DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left bicondylar tibial plateau fracture.
POSTOPERATIVE DIAGNOSIS: Left bicondylar tibial plateau fracture with wound infection of femoral external fixator pin sites.
OPERATION PERFORMED:
1. Staged removal of external fixator, left lower extremity.
2. Irrigation and debridement of left thigh abscess.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
COMPLICATIONS: None.
SPECIMENS: Tissue from the femoral external fixator pin sites for culture.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman who was involved in a motorcycle accident. The patient was initially with a spanning external fixator and was brought back today for operative fixation of his plateau fracture. Upon removing his dressings, it was noted that he had gross purulent discharge from his left femoral external fixator pin sites. His fracture appeared to be an old fracture with sclerosis around the fracture edges on the CT scan. Our plan was initially to perform an open reduction and internal fixation with iliac crest bone grafting of this nonunion area. However, upon noting the infection of his femoral external fixator pin sites, we decided to do an incision and irrigation of these sites and allow his wounds to be controlled and once the infection has resolved bring the patient back in 7-10 days for definitive treatment of his fracture.
Our plan was initially to perform an open reduction and internal fixation with iliac crest bone grafting of this nonunion area. However, upon noting the infection of his femoral external fixator pin sites, we decided to do an incision and irrigation of these sites and allow his wounds to be controlled and once the infection has resolved bring the patient back in 7-10 days for definitive treatment of his fracture.
DESCRIPTION OF OPERATION: The patient was brought to the OR and laid supine on the OR table. After general anesthesia was induced, the left lower extremity was prepped and draped in the usual sterile fashion after the external fixator was removed. Both pins from the femur were removed with purulent drainage from both sites. The tibial external fixator pins were also removed. These sites were intact and clean with no evidence of infection.
Next, an elliptical incision was made excising the eschar around the femoral pin sites. Dissection was carried out to the level of the muscle, which was noted to be clean without evidence of infection. The wound was then thoroughly irrigated with normal saline after specimens were sent for culture. A curette was also used to debride out the bone at the site of the pin insertion.
After thorough irrigation and debridement of these sites, the anterior tibial eschar was also unroofed and this was not noted to be infected. The tibial pin sites were then irrigated out. Next, the femoral wounds were closed with a 2-0 nylon suture in a horizontal mattress fashion. Sterile dressings were applied. The patient was placed into a knee immobilizer. The patient will be admitted and possibly placed into a nursing home due to poor condition of his home and inability to take care of his wounds. The patient will be started on IV antibiotics as well. Again, the patient will be brought back to surgery in 7-10 days for definitive fixation of his tibial plateau fracture.
