DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Fracture dislocation, right hip.
2. Fracture of both wrists.
POSTOPERATIVE DIAGNOSES:
1. Fracture dislocation, right hip.
2. Fracture of both wrists.
OPERATION PERFORMED:
1. Closed reduction of right hip fracture dislocation.
2. Open reduction internal fixation of right distal radius fracture.
3. Closed reduction with pinning of fracture, left distal radius, and external fixator application.
SURGEON: John Doe, MD
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who fell approximately 20 feet injuring his right hip and both wrists. He was brought to the emergency room for evaluation. In the ER, he was found to have fractures of both wrists and a fracture dislocation of the right hip. Attempt at closed reduction of the right hip was carried out in the ER by the ER physician; this was unsuccessful. We were consulted and evaluated the patient in the ER. He was noted to have bilateral intra-articular displaced fractures of the distal radius. On the left side, this was severely comminuted and displaced. On the right side, it was mildly displaced. He also had a fracture dislocation of the right hip with the rim fracture of the posterior acetabular wall. Surgical treatment was recommended.
DESCRIPTION OF OPERATION: The patient was taken to the operating room. He was given preoperative antibiotics. He was kept in supine position on the OR table. Closed reduction of the right hip was carried out with longitudinal traction oriented in an anterior direction. We had to stand on the bed to pull this into position. It appeared to be quite difficult and muscle relaxation was required.
Following that, we applied tourniquets to both arms. Sterile prep and drape of both upper extremities was carried out. We addressed the right wrist first. The right wrist was moderately swollen. We exsanguinated the limb with an Esmarch and inflated the tourniquet to 250 mmHg. We then made a volar approach to the right wrist. We incised the FCR tendon sheath, retracted the tendon and then incised the floor of the sheath. The muscles were retracted to expose the distal radius. We released the pronator muscle from the radial border and swept at a side to expose the radius. Once the radius was exposed, we reduced the fracture and inserted a pin to hold its position. We then applied a Synthes volar locking distal radius plate. We secured it to the shaft and to the fracture fragment with locking screws. In the shaft, we used cortical screws. Satisfactory reduction was achieved. We checked a postreduction alignment with the C-arm and found it to be satisfactory. We then irrigated the wound and closed the volar incision with interrupted Prolene sutures. Sterile dressings were applied. The tourniquet was released.
We then addressed the left wrist. We felt that the swelling in the left wrist was too severe to risk performing an open reduction and internal fixation. We felt that we needed to do volar and dorsal plating in fear that we would not be able to get the incisions closed. This decision was based on the fact that the right wrist itself, which was less severe than the left, was difficult to close. We therefore decided to proceed with external fixation and bring the patient back at a later time for definitive stabilization. We applied an external fixator to the left wrist by placing two pins in the second metacarpal and two in the radial shaft. Once these were in position, we attached pin-bar clamps and a connecting bar. We aligned the fracture as well as we could and secured the external fixator. We then placed three additional pins into separate fracture fragments of the distal radius, including a dorsal ulnar fragment and radial styloid fragment.
Once this was done, sterile dressings were applied. Tourniquet control was not used on the left. We then broke down the sterile field and applied a volar splint to the right wrist. The patient was then revived and taken to the recovery room in stable condition.
