DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Gunshot wound, right elbow.
2. Fracture, right radial head.
3. Retained foreign body, bullet, in elbow.
4. Wound, right forearm.
POSTOPERATIVE DIAGNOSES:
1. Gunshot wound, right elbow.
2. Fracture, right radial head.
3. Retained foreign body, bullet, in elbow.
4. Wound, right forearm.
OPERATIONS PERFORMED:
1. Irrigation and debridement, right forearm.
2. Removal of foreign body with arthrotomy, right elbow.
3. Open reduction and internal fixation of right radial head.
4. Delayed closure of right forearm wound.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, PA
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 50 mL.
DESCRIPTION OF OPERATION: The patient was placed in the supine position on the OR table after adequate general anesthetic. The splint was taken down from the right arm, and tourniquet placed on the right upper arm over Webril cast padding. The previous forearm wound, which was about 10 cm in length, was closed with rubber band type of closure. The staples were removed and then the arm was prepped and draped in a sterile fashion, first irrigating the forearm wound out and inspecting it. There was no necrotic tissue.
Next, the elbow was approached through a lateral Kocher-type incision. This was about 10 cm in length, taken down through the subcutaneous tissue. The extensor apparatus was identified and interval between the ECU and anconeus was developed and taken down to the epicondyle distally. We identified the supinator muscle, and this was split with scissors and careful dissection to make sure we did not enter the PIN. The joint was entered and a fair amount of hemarthrosis was evacuated. The bullet fragment was identified anteriorly, and it was somewhat wedged into the radial head between the radial head and the coronoid. The fragment was removed, and there were a large number of bone fragments that were also debrided off of both the coronoid and the radial head. Radial head fragments were only about two or three and comprised less than 10% of the joint. On inspection, there was also another split into the radial head that involved about 30% of the joint. It was relatively nondisplaced, but in order to make sure that the fracture did not displace, it was held reduced with K-wires and two 2.0 mm screws were placed to stabilize it. These were drilled with 1.5 drill bit and over-drilled with a 2.0 drill bit. Appropriate Synthes screws placed. The arthrotomy was then irrigated out well. The elbow joint was put to a range of motion and was noted to be stable as was the forearm pronation/supination.
The wound was irrigated out well and the wound closed. The deep fascia and capsule were closed with interrupted 0 Vicryl and the fascia of the extensor muscle was also closed with 0 Vicryl. 3-0 Vicryl was used for the subcutaneous and staples for the skin. Next, the forearm wound was irrigated out one more time and was closed with 3-0 Vicryl for the subcutaneous and staples for the skin. Adaptic, dry sterile dressing, as well as a posterior splint were applied. The tourniquet was released prior to the closure, and he tolerated the procedure well and was transferred to the recovery room in satisfactory condition.
