DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right grade I Monteggia fracture.
POSTOPERATIVE DIAGNOSIS: Right grade I Monteggia fracture.
OPERATIONS PERFORMED:
1. Open reduction and internal fixation of right olecranon fracture.
2. Irrigation and debridement of an open fracture.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 200 mL.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who was transferred from an outside facility with the above-stated injury. The patient also has a nondisplaced fracture of the left inferior pubic ramus. The patient also consented for the above-stated operation.
DESCRIPTION OF OPERATION: The patient was brought to the OR and laid supine on the OR table. After general anesthesia was induced, a tourniquet was placed high up on his arm. The left upper extremity was then prepped and draped in the usual sterile fashion. Standard approach was performed exposing the olecranon. The open fracture was measured approximately 1 cm in length and was incorporated into the incision. The skin edges around the open area were debrided. The fracture was exposed, and the fracture was then thoroughly irrigated with 9 liters of normal saline, the middle 3 liters of which contained 100,000 units of bacitracin.
After thorough irrigation and debridement, attention was directed towards fixation of the fracture. The fracture was cleaned of fibrin clots and periosteum. There was noted to be a large butterfly fragment in the proximal portion of the ulna. The olecranon fracture was very proximal. The butterfly fragment was not devascularized, and the muscle attachments were maintained. After fracture surfaces were identified, provisional reduction was performed using a tenaculum. The butterfly fragment was reduced to the distal portion of the shaft and held provisionally with K-wires.
Next, one lag screw was placed through this butterfly fragment obtaining a fixation to the distal shaft. Excellent reduction of this fragment was obtained. Next, the proximal olecranon fracture was reduced to the remainder of the ulna and held again with provisional K-wires. A plate from the Acumed set was then fashioned to the olecranon. One screw was placed along the tip of the olecranon extending into the anterior cortex of the ulna. Two more screws were placed into the olecranon plate in the proximal portion of the fracture. Three screws were placed distally obtaining excellent fixation in the shaft. The radial head was also exposed through the same approach, and no fractures were noted in the radial head. C-arm fluoroscopy was used to confirm excellent position of all screws as well as the reduction of the fracture and radial head.
Next, the wound was again thoroughly irrigated with normal saline. Subcutaneous layer was closed with 2-0 Vicryl suture, and staples were used to close the skin. Sterile dressings were applied, and the patient was placed into a posterior elbow splint. He was then awakened from anesthesia and transferred back onto a stretcher and taken to the PACU for recovery. There were no complications.
