DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left grade IIIA pilon fracture.
POSTOPERATIVE DIAGNOSIS: Left grade IIIA pilon fracture.
PROCEDURE PERFORMED: Left ankle arthrodesis with removal of external fixator and closure of ankle wound.
SURGEON: John Doe, MD
ANESTHESIA: General anesthesia.
ESTIMATED BLOOD LOSS: 100 mL.
DRAINS: Penrose drain placed in a closed wound for later removal.
SPECIMENS: None.
COMPLICATIONS: None.
CONDITION OF PATIENT: Stable to recovery.
INDICATIONS FOR PROCEDURE: The patient was involved in a motor vehicle accident sustaining a severe left grade IIIA pilon fracture. The patient underwent two rounds of previous irrigation and debridement. The patient lost a significant amount of her joint space and was felt by the attending surgeons to have a nonreconstructable ankle joint.
The decision was made to proceed with primary tibiotalar fusion and closure of the wound. The patient understands the risks and benefits of this procedure and has been consented appropriately for this procedure.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed supine on the operating room table. External fixator was removed and then the left lower extremity was then prepped and draped in a sterile fashion. The patient’s open wound was cleaned thoroughly and irrigated with normal saline under Pulsavac lavage. All compromised tissue was removed.
At this point, the remaining articular surface of the tibiotalar joint was debrided through the traumatic wound. The joint was flushed out well and care was taken to debride all articular cartilage to ensure appropriate arthrodesis of the tibiotalar joint. Bone graft was obtained in the standard manner from the ipsilateral proximal tibia.
An incision was made over Gerdy’s tubercle and carried down Gerdy’s tubercle. The IT band was split, and the tibia was opened at Gerdy’s tubercle and approximately 15-20 mL of cancellous bone was removed using a curette. Allograft croutons were placed back into the proximal tibia, and the wound was irrigated, and the IT band and skin were then closed in the standard fashion.
At this point, attention was turned back to the ankle. The ankle was arthrodesed in the standard fashion using three cannulated screws. These were partially threaded cannulated screws. These were placed across the tibiotalar joint using guidewire placement and fluoroscopic imaging. The tibiotalar joint was fused using these three screws, all of which had excellent purchase across the tibiotalar joint. The tibiotalar joint was locked in place in approximately neutral plantar flexion and dorsiflexion. The ankle was placed into neutral varus-valgus alignment as well. The foot was plantigrade in its fusion position to obtain a stable weightbearing surface.
At this point, after the screws had been sterilely placed, bone graft was packed into the decorticated tibiotalar joint around the screws. Before the bone graft was placed, the wound was irrigated out thoroughly again with normal saline and Pulsavac lavage. The bone graft was placed and then nylon sutures were used in a simple interrupted fashion to close the traumatic wound.
A Penrose drain was placed between the sutures for later removal in order to facilitate drainage to the wound. At this point, standard sterile dressings were placed, and the patient was placed in a splint. We awoke the patient from general anesthesia and transported her to the recovery room in stable condition.
