PREOPERATIVE DIAGNOSIS(ES):
Left middle mallet finger with bony fracture. Displaced and slight subluxation of the phalanx.
POSTOPERATIVE DIAGNOSIS(ES):
Same
OPERATIVE FINDINGS:
Large fragment consisting of at least 40-45% of the joint surface going dorsal to volar..
PROCEDURE(S)/OPERATION(S) PERFORMED:
Procedure(s):
Open reduction and internal fixation of bony mallet finger left middle finger
ANESTHESIA:
general anesthesia
FLUIDS:
Crystaloid
ESTIMATED BLOOD LOSS:
Less than 25 mL
TOURNIQUET TIME:
56 minutes
SPECIMENS:
None
INDICATIONS:
Patient is an 11-year-old female who was playing football and the football hit her in the tip of her middle finger of left hand. She had immediate deformity. X-rays revealed a displaced dorsal fragment and a mallet finger area. She was splinted and sent to orthopedics. In orthopedics has found that it was not significantly reducible with extension splinting. She was also starting to sublux volarly. It was recommended that she have this reduced and pinned in position. Her mother was present and agreed with this. She is therefore scheduled today. She comes in with parents knowing the risks of neurovascular compromise and infection and the fact that no guarantee can be given as to outcome of surgery. He also new pins would be placed which would later have to be removed. He also knew that it could become worse with surgery. With all of this in mind they opted to proceed.
SUMMARY:
Patient was seen in the preop holding area. I answered her questions and her mother's questions again. Mother then sign the option sent. She was also seen by anesthesia and signed the operative consent for anesthesia. She was then brought to the operating room.
In the operating room she is placed in a supine position given a general anesthetic. She was position with left arm on an arm board. She described prepped and draped usual manner for left hand surgery. Time out occurred and her identity was checked by 2 methods as well as laterality operation and the fact that she had antibiotics on board. Following this a curvilinear incision was then made over the dorsum of the middle finger DIP joint of the left hand. Is taken down through skin and subcutaneous tissue to the level of the extensor mechanism dorsally and through skin and subcutaneous tissue on the mid lateral portion of the incision. Exposure was then gained. C-arm was used to identify the exact location of the fragment and then the extensor tendon was sectioned about 7 mm proximal to its insertion. This was reflected and the fragment was easily seen. The fragment was easily reducible. The area was irrigated and the fragment was reduced. 0.028 Kirschner wire was then placed initially to hold this reduction was good. A second 0.028 Kirschner wire was placed in a divergent angle from the opposite side of the fragment. These are placed from dorsal proximal to volar distal. At this point the fragment was well reduced and the joint was congruent. No evidence of subluxation. A 0.035 Kirschner wire was then brought in through the distal phalanx across the joint into the proximal portion of the middle phalanx. He was brought up to the subchondral bone and stopped there. At this point the extension was good to remove the pressure from the extensor tendon. The pins were cut long enough to be accessible but short enough to fit under the skin. The area was again irrigated and then the extensor tendon was repaired with 4-0 nylon in a continuous fashion. Irrigation was then done and the skin was closed again with 4-0 nylon in interrupted horizontal mattress fashion. At this point then a sterile dressing was applied followed by a splint to protect her in extension. She was then awakened from her anesthetic and taken to the recovery room in stable condition having tolerated the procedure well. Counts were correct x2.
Left middle mallet finger with bony fracture. Displaced and slight subluxation of the phalanx.
POSTOPERATIVE DIAGNOSIS(ES):
Same
OPERATIVE FINDINGS:
Large fragment consisting of at least 40-45% of the joint surface going dorsal to volar..
PROCEDURE(S)/OPERATION(S) PERFORMED:
Procedure(s):
Open reduction and internal fixation of bony mallet finger left middle finger
ANESTHESIA:
general anesthesia
FLUIDS:
Crystaloid
ESTIMATED BLOOD LOSS:
Less than 25 mL
TOURNIQUET TIME:
56 minutes
SPECIMENS:
None
INDICATIONS:
Patient is an 11-year-old female who was playing football and the football hit her in the tip of her middle finger of left hand. She had immediate deformity. X-rays revealed a displaced dorsal fragment and a mallet finger area. She was splinted and sent to orthopedics. In orthopedics has found that it was not significantly reducible with extension splinting. She was also starting to sublux volarly. It was recommended that she have this reduced and pinned in position. Her mother was present and agreed with this. She is therefore scheduled today. She comes in with parents knowing the risks of neurovascular compromise and infection and the fact that no guarantee can be given as to outcome of surgery. He also new pins would be placed which would later have to be removed. He also knew that it could become worse with surgery. With all of this in mind they opted to proceed.
SUMMARY:
Patient was seen in the preop holding area. I answered her questions and her mother's questions again. Mother then sign the option sent. She was also seen by anesthesia and signed the operative consent for anesthesia. She was then brought to the operating room.
In the operating room she is placed in a supine position given a general anesthetic. She was position with left arm on an arm board. She described prepped and draped usual manner for left hand surgery. Time out occurred and her identity was checked by 2 methods as well as laterality operation and the fact that she had antibiotics on board. Following this a curvilinear incision was then made over the dorsum of the middle finger DIP joint of the left hand. Is taken down through skin and subcutaneous tissue to the level of the extensor mechanism dorsally and through skin and subcutaneous tissue on the mid lateral portion of the incision. Exposure was then gained. C-arm was used to identify the exact location of the fragment and then the extensor tendon was sectioned about 7 mm proximal to its insertion. This was reflected and the fragment was easily seen. The fragment was easily reducible. The area was irrigated and the fragment was reduced. 0.028 Kirschner wire was then placed initially to hold this reduction was good. A second 0.028 Kirschner wire was placed in a divergent angle from the opposite side of the fragment. These are placed from dorsal proximal to volar distal. At this point the fragment was well reduced and the joint was congruent. No evidence of subluxation. A 0.035 Kirschner wire was then brought in through the distal phalanx across the joint into the proximal portion of the middle phalanx. He was brought up to the subchondral bone and stopped there. At this point the extension was good to remove the pressure from the extensor tendon. The pins were cut long enough to be accessible but short enough to fit under the skin. The area was again irrigated and then the extensor tendon was repaired with 4-0 nylon in a continuous fashion. Irrigation was then done and the skin was closed again with 4-0 nylon in interrupted horizontal mattress fashion. At this point then a sterile dressing was applied followed by a splint to protect her in extension. She was then awakened from her anesthetic and taken to the recovery room in stable condition having tolerated the procedure well. Counts were correct x2.
