DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Failure of DHS hardware, left proximal femur.
2. Infection, right proximal femur.
POSTOPERATIVE DIAGNOSES:
1. Failure of DHS hardware, left proximal femur.
2. Infection, right proximal femur.
PROCEDURES PERFORMED:
1. Removal of DHS implant from right hip.
2. Irrigation and debridement of right hip.
3. Excision of proximal femur for placement of antibiotic cement spacer.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: One liter.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid supine on the OR table. After general anesthesia was induced, the patient was turned over to the lateral decubitus position on a bean bag. The right lower extremity was then prepped and draped in the usual sterile fashion. The previous incision was used and extended more proximally. The dissection was carried out through the subcutaneous tissue down to the level of the greater trochanter.
The DHS hardware was noted to be loose. The DHS hardware was not removed but rather was used as a lever to help in removal of the proximal femoral fragments, including the femoral head, neck and the greater trochanter. Dissection was carried out around the circumference of the greater trochanter and the proximal femur using electrocautery. Using a combination of osteotome, rongeurs and electrocautery, the proximal femur was removed including the DHS implant and all screws.
Next, the remaining femoral portion was smoothed using rongeur. The wound was thoroughly irrigated with 9 liters of normal saline, the middle 3 liters of which contained 100,000 units of bacitracin. Cultures were obtained prior to irrigation and debridement including soft tissue as well as bone cultures. Next, an antibiotic cement spacer including vancomycin and tobramycin was made using the cement molding. Once the cement had hardened, it was placed into the proximal femur and the hip was reduced.
Next, after a drain was placed, the wound was closed in layers using 0 PDS for the deep layer and 2-0 PDS for the superficial layer. The skin was closed using 2-0 nylon suture in a horizontal mattress fashion. Sterile dressings were applied. The patient was turned over to the supine position and taken to the PACU for recovery. There were no complications. The patient will be observed closely by the medicine team postoperatively and will be transferred to the CCU for further care.
