Post Op: Right knee status post open reduction and internal fixation with failure of fixation and nonunion with decreased extensor mechanism function and pain and also where the bone is the skin.
Procdure Performed: Right knee irrigation and debridement down to the bone with removal of deep implants (three cannulated screws); revision ORIF of the patella using #5 ethibond suture.
Description of Procedure:
A knife was used to make an incision over this small ulcer and some fluid was drained out. It appeared to be joint fluid. No obvious purulence was identified. This was thoroughly debrided and irrigated. Cultures were obtained prior to this, which were aerobic and anaerobic. The main incision which was just medial to the midline in the previous scar was then made from superior to the patella to inferiorly to the patella. The soft tissues anteriorly to the patella were intact, but the patella was completely displaced deep to this. An incision was made transversely across where the patella fracture was. It appeared that it was probably joint fluid, which was leaking out of this ulceration because this was continuous with joint below. Copious irrigation was again done with irrigation with antibiotics. The retinaculum was released slightly medially and laterally and the fracture site was fully exposed. He had a significant spike ot the fracture at the central aspect of the patella, which was the portion, which debris present on both fracture edges. Therefore, a curette was used to thoroughly debride this. Copious irrigation was again done. Three screws were then visualized at the fracture site. These were the non-head ends of the the screws. Therefore, the screws were exposed and all three screws were removed. These were cannulated screws and a guidepin was used to localize the head of the screw and soft tissue more distally. Thorough irrigation and debridement of the screw holes was done. No evidence of infection was appreciated.
At this point, I decided that it would be reasonable to proceed with revision ORIF. I feel that large suture with #5 Ethibond would be the best to repair it. Therefore, one of the drill holes from the previous screws was utilized in the central aspect of the patella. Two parallel screw drill holes were made inferiorly and then three holes equally spaced were made superiorly. Two strands of #5 Ethibond were pulled up to the central hole. The corresponding end was pulled thorugh each side through the hole to both fragments. The knee was kept fully extended and the two large #5 Ethibond sutures were tied. This held the two bony pieces well approximated. The #2 Ethibond and #5 Ethibond were then used to place several figure-eight sutures in the medial and lateral retinaculum as well as soft tissue anteriorly to the patella. No further bony spike was palpable. The wound was again copiously irrigated. The subcutaneous tissues were closed with 2-0 Vicryl in a buried fashion.
The culture final was no growth in 2 days.
I was looking at 27524, but not sure? Any input would be appreciated. Thank You
Procdure Performed: Right knee irrigation and debridement down to the bone with removal of deep implants (three cannulated screws); revision ORIF of the patella using #5 ethibond suture.
Description of Procedure:
A knife was used to make an incision over this small ulcer and some fluid was drained out. It appeared to be joint fluid. No obvious purulence was identified. This was thoroughly debrided and irrigated. Cultures were obtained prior to this, which were aerobic and anaerobic. The main incision which was just medial to the midline in the previous scar was then made from superior to the patella to inferiorly to the patella. The soft tissues anteriorly to the patella were intact, but the patella was completely displaced deep to this. An incision was made transversely across where the patella fracture was. It appeared that it was probably joint fluid, which was leaking out of this ulceration because this was continuous with joint below. Copious irrigation was again done with irrigation with antibiotics. The retinaculum was released slightly medially and laterally and the fracture site was fully exposed. He had a significant spike ot the fracture at the central aspect of the patella, which was the portion, which debris present on both fracture edges. Therefore, a curette was used to thoroughly debride this. Copious irrigation was again done. Three screws were then visualized at the fracture site. These were the non-head ends of the the screws. Therefore, the screws were exposed and all three screws were removed. These were cannulated screws and a guidepin was used to localize the head of the screw and soft tissue more distally. Thorough irrigation and debridement of the screw holes was done. No evidence of infection was appreciated.
At this point, I decided that it would be reasonable to proceed with revision ORIF. I feel that large suture with #5 Ethibond would be the best to repair it. Therefore, one of the drill holes from the previous screws was utilized in the central aspect of the patella. Two parallel screw drill holes were made inferiorly and then three holes equally spaced were made superiorly. Two strands of #5 Ethibond were pulled up to the central hole. The corresponding end was pulled thorugh each side through the hole to both fragments. The knee was kept fully extended and the two large #5 Ethibond sutures were tied. This held the two bony pieces well approximated. The #2 Ethibond and #5 Ethibond were then used to place several figure-eight sutures in the medial and lateral retinaculum as well as soft tissue anteriorly to the patella. No further bony spike was palpable. The wound was again copiously irrigated. The subcutaneous tissues were closed with 2-0 Vicryl in a buried fashion.
The culture final was no growth in 2 days.
I was looking at 27524, but not sure? Any input would be appreciated. Thank You
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