steri-Strips over the top, where sterile dressings and a sling were applied. The patient was placed supine, was awakened, and transferred in fair condition.
