ctown
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Postoperative Diagnosis: Right Tibial Plateau Fracture
Operation performed: Closed reduction and placement of spanning external fixator device to the right lower extremity
Anesthesia type: General
Indications for surgery: Patient is a 58-year-old male who presented to the hospital yesterday evening after being involved in a motor vehicle collision. The patient was brought into the emergency department as a trauma activation and x-rays of the right knee joint were obtained which showed evidence of a right tibial plateau fracture with intra-articular extension and posterior condylar split. There was noted to be displacement of the fracture fragment and the patient was indicated to undergo placement of an external fixator device for stabilization of the fracture. I had an extensive discussion with patient regarding the injury that he had sustained. We discussed that today the surgical plan was involving placement of an external fixator device to the right lower extremity for stabilization of the fracture. I informed the patient that he will require a second operation with our trauma service for removal of the external fixator and definitive internal fixation of the right tibial plateau fracture once the soft tissue swelling had decreased and was amenable to fixation. Patient was in agreement with the proposed treatment plan and understood all the risks of surgery and consented to undergoing surgery.
Procedural details: Patient was identified in the preoperative holding area and the consent and laterality were reviewed. The surgical site was marked in the preop holding area. The patient was brought back to operating room #3 by the orthopedic and anesthesia service. Patient underwent general endotracheal anesthesia and was transferred onto the operating room table. The right lower extremity was prepped and draped in the sterile fashion. A surgical timeout was performed in which we again confirmed the patient's identity, laterality and proposed surgical plan.
We began the surgical procedure by obtaining x-rays of the proximal tibia and identifying the fracture site. We then identified the femoral shaft and utilizing a 15 blade made an incision and subsequently dissected down bluntly to the femur. We subsequently utilized a drill guide and drilled the proximal and distal cortex. We placed our Schanz pin through this drill hole. We confirmed on AP and lateral radiographs that the pin is in satisfactory position within the femoral shaft. We then turned our attention to placing the proximal pin utilizing the same technique. 3 Schanz pins were placed in the femur measuring 5mm x 200mm length . We turned our attention now to placement of the of the Schanz pins within the tibia. We identified the tibial crest and went just medial to the tibial crest. We made a stab incision and dissected to the tibia. Again utilizing a drill guide we drilled and placed a Schanz pin through the tibial shaft. We repeated this process with another 2 Schanz pins. A total of 3 Schanz pins placed in the tibia measuring 5mm x 175mm placed in the tibia. We now fashioned our external fixator device placing our spanning rods measuring 500mm length each across the fracture site. We then obtained AP and lateral x-rays of the fracture site and noted that there is an satisfactory alignment of the right knee joint. We subsequently locked the external fixator in place. The pin sites were then subsequently dressed with Xeroform and Kerlix. Patient was then extubated at the end of the procedure and transferred in stable condition to the PACU.
Postoperative plan: Patient will be admitted back to the trauma surgery service postoperatively.
Operation performed: Closed reduction and placement of spanning external fixator device to the right lower extremity
Anesthesia type: General
Indications for surgery: Patient is a 58-year-old male who presented to the hospital yesterday evening after being involved in a motor vehicle collision. The patient was brought into the emergency department as a trauma activation and x-rays of the right knee joint were obtained which showed evidence of a right tibial plateau fracture with intra-articular extension and posterior condylar split. There was noted to be displacement of the fracture fragment and the patient was indicated to undergo placement of an external fixator device for stabilization of the fracture. I had an extensive discussion with patient regarding the injury that he had sustained. We discussed that today the surgical plan was involving placement of an external fixator device to the right lower extremity for stabilization of the fracture. I informed the patient that he will require a second operation with our trauma service for removal of the external fixator and definitive internal fixation of the right tibial plateau fracture once the soft tissue swelling had decreased and was amenable to fixation. Patient was in agreement with the proposed treatment plan and understood all the risks of surgery and consented to undergoing surgery.
Procedural details: Patient was identified in the preoperative holding area and the consent and laterality were reviewed. The surgical site was marked in the preop holding area. The patient was brought back to operating room #3 by the orthopedic and anesthesia service. Patient underwent general endotracheal anesthesia and was transferred onto the operating room table. The right lower extremity was prepped and draped in the sterile fashion. A surgical timeout was performed in which we again confirmed the patient's identity, laterality and proposed surgical plan.
We began the surgical procedure by obtaining x-rays of the proximal tibia and identifying the fracture site. We then identified the femoral shaft and utilizing a 15 blade made an incision and subsequently dissected down bluntly to the femur. We subsequently utilized a drill guide and drilled the proximal and distal cortex. We placed our Schanz pin through this drill hole. We confirmed on AP and lateral radiographs that the pin is in satisfactory position within the femoral shaft. We then turned our attention to placing the proximal pin utilizing the same technique. 3 Schanz pins were placed in the femur measuring 5mm x 200mm length . We turned our attention now to placement of the of the Schanz pins within the tibia. We identified the tibial crest and went just medial to the tibial crest. We made a stab incision and dissected to the tibia. Again utilizing a drill guide we drilled and placed a Schanz pin through the tibial shaft. We repeated this process with another 2 Schanz pins. A total of 3 Schanz pins placed in the tibia measuring 5mm x 175mm placed in the tibia. We now fashioned our external fixator device placing our spanning rods measuring 500mm length each across the fracture site. We then obtained AP and lateral x-rays of the fracture site and noted that there is an satisfactory alignment of the right knee joint. We subsequently locked the external fixator in place. The pin sites were then subsequently dressed with Xeroform and Kerlix. Patient was then extubated at the end of the procedure and transferred in stable condition to the PACU.
Postoperative plan: Patient will be admitted back to the trauma surgery service postoperatively.
