danielle0419
Networker
I want to use 27138 & 27244??? Correct?
OPERATIVE REPORT
PROCEDURE: Right hip open reduction internal fixation of proximal femur with revision of the femoral component.
INDICATIONS: This is a 78-year-old female who 2 days ago had a right hip replacement. She was in physical therapy yesterday and felt a pop in her hip.
An x-ray was taken and there were a few millimeters of subsidence, but no fracture seen. My intent was to order a CT because sometimes these fractures can be occult. When I saw her this morning, her foot was externally rotated and short and I noticed that she had broken. A CT confirmed posterior medial femur had broken off through the lesser trochanter. The stem had further subsided overnight.
DESCRIPTION OF PROCEDURE: The right hip was marked as the site of surgery. The patient was asleep in a the left lateral decubitus position and the right hip was prepped and draped in the usual sterile fashion. Timeouts were taken and I opened the previous incision. The gluteus medius and minimus repair had torn away. I got an extractor on the stem of the femoral component and backed out the femoral component. The proximal femur was cerclage cabled with Dall-Miles cables times 3, one above the lesser trochanter and 2 below, with the original implant in place so as not to crush the bone. I then took the implant out and reinserted it and it was seated extremely firm. I waited a minute to see if I could tap it in any further and it was very well seated. I had been prepared if need be, to cement the femoral component or a new femoral component. I put the 0 mm, 28 metal head back on a clean, dry Morse taper. It had a dual modular component still intact and in good condition. I tested the cup and despite some lucency around the cup, because she had a fairly sclerotic acetabulum, the cup was extremely well seated and stable. I reduced it and ran it through a range of motion and everything was very secure. I took an x-ray intraoperatively on C-arm and everything was in good position. The fluted stem on this secure fit Stryker implant was compressed, so we had some distal fixation with fluted stem, so I felt reasonably confident that we could close. The superior aspect of the gluteus medius and minimus was repairable. The inferior third was not. I copiously irrigated the wound with gentamicin solution and cleaned and sprayed it with Tisseel. The IT band was closed with interrupted and running locked Vicryl suture. The subcutaneous tissues were closed with multiple layers of Vicryl suture and then staples on the skin. Sterile dressings were applied. The patient was turned supine on the bed and awakened and taken to the PACU in stable condition.
OPERATIVE REPORT
PROCEDURE: Right hip open reduction internal fixation of proximal femur with revision of the femoral component.
INDICATIONS: This is a 78-year-old female who 2 days ago had a right hip replacement. She was in physical therapy yesterday and felt a pop in her hip.
An x-ray was taken and there were a few millimeters of subsidence, but no fracture seen. My intent was to order a CT because sometimes these fractures can be occult. When I saw her this morning, her foot was externally rotated and short and I noticed that she had broken. A CT confirmed posterior medial femur had broken off through the lesser trochanter. The stem had further subsided overnight.
DESCRIPTION OF PROCEDURE: The right hip was marked as the site of surgery. The patient was asleep in a the left lateral decubitus position and the right hip was prepped and draped in the usual sterile fashion. Timeouts were taken and I opened the previous incision. The gluteus medius and minimus repair had torn away. I got an extractor on the stem of the femoral component and backed out the femoral component. The proximal femur was cerclage cabled with Dall-Miles cables times 3, one above the lesser trochanter and 2 below, with the original implant in place so as not to crush the bone. I then took the implant out and reinserted it and it was seated extremely firm. I waited a minute to see if I could tap it in any further and it was very well seated. I had been prepared if need be, to cement the femoral component or a new femoral component. I put the 0 mm, 28 metal head back on a clean, dry Morse taper. It had a dual modular component still intact and in good condition. I tested the cup and despite some lucency around the cup, because she had a fairly sclerotic acetabulum, the cup was extremely well seated and stable. I reduced it and ran it through a range of motion and everything was very secure. I took an x-ray intraoperatively on C-arm and everything was in good position. The fluted stem on this secure fit Stryker implant was compressed, so we had some distal fixation with fluted stem, so I felt reasonably confident that we could close. The superior aspect of the gluteus medius and minimus was repairable. The inferior third was not. I copiously irrigated the wound with gentamicin solution and cleaned and sprayed it with Tisseel. The IT band was closed with interrupted and running locked Vicryl suture. The subcutaneous tissues were closed with multiple layers of Vicryl suture and then staples on the skin. Sterile dressings were applied. The patient was turned supine on the bed and awakened and taken to the PACU in stable condition.