Wednesday, November 9, 2011

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ORIF of distal tibia plafond intra-articular fracture OP Report

PREOPERATIVE DIAGNOSIS: Displaced left ankle distal tibial plafond fracture, intra-articular.

POSTOPERATIVE DIAGNOSIS: Displaced left ankle distal tibial plafond fracture, intra-articular.

OPERATION PERFORMED: ORIF of distal tibia plafond intra-articular fracture.

ANESTHESIA: General.

OPERATION:
Patient taken to the main operating theatre with anesthesia general. Ancef was given. A time-out was done. Sterile prep and drape was utilized. The tourniquet was set at 250 on the left leg and a bump was placed under the left hip. After elevation, exsanguination, the tourniquet was set, sterile prep and drape was done and fluoro imager was used to guide the skin incision, and an anterior 1-inch incision was made over the distal tibia at the articular surface of the ankle joint, adjacent to the fibula dissection was taken down to the subcutaneous tissues, they were divided. Extensor tendons were retracted. Dissection was taken through the capsule and the hematoma from the fracture was evacuated, irrigated with both saline and Marcaine. Soft tissues were gently retracted until the surface of the joint and the tibial plafond could be identified clearly. The fracture fragment was displaced a centimeter and rotated out of position.

With gentle distraction and rotation, the fragment was pushed back into position and the final 3 mm of reduction was performed with a small tamp that was used to tamp the fragment back into anatomic position.

Fixation was then performed with a 2-mm Steinmann pin placed obliquely across the fragment capturing the posterior cortex. Fluoro imaging showed a very nice reduction and excellent position of the hardware.

Hardware was cut under the skin. The wound was irrigated and injected with Marcaine. The subcutaneous tissues were then closed with Vicryl. The skin was closed with 4-0 Monocryl stitch and a sterile compressive dressing was applied. Total tourniquet time was less than 40 minutes with distal extremity circulation returning in a timely fashion. The patient's leg was then placed into well-padded short leg cast with the ankle at neutral. Cast was trimmed at the toes, split, and spread to allow for swelling. The patient was then brought to the recovery area in stable condition.

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