Female Date Operation Question & Answer Guide (With Explanation)

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Original Question

SEX: FEMALE AGE:69 DATE OF OPERATION: 12/10/20XX PREOPERATIVE DIAGNOSIS: DISPLACED FRACTURE DISTAL LEFT TIBIA. PROCEDURES: LOCKING INTRAMEDULLARY ROD FIXATION (STRYKER) OF THE LEFT TIBIA; ROD 10 X 315-MM; PROXIMAL SCREWS INCLUDE 40 X 5-MM AND 35 X 5-MM; DISTAL SCREWS INCLUDE 35 X 5-MM AND 40 X 5-MM. POSTOPERATIVE DIAGNOSIS: DISPLACED TRANVERSE FRACTURE SHAFT LEFT TIBIA. SURGEON: Jacques Thomas, M.D. FIRST ASSISTANT: None ANESTHESIA: GENERAL. ANESTHESIOLOGIST: Ricardo Kramer, M.D. PROCEDURE: After adequate induction of general anesthesia and the patient in supine position, a pneumatic tourniquet was applied to the high left thigh region and not inflated. The left lower extremity was then scrubbed, prepped with Betadine and draped in the usual manner for leg surgery. An Esmarch tourniquet was applied to the left lower extremity which was elevated for a period of two minutes. The pneumatic tourniquet was inflated to the appropriate level and the Esmarch removed. A linear incision measuring 2 inches was made over the mid patellar tendon region and brought down through subcutaneous tissue and patellar tendon. A minimal amount of the infrapatellar fat pad was removed and the entry point was identified utilizing the image intensifier in the AP and lateral planes. The guidewire was introduced into the proximal tibia followed by reaming of the proximal metaphysis. This was followed by application of a ball-tip guidewire which was advanced through the proximal fragment. Utilizing manual traction and manipulative technique, reduction was achieved and the guidewire was advanced purchasing the shaft tibial fracture fragment. The fracture fragments were oriented and the intramedullary canal was progressively, reamed from 9-mm to 12.5-mm. Based upon appropriate measurement, a 10 x 315-mm rod was selected and with its guide attachment advanced through the shaft fragments. The fracture fragments were impacted , neutralizing any distraction. Utilizing the guide system proximally, two fixation pins were applied through sheaths that were brought down to the skin level. The skin was incised in these two regions followed by advancement of the sheaths to the bone. A guidewire was utilized followed by depth gauge and application of the screws. Two distal screws were applied utilizing the targeting technique with the image intensifier. This was performed whereby distal drill holes was made through the bone and the shaft fixative rod foramina. A depth gauge was utilized and the appropriate screws were applied. All operative sites were thoroughly irrigated with saline solution. The patellar tendon was repaired with figure-of-eight #1-Vicryl suture. All incisions were approximated with a number of subcutaneous sutures of 2-0 Vicryl. The skin was approximated with multiple metallic staples. Xeroform and dry sterile dressings were applied. The pneumatic tourniquet was released and the peripheral pulses were bounding. There was normal capillary refill of all toes in the left foot. Dry sterile dressings along with compression dressings of Webril and Kerlix were applied. The procedure was tolerated well and the patient was sent to the recovery room without incident.

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