DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Four-part fracture dislocation of the right shoulder.
POSTOPERATIVE DIAGNOSIS:
Four-part fracture dislocation of the right shoulder.
OPERATION PERFORMED:
Hemiarthroplasty of the right shoulder.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General.
DESCRIPTION OF OPERATION: After satisfactory general anesthesia, the patient was positioned in the semi-Fowler position on a sling frame, and then the right shoulder area was prepped and draped in the routine manner. The patient was operated on in the laminar flow room and did receive preoperative antibiotics. The shoulder was prepped and draped in the usual fashion, and skin markings were made with an indelible pencil. Then, the area to be incised on the skin was infiltrated with 25 mL of 0.5% Marcaine with epinephrine.
A skin incision was made over the deltopectoral interval and dissection made through the subcutaneous tissue with minor bleeding controlled with electrocautery. Then, the deltopectoral interval was identified and was retracted. The conjoint tendon was exposed and was retracted medially. The fracture was encountered and removed a fracture hematoma. The fragment that was attached to the subscapularis tendon was tagged, and the bony part was removed. Then, the joint was opened and the humeral head was removed and measured. It was approximately 48 mm in diameter. Then, the remainder of the bony fragments were all removed and pulse lavage irrigator was used to clean the joint.
The humeral canal was opened, and using hand broaches for the canal to a size 11.5, a trial broach was placed and a trial head was placed, and the shoulder was reduced and taken through range of motion and noted to be quite stable. The 11.5 mm stem was placed down the humeral canal in proper alignment position in approximately 30 degrees of retroversion as measured by the guide. Then, the trial humeral head was placed and a 48 x 28 eccentric head was placed. The eccentric head was used because of the loss of humeral length from the fracture, and this allowed for proper length and position and stability of the proximal humerus in the glenoid. The trial head was removed and the 48 x 28 mm offset head was placed in position with the offset in the upper position at approximately the 12 o’ clock position. This supported an extra, approximately 1 cm of length for the shoulder. The shoulder was taken through range of motion and was stable.
The subscapularis and rotator cuff structures were then reapproximated with nonabsorbable suture. The deltoid muscle and pectoralis muscles were allowed to fall back into their normal position. Subcutaneous tissue was approximated using 2-0 Vicryl and the skin was approximated using skin staples. A sterile dressing was applied. The patient was then brought to the recovery room in satisfactory and stable condition. The patient tolerated the procedure well, and there were no complications. Blood loss was about 100 mL and there were no specimens. Sponge and needle counts were correct.
