DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right shoulder grade 3 acromioclavicular joint separation.
POSTOPERATIVE DIAGNOSIS: Right shoulder grade 3 acromioclavicular joint separation.
OPERATION PERFORMED: Right open Weaver-Dunn procedure.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DISPOSITION: The patient was transferred to the recovery room in stable condition.
INDICATION FOR OPERATION: The patient is a (XX)-year-old male who sustained a grade 3 acromioclavicular joint separation and has had this chronic condition. The patient chose to undergo reconstruction of his deformity.
DESCRIPTION OF OPERATION: Following informed consent, the patient was taken to the operating room and placed on the operating table. Upon adequate induction of general anesthesia, he was placed into a semi-beach chair position. All bony prominences were well padded. The patient’s head was anatomically supported in the head holder. The right shoulder was then prepped and draped in the usual sterile fashion.
A curvilinear incision centered over the acromioclavicular joint, extending down towards the coracoid, was marked out. A second DuraPrep was used to prep out his upper extremity. The skin was incised, and dissection was carried down to the deltoid fascia. A transverse incision in the fascia was then made directly over the clavicle in the AC joint. Dissection was carried down directly to the clavicle. The clavicle was exposed in a subperiosteal fashion. He had obvious osteolysis of his clavicle and previous avulsion fracture with small fragments of the clavicle inferiorly. The coracoid was identified as was the coracoacromial ligament. The coracoacromial ligament was identified and tagged with mono sutures and divided from the acromion.
A small puncture wound was made in the fascia to gain exposure to the undersurface of the acromion. At this time, approximately 1 cm of his distal clavicle was excised, and two drill holes were made for passage of the #5 FiberWire in line with the coracoid. Two smaller drill holes were made further lateral in the clavicle for passage of the coracoacromial ligament. At this time, a curved suture passer was placed inferiorly around the coracoid with direct palpation and visualization. The triple looped #5 FiberWire was triply braided. The FiberWire was then passed underneath the coracoid and through the drill holes in the clavicle.
At this time, superior force was placed on the elbow to elevate the acromion followed by downward pressure of the clavicle to correct the deformity. The FiberWire was then sutured into place. This allowed excellent fixation of his clavicle. Sutures were passed through the previous drill holes and then tied back down at the end of the clavicle. Final examination revealed the clavicle to be extremely stable, and the deformity was well reduced. The wound was then copiously irrigated with irrigation. The deltoid fascia was meticulously reapproximated with the use of 0 Ethibond sutures followed by 2-0 Vicryl for subcutaneous tissues and 4-0 Monocryl suture for skin in subcuticular fashion. A sterile dressing and pain catheter were placed, as well as a sling. The patient tolerated the procedure well.
