DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left femoral neck fracture.
POSTOPERATIVE DIAGNOSIS: Left femoral neck fracture.
PROCEDURE PERFORMED: Left hip pinning arthroplasty.
SURGEON: John Doe, MD
ESTIMATED BLOOD LOSS: 250 mL.
DRAINS: None.
SPECIMENS: None.
COMPLICATIONS: None.
CONDITION: Stable to recovery.
INDICATIONS FOR PROCEDURE: The patient is an (XX)-year-old male who was found down in his home after several days from an apparent fall. He was brought to the hospital and admitted. He was found to have a left femoral neck fracture and Orthopedics was consulted. Orthopedics saw the patient, and he was consented appropriately for left hip hemiarthroplasty. The risks and benefits of the procedure were explained.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating room table. General anesthesia was initiated, and the patient was flipped into the right lateral decubitus position. An axillary roll was placed. All pressure points were padded well. Lateral positioning padded posts were used to hold the patient in position. The left lower extremity and hip were then prepped and draped in a sterile fashion.
The patient had an area of eschar due to pressure skin breakdown over the posterior aspect of his greater trochanter. Therefore, the incision was placed slightly more anterior than usual and was lengthened slightly over the standard incision.
A lateral incision was made over the anterior aspect of the patient’s greater trochanter in line with the femoral shaft distally and extending towards the iliac crest proximally. Dissection was carried down to the level of the iliotibial band, and the iliotibial band was split in line with the incision.
The Charnley retractor was placed. It was noted during initial approach to the hip that there was some purulent material that appeared to be an infected bursitis from the patient having a pressure injury. This was irrigated thoroughly and any compromised tissues were debrided aggressively.
After all tissues had been debrided, the wound was examined, and there was no evidence of deep spread of this infection, and the decision was made to continue with hemiarthroplasty. Cultures and swabs were sent from surgery.
At this point, the abductor musculature was identified, and the gluteus medius and minimis were taken down in a standard fashion for the direct lateral approach to the hip. The joint capsules were then elevated up and the femoral neck fracture was identified. A standard femoral neck cut was made approximately one fingerbreadth above the level of the lesser troch.
At this point, a corkscrew was used to remove the femoral head, and the femoral head was sized and found to be compatible with a size 54 head. At this point, attention was turned back to the femur and the femoral neck elevator was placed. A box cutter followed by canal finder and lateralizing reamer were used. Broaches were then inserted, and the femur was broached up appropriately. A size 12 was found to be appropriate.
At this point, the femoral canal was repaired using third-generation cement techniques by placing the cement restrictor, using a rasp brush, and irrigation and suction. The femoral canal was dried and cement was placed. The femoral stem was cemented in the standard fashion. Trials were undertaken and a +8 mm neck length was chosen through the 54 mm head. The final components were placed using a mortise taper and a mallet.
After the assembly had been put together, the hip was reduced, taken through range of motion and found to be stable. At this point, the wound was irrigated out well in all levels using Pulsavac lavage.
The capsule and abductor layers were closed using 0 Ethibond. The iliotibial band was closed using 0 Ethibond. 0 Vicryls were used for the distal part of the iliotibial band and 2-0 Vicryls were used for the subcutaneous tissues. Staples were used for final skin closure and a standard shell dressing was placed.
The patient was then placed in an abduction brace after the drapes had been taken down and transported to recovery in stable condition.
