DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left small finger proximal phalanx displaced fracture, closed.
POSTOPERATIVE DIAGNOSIS:
Left small finger proximal phalanx displaced fracture, closed.
OPERATION PERFORMED:
Left small finger proximal phalanx closed reduction and percutaneous pinning.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Minimal.
HARDWARE UTILIZED: K-wires x2.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who suffered an injury. He was evaluated and noted to have a proximal phalanx fracture that was just proximal to the condyle. The fracture was slightly displaced, and the finger was slightly angulated and rotated. Recommendation for closed reduction and percutaneous pinning of the fracture was offered to the patient for optimizing healing and final outcome. Risks, benefits, and alternatives of the surgery were discussed in detail. Risks including, but not limited to, infection, pain, bleeding, need for further surgeries, malunion, nonunion, persistent stiffness of the finger were discussed in detail with the patient and his father. Questions regarding surgery were answered and verbal and written consent was obtained from both the patient and his father.
DESCRIPTION OF OPERATION: After informed consent was obtained from the patient and his father, he was taken to the operating theater. The patient was transferred from the gurney to the operating table and placed in the supine position. General anesthesia was administered by the anesthesia staff, and he was intubated with LMA without difficulty. The patient received Ancef 1 gram IV preoperatively for infection prophylaxis. A well-padded tourniquet was placed in the proximal aspect of the left arm. The left upper extremity was then sterilely prepped and draped in the usual fashion.
The left small finger proximal phalanx was then manually manipulated with a traction and direct pressure on the fracture site. Mini C-arm imaging under fluoroscopy demonstrated adequate alignment with manipulation on the fracture manually. While the fracture was held and reduced, two K-wires were then placed from the ulnar aspect of the condyle of the proximal phalanx across the other side. They were placed in diverted fashion to secure fixation and to prevent rotation following fixation.
C-arm image has confirmed adequate alignment on AP and lateral oblique planes of the fracture with pin in place. There was no malrotation grossly of the digit and no significant angulated deformity was noted after pinning. The K-wire was then cut and bent with pin cap supplied.
Xeroform dressings were then placed around the pin sites and a sterile dressing was applied. A well-padded ulnar gutter splint with small and ring finger placed in a safe position was then put on the left upper extremity mobilizing and protecting the repair of the fracture. The splint was held in place with a light Ace wrap. Tourniquet was not inflated during the procedure.
The patient had general anesthesia reversed after completion of the case. He was extubated and returned to recovery room in stable condition. Note that a digital block was performed of the small finger with 0.5% Marcaine without epinephrine, approximately 8 mL used. This was used for a postoperative analgesia as well. The patient will likely be discharged after observation in the recovery room when stable and comfortable. He will be instructed regarding elevation of left upper extremity, keeping his splint clean, dry, and intact until followup in approximately 7-10 days. He was given prescription for Percocet for postoperative pain relief. He will follow up sooner if he is having any difficulties with the splint or high fevers, chills, or worsening pain of the digit.
