DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left proximal femur (subtrochanteric/intertrochanteric fracture).
POSTOPERATIVE DIAGNOSIS: Left proximal femur (subtrochanteric/intertrochanteric fracture).
OPERATION PERFORMED: Open reduction internal fixation of left proximal femur fracture with Synthes trochanteric fixation nail.
SURGEON: John Doe, MD
ANESTHESIA: General.
BLOOD LOSS: 100 mL.
COMPLICATIONS: None.
DISPOSITION: Stable to recovery.
DESCRIPTION OF OPERATION: The patient was brought into the operating room after receiving IV Ancef prophylactically. He was given general anesthesia and placed on the fracture table. The bony prominences were padded and protected. The left leg was slightly adducted and taken out to proper length with plate traction and with correct orientation and rotation. The C-arm showed excellent position of the fracture. The limb was then sterilely prepped and draped.
A longitudinal incision was made from the tip of the trochanter extending posteriorly and proximally. This was then taken through the fascia, and the guidewire was positioned on the top of the greater trochanter. Once the center of the trochanter was identified at its tip, the guidewire was placed across it and down the shaft. A large drill was then used to open the proximal femur, and the nail was positioned through this opening. This extended past the comminuted portion of the fracture containing the calcar and lesser tuberosity portion. The sized nail was 11 x 170 mm with a 130-degree angle helical blade orientation. Once the nail was positioned appropriately and seated adequately, it was confirmed on the fluoroscopy to be in an appropriate position.
The second incision was made slightly distal, and the guide was placed up against the lateral portion of the cortex. A guide pin was placed across the nail up into the head and neck, and the position was confirmed with C-arm assistance. Measured 105 mm in length and the 105 mm helical blade was positioned after drilling the lateral cortex. Once this was positioned, the nail was locked through the proximal locking mechanism. The distal locking screw was then placed without difficulty and measured 44 mm in length. The external jig was then disassembled and removed. The nail was found to be seated appropriately with proper alignment in the AP and lateral planes. Fluoroscopy was used to confirm this.
The incisions were then irrigated and closed with interrupted 0 and 2-0 Vicryl and the skin with staples. A sterile compressive dressing was placed. The patient was awakened and taken to recovery in stable condition. He tolerated the procedure well with no complications.
