DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Tibia malunion.
2. Osteomyelitis of the tibia.
3. Retained hardware.
PROCEDURES PERFORMED:
1. Removal of hardware, left tibia.
2. Irrigation and debridement of the tibia.
3. Tibia-fibula osteotomy.
4. Insertion of intramedullary skeletal kinetic distractor for lengthening osteoplasty of the tibia.
SURGEON: John Doe, MD
DESCRIPTION OF OPERATION: The patient was taken to the operating room and anesthesia was administered. After adequate anesthesia, the limb was prepped and draped in a sterile manner. Approach to the patient’s distal locking screw was performed. Incision was made sharply through the skin and subcutaneous tissues, screw engaged and backed out. Proximal screws were removed in a similar manner. K-wire was then used crossing the proximal fragment. The knee was flexed and an incision was made along the medial aspect of the patella and then the patient’s nail was identified. A K-wire was used to identify the exact axis. Widening of the soft tissue plane was accomplished followed by placement of a guide bolt and then retrograde mallet blow was performed with the guide ball. The nail was removed in this manner.
The patient had active osteomyelitis. The patient had an area of small vesicle anterior with minimal soft tissue coverage. Debridement of the canal was accomplished. Curettes were utilized, reamers were used and brushes were used. A vent site was made distally and the flow established from distal to proximal. Separate gloves, instruments and drapes were utilized for the second procedure.
The tibia-fibula osteotomy was then performed. Care was taken to assure proper positioning. An incision was then made through the skin, subcutaneous tissues, anterolateral aspect of the tibia. Drilling was performed with a 3.5 drill bit. The drill bit fanned in multiple directions but all transverse. A separate incision was then made posteromedial and again drilling with a 3.5 drill bit interrupting the cortex of the tibia. A 1/4 inch osteotome was then used and was then impacted across the tibia. It was then twisted. This was performed both anterior and posterior. Completion of the osteotomy was assured by C-arm image.
Intramedullary skeletal distractor was then inserted. An incision was made along the medial aspect of the patellar tendon. A guidewire was passed. Overreaming was performed followed by passage of the nail. The nail was impacted. The nail was dialed out to allow for precise lengthening followed by insertion of the nail in the tibia. The nail was locked distally. C-arm image in line of traction of the distal locking screw with some drilling was performed and placement of 2 locking screws. Mallet blows were then applied to the proximal aspect of the nail through the jig. Some lengthening of the osteotomy site occurred followed by insertion of the locking screws. Guide was utilized both anterolateral and anteromedial. Pins were placed.
The patient had significant resection of the fibula. To maintain alignment of the ankle joint, the fibula fixation was required. C-arm image was positioned. A true sagittal plain view of the ankle joint was obtained. Drilling was performed from the medial aspect of the tibia posteriorly to the posterolateral fibula. Drilling was performed in the posterolateral direction. Following this, placement of a large screw, 4.8 diameter, was accomplished. The patient’s wounds were then approximated. Soft dressing was applied. The patient was transferred to the recovery room.
