DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right Weber B bimalleolar ankle fracture dislocation.
POSTOPERATIVE DIAGNOSIS: Right Weber B bimalleolar ankle fracture dislocation.
OPERATION PERFORMED:
1. ORIF of right bimalleolar ankle fracture.
2. Placement of syndesmotic screw.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 200 mL.
DESCRIPTION OF OPERATION: The patient was brought to the OR and laid supine on the OR table. General anesthesia was induced. A tourniquet was placed high up on his right thigh. The right lower extremity was then prepped and draped in the usual sterile fashion. Next, Esmarch bandage was used to exsanguinate the right lower extremity, and the tourniquet was inflated to 300 mmHg.
Next, standard lateral approach to the distal fibula was performed. The fracture was exposed. There was a moderate amount of comminution in the fibula. Therefore, the comminuted segment was not devascularized, and a 10-hole LCDC plate was fashioned to the fibula. This plate was contoured. C-arm fluoroscopy was used to establish length with the application of the plate. A push screw was used to establish length. Two screws were placed in the distal fragments followed by four screws in the proximal fragment. The comminuted segment was bridged with the plates. Excellent reduction was obtained with good length of the fibula.
Next, attention was directed towards the medial malleolar fracture. A standard medial approach was then performed exposing the medial malleolar fracture. The fracture was noted to be comminuted into four pieces. There was impaction of the medial tibial plafond. There was a small area of injury to the chondral surface of the talus.
Next, the medial malleolar fracture fragments were provisionally reduced using K-wires. Again, the fracture was highly comminuted. The articular surface was restored as best as possible. However, again, there was impaction of the medial tibial plafond with missing cartilage in this area. One 4.0 mm cancellous screw was placed into the main fragments up into the distal tibial metaphysis. Another K-wire was placed holding the medial malleolar fragment to the tibial metaphysis.
A four-hole one-third tibial plate was then contoured to the medial malleolus, and this was used as a buttress. Two screws were placed into tibial metaphysis proximally. This plate served to buttress the remaining fragments, which did not have an articular surface associated with it.
Next, C-arm fluoroscopy was used to confirm excellent reduction of the ankle mortise as well as placement of all hardware. Next, the external rotation of the foot under live fluoroscopy showed some widening of the mortise. Therefore, decision was made to place one syndesmotic screw. The syndesmotic screw measured 45 mm in length and was tricortical. This was placed in standard fashion through one of the holes in the fibular plate.
Next, again, C-arm fluoroscopy was used to confirm reduction of the mortise and good placement of all hardware with good length of all screws. Next, plain films were obtained in the OR. Both wounds were thoroughly irrigated with normal saline. Closure was obtained using 2-0 Vicryl suture in inverted fashion. Staples were used to close the skin. Sterile dressings were applied, and the patient was placed into an AO splint. Next, the patient was awakened from anesthesia, transferred back onto the stretcher, and taken to the PACU for recovery. Prior to closure, the tourniquet was deflated, and hemostasis was obtained.
