DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Comminuted left patella fracture.
POSTOPERATIVE DIAGNOSIS: Comminuted left patella fracture.
OPERATION PERFORMED: Open reduction internal fixation, left patella fracture.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: After the induction of anesthesia, time-out was carried out to verify patient, procedure to be done, and site to be operated on. The patient was cleared medically prior to surgery. The patient had a tourniquet applied to the proximal portion of the left lower extremity. The extremity was scrubbed, prepped, and draped in a sterile manner. The patient was given Keflex IV before the tourniquet was elevated, after which wrapped with an Esmarch at 250 mmHg. A longitudinal prepatellar incision was made. A significant amount of hematoma was evacuated, and pulse lavage irrigation was used to clean out the remainder of the hematoma. After that was performed, it was noted that although the patella was comminuted, there was still a small fragment distally, and approximately 60% and 70% proximally, she had a fracture line through it. First #2 Ethibond sutures were placed and interrupted sutures in the medial lateral retinaculum clamped and to be tied later.
Next, the bone reduction clamp was used to reduce the proximal patellar fracture, and using cannulated four partially long threaded screws, a 38 mm screw was inserted with good purchase on the patella and good reduction to a near anatomic position. Next, FiberWire from Arthrex was used. Drill holes were made in the large patella fragment and in the distal patellar fragment, and sutures were placed in the patellar ligament, back up through the proximal bone, and then the back up through the large patellar fragment which has the bone screw. Sutures, once they were passed, they were looped back through the proximal pole and tied to the medial lateral side. It was noted that on first attempt to reduce it and tie the suture down, the sutures were loose, so they had to be removed and it was redone in the same manner using additional FiberWire to the same drill holes through the same patellar ligament tissue. At this time, a good hold was made once we applied tension to the FiberWire medially and laterally and brought the patella together. C-arm image showed good position of the screw and good position of the reduced patellar fracture.
Next, the retinacular sutures were sutured both medially and laterally, the ones previously applied. The slight bony protuberance anteriorly was shaved using a rongeur. Then, 2-0 Vicryl was used to close the remainder of the retinaculum from top to bottom, 2-0 undyed Vicryl subcutaneously, and the staples for the skin. Also, Dermabond was used on the skin. No drain was needed. The tourniquet time was 92 minutes, but once the tourniquet was released, and before the final sutures were put in, the remainder of the 2 liters of pulse lavage irrigations was used. The patient was placed in a fresh new knee immobilizer and brought from the operating room in stable condition.
