Hillcrest Case 7 Operative
OPERATIVE REPORT Patient: T. J. Moreno Accommodating ID: 110497DOB: 02/15Age: 44Sex: M Date of Admission: 10/09/2013 Date of Procedure: 10/09/2013 Admitting Physician: Patrick Keathley, MD Endocrinology Surgeon : Dr. Max Hirsch, MD Orthopedics Assistant: Markus Leroy Johnson PAC (Surgical abettor was acclimated for bendable tissue aegis and retraction and additionally for advancement abridgement during acting and abiding fixation use of surgical abettor was medically necessary, and to prove the assurance and ability of the procedure. Preoperative Diagnosis: Left hindfoot osteoarthritis. Postoperative Diagnosis: Left hindfoot osteoarthritis. Operative Procedure: 1) Triple arthrodesis . 2) Popliteal sciatic block placed by surgeon absolutely for postoperative affliction management. Anesthesia: Accepted by Chuck Delaney, MD. Action during anesthesia, stable. Specimen Removed: Nine. IV Fluids: See nurse’s notes. Estimated Blood Loss: See nurse’s notes. Urine output: See nurse’s notes. Complications: None. Postoperative condition: Abiding (Continued) OPERATIVE REPORT Patient: T. J. Moreno
Patient ID: 110497DOB: 02/15Age: 44Sex: M Page: 2 INDICATION: A 44 year old macho with hindfoot osteoarthritis pain, who has bootless bourgeois administration afterwards reviewing risks, allowances and alternatives, he has agreed to advance with surgical management. Risks of delayed healing, non-healing and infection, assumption barge bond injury, advancing affliction and discomfort, action failure, charge for afterlight surgery, and/or accouterments abatement noted. The actuality that he will accept a stiffed hindfoot noted. Patient’s questions were answered, and he was consented for the planned procedure.
PROCEDURE IN DETAIL: The accommodating was taken to the operating allowance area accepted anesthesia was induced. Time out was taken advertence the appointed site, procedure, and patient. Operative armpit was initialed, one gram of Ancef accustomed IV. Popliteal block was placed centermost to crabbed hamstring, 3 fingerbreadths adjacent flexion bulge to the knee. Intraneural bang of abhorred by abbreviation the amperage to beneath 1 milliamp, seeing an abolishment of motor response. The acme was able and draped in the accepted fashion. Acme exsanguinated, tunicate inflated.
No equinus was present. Metier cavity fabricated from the tip of the fibula to the abject of the fourth metatarsal. Extensor digitorum brevis and fat pad were animated off the inferior peroneal retinaculum. Calcaneocuboid and subtalar joints were anxiously exposed, bald of cartilage, and able with a 4mm osteotome for arthrodesis. The calcaneocuboid collective was awfully osteoarthritic. The talonevicular collective beeline cavity was fabricated in band with the afterwards tibial course, aciculate anatomization agitated bottomward through bark with edgeless anatomization of subcutaneous tissues.
Saphenous attitude was abandoned in a afterwards postion, beeline cavity fabricated in the periosteum. The calcaneo and the talonavicular collective were anxiously exposed. Cartillage, or what was actual of cartilage was removed. There were acute osteoarthritic thoughout. Essentially 5%-10% of cartilage remained. The osteophytes were anxiously excised with osteotome, the collective was able with microfracture application an osteotome on both abandon of the joint. (Continued) OPERATIVE REPORT Patient: T. J. Moreno Accommodating ID: 110497DOB: 02/15Age: 44Sex: M Page: 3
Shortly the cavity fabricated off the weight address apparent of the afterwards heel. Guide wire from the 70 cannulated set was avant-garde beyond the afterwards heel beyond the subtalar collective into the talor close anatomy junction. This was done while the heel was captivated in a slight valgus position. Afterwards acceptance position and measuring, the wire was avant-garde to the antecedent ankle, captivated with a hemostat. This was followed by consecutive reaming with 4. 0 and afresh 7. 0 cannulated reamers. Next, afterwards tapping, a absolutely threaded 100 mm spiral was placed over a washer. Affliction was taken to abstain bendable tissue approximation posteriorly.
Excellent compression, fixation, subtalar collective were acquired after approximation of the ankle. Next the talonavicular collective was bargain to a bottom plantar brand position, captivated with two 4. 0 cannulated screws starting at the naviculocuneiform joint. Next the calcaneocuboid collective afresh was adapted to acquiesce for plantar brand bottom position. The collective was captivated with 4 staples from the 3M 15X16mm stabilizer. All wounds were anhydrous with accustomed saline, accomplished compression was present in anniversary position, the centermost periosteal was repaired with 3. 0 vicral suture.
Subcutaneus tissues bankrupt with 3. 0 vicral and bark bankrupt with bark clips. On the crabbed side, extensor digitorum brevis was repaied to the inferior peroneal retinaculum as was the fat pad. Subcutaneous tissue was bankrupt with 3. 0 vicral. Bark bankrupt with 4. 0 nylon. The afterwards heel was anhydrous and bankrupt with 4. 0 nylon suture. A antiseptic bathrobe was activated additional telfa dressing, sponge, Webril, affection roll, and adhesive splint. The bottom was at a final plantar brand position. Image accession showed able-bodied placed hardware, added articular to the ankle.
Patient was taken to the accretion allowance in abiding action with no accepted complications. POST-OPERATIVE PLAN: The accommodating will be empiric brief with affliction ascendancy maintained. Once he is surgically stable, accommodating will be transferred to endocrinology for appraisal and affliction of his anew diagnosed diabetes and hypertension. He is to chase up in my appointment in one anniversary for anguish check. _______________________________________________________________ Max L. Hirsch, MD Orthopedic Anaplasty mh/xx D: 10/15/20 T: 10/15/20
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