DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right elbow osteoarthritis.
POSTOPERATIVE DIAGNOSIS: Right elbow osteoarthritis.
OPERATION PERFORMED: Debridement of right elbow joint.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 100 mL.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female with advanced osteoarthritis of her right elbow with significant osteophytes limiting her range of motion. Informed consent was obtained for debridement of these osteophytes in order to improve her range of motion and her symptoms.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid supine on the OR table. After general anesthesia was induced, her right upper extremity was prepped and draped in the usual sterile fashion. Next, a sterile tourniquet was placed. A standard lateral approach to the elbow joint was performed. Once we got down to the fascia, we made an anterior limb of the approach to the elbow joint as well as a posterior limb to allow access to the posterior aspect of the elbow joint.
Initially, attention was directed towards the anterior elbow joint. Dissection was carried out over the anterior aspect of the humerus over the medial side. A very large osteophyte was identified overlying the coronoid. This osteophyte was removed in piecemeal fashion until normal anatomic contour of the coronoid was identified. Next, there was an osteophyte along the coronoid fossa in the anterior aspect of the humerus, which was also removed with the osteotome. Medially, the osteotome was again used to remove an osteophyte along the anteromedial aspect of the distal humerus. Next, using a rongeur, the coronoid fossa was created for more anatomic articulation.
Next, after adequate debridement of the anterior aspect of the joint, attention was directed towards the posterior elbow joint. The posterior limb of the incision through the fascia was explored, and the posterior aspect of the elbow joint, including the olecranon as well as the olecranon fossa, were visualized. There were significant degenerative changes of this joint. Osteophytes were removed, again using a combination of an osteotome and a rongeur from the tip of the olecranon as well as the olecranon fossa in the posterior aspect of the humerus. Several loose bodies were identified in the posterior aspect of the elbow joint, which were removed using a rongeur.
Once thorough debridement of any prominent osteophytes was performed, the elbow range of motion was again checked and noted to be much improved from preoperatively. Preoperatively, the patient had range of motion from about 40 degrees to 120 degrees. After thorough debridement of the anterior as well as the posterior aspects of the elbow joint, the patient could flex up to 140 degrees and extension to 15 degrees, short of full extension. There were significant degenerative changes, in particular, over the capitellum.
Next, the wound was thoroughly irrigated with normal saline. Adequate hemostasis was obtained. Next, the deep fascial layer was closed with 0-Vicryl suture in figure-of-eight fashion followed by 2-0 Vicryl suture for the subcutaneous layer and staples for the skin. Sterile dressings were applied, and the patient was placed into a sling. There were no complications. The patient was awakened and transferred back onto a stretcher and taken to the PACU for recovery.
