DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right distal tibial malunion.
POSTOPERATIVE DIAGNOSIS: Right distal tibial malunion.
OPERATIONS PERFORMED:
1. Revision of Taylor spatial frame.
2. Tibial osteotomy for correction of malunion.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
SPECIMENS: None. None.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought back to the operating room and placed supine on the operating table. A bump was placed under his hip. He was then prepped and draped in the usual standard sterile fashion after anesthesia was induced by the anesthesia team. The leg was prepped and draped with Betadine over the external fixator. A nonsterile tourniquet was placed and was used in a limited fashion for approximately 5 minutes.
Once an operative time-out was performed, including the patient’s name and operative site, preoperative antibiotics in the form of 1 gram of Ancef was given. Removal of the distal aspect of the Taylor spatial frame was performed. The distal ring was removed and the pins were left in the leg into the distal tibia, and the Taylor spatial components were removed from the distal ring to the middle ring. The distal ring was then placed higher up, approximately 2 cm distal to the middle ring. This was then connected with 4 threaded rods to this ring after being attached in the tibia. This was connected together in a compression to compress across the docking site of the previous tibial osteotomy.
Once this was done, it was attempted to use the middle pin in the distal tibia to attach this to the circular ring; however, this was unable to be accomplished. Following this and using fluoroscopic visualization, a long guidewire was placed through the distal tibia along the angle of the tibial plafond in order to correct the valgus angulation.
Once this was placed, the ring was attached to it and tensioned in the normal fashion. The distal tibial pin was then noted to be in an inappropriate place, and this was removed for placement of a second pin. Following this, a pin was placed using Rancho Cube as a guide and was attached to a newly placed distal tibial ring.
A 6 mm screw was then placed through this Rancho Cube and attached to the ring without complication. A second wire was then passed through the fibula and through the tibia in the posterolateral to anteromedial direction and fixed to the ring after being tensioned in the standard fashion. A second distal tibial pin was then placed through a Rancho Cube and fixed in the standard fashion. This was a 6 mm pin as well.
Following this, the Taylor spatial components were then placed in the standard fashion, including 6 threaded adjustable rods. It was felt that the previously placed middle distal tibial pin would be in the way of the construct, and this was then removed, and when the construct was in place, an anteromedial pin was replaced using the Rancho Cube as a guide and a 5 mm pin was placed to fixate the now third from proximal ring.
Following this, the Taylor spatial components were noted to be in good alignment, and measurements were taken down from all the components. The components were then removed in order to allow a tibial osteotomy to be performed. This was marked out and osteotomy was performed using drill to drill holes to the proximal and distal cortex of the tibia in a line parallel to the distal tibial plafond. This was done from an anterolateral and a posteromedial approach.
Then, using osteotome under fluoroscopic visualization, the osteotomy was completed, and it was noted to be fully free and motion was able to be corrected passively. Osteotomy of the fibula was not performed as it was noted that there was a nonunion of the fibula at the level of the previous docking site of the tibial shaft, and this was freely mobile when stressed under fluoroscopy. The Taylor spatial components were then replaced in the same order and verified. The length of the components were then verified and corrected. Each component was then compressed 3 mm in order to bring the osteotomy into some compression without complication.
Following this, the wounds were irrigated and closed. X-rays were taken and showed good alignment and good fixation, and the wounds were sutured closed with 3-0 nylon sutures and the pin sites were then covered with bacitracin and Adaptic. The patient’s external fixator was then covered with Kerlix and an Ace wrap. The patient was then awoken from anesthesia and brought to the PACU in stable condition.
