DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Talonavicular subluxation, right foot.
2. Comminuted intra-articular calcaneal fracture, right foot.
POSTOPERATIVE DIAGNOSES:
1. Talonavicular subluxation, right foot.
2. Comminuted intra-articular calcaneal fracture, right foot.
OPERATION PERFORMED:
1. Application of multiplanar external fixator to address talonavicular subluxation.
2. Open reduction and internal fixation comminuted right intra-articular depressed calcaneal fracture.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and anesthesia was administered. After adequate anesthesia, the patient was carefully positioned in the lateral decubitus position. The right lower extremity was prepped and draped in sterile manner. Drilling was performed in the anterior aspect of the distal fibular joint. Drilling was performed just above the ankle joint. The drilling was performed by 4.5 drill bit, exiting the posterior medial tibia. Placement of 5.0 centrally-threaded pin was then performed. Drilling was then preformed with a 0.062 K-wire. Drilling was performed in the distal aspect of the posterior tuberosity, drilling from lateral to medial.
Placement of a medial frame and lateral frame was then performed utilizing radiolucent 11 mm rods and special distractors positioned proximally. A bar was then attached between the 0.062 K-wire distally. Strong distraction force was then accomplished. Further pin was then placed. The drilling was performed in the posterolateral talus, entering the talar body and neck. Placement of 5.0 half-pin was then performed. Elevation of half-pin was then performed. This elevated the talus off posteriorly, depressed it anteriorly, reduced the talocalcaneal angle and reduced the talonavicular joint confirmed by C-arm imaging in lateral and AP view.
The patient had a four-part posterior facet fracture with significant comminution and osteoporosis present. Lateral approach was performed. Incision was made after the incision marked with a marking pen utilizing a K-wire as a guide with x-ray. The limb was then elevated and exsanguinated and incision made through the skin and subcutaneous tissue. Dissection was performed without layering. The lateral talus was identified and K-wire was placed for retraction. The patient’s posterior facet fragments were then elevated beginning medially, then central, then lateral. The facet fragments were completely devoid of soft tissue attachments laterally without any dissection performed. These were elevated, 2 mm screw used for the posterior facet.
Following this, the body screws were then directed from lateral to medial with AP view utilized to aid in reduction. A Broden view had been utilized in the posterior facet, as well as a lateral view. Axillary view was obtained and the tuberosity was positioned. Good alignment drilling was the performed to the posterior tuberosity superiorly, drilling through the body of the calcaneus and placement of 0.035 fully-threaded screws. The screws were then directed from the plantar aspect of the posterior tuberosities, were directed to help buttress the posterior facet with drilling and placement of the fully-threaded 0.035 screws. The patient’s wounds were then approximated, soft dressings and splint applied. The patient was transferred to the recovery room.
