DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Fracture subluxation, right ring and little finger carpometacarpal joints.
POSTOPERATIVE DIAGNOSIS: Fracture subluxation, right ring and little finger carpometacarpal joints.
PROCEDURE PERFORMED: Right hamate fracture open reduction and internal fixation. Reduction and pin fixation, ring and little finger carpometacarpal joints.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room when axillary block was placed by the anesthesia department. The right upper extremity was prepped and draped in the usual manner for hand surgery.
Under tourniquet control using loupe magnification, a longitudinal incision was placed dorsal ulnar aspect of the hand/wrist area, centered at the level of the ulnar CMC joints. Subcutaneous tissue was bluntly divided. Large sensory nerve was identified and carefully protected during the procedure. The extensor mechanism was mobilized to allow retraction.
An incision was made along the base of the little finger metacarpal. This was carried approximately over the area of the dorsal hamate. The tissues were elevated by sharp dissection. This allowed identification of the fracture of the hamate. There was a coronal fracture of a substantial nature involving the articular surface. The little finger metacarpal joint was also subluxated dorsally with the fracture displacement. There was laxity of the ring finger CMC joint.
The fracture fragment was carefully mobilized and fracture site was debrided with rongeur and curette. Traction was placed on the ring and little finger metacarpals. This allowed manual reduction of the fracture fragment. This was then held in place with four 0.045 inch Kirschner wires placed at different angles. Each of the pins was placed carefully so as not to protrude beyond the far cortex. The reduction appeared to be stable by direct stressing and also felt to be in satisfactory position by both direct visualization and Fluoroscan examination. Each of the metacarpal bases was then reduced and held in place with a separate 0.045 inch Kirschner wire.
Again, final fixation and reduction of the joints was made by Fluoroscan and also direct visualization. The hamate-capitate joint appeared good. The ulnar to the CMC joints appear to be well aligned. All pins were cut short beneath the level of the skin. The split soft tissues were reapproximated with Vicryl suture. The skin was closed with nylon suture. The wound was sterilely dressed and a bulky dressing was applied. Protective splint was applied. The operative course was uneventful, no complications. The patient tolerated the procedure and was brought to the recovery room in good condition.
