INDICATIONS: The patient is a 69 year old black female who fell, landing on her right hip. She was seen in the emergency room where physical exam and x-ray revealed an intertrochanteric right femoral fracture. She was admitted to Dr. Loyd’s service after an orthopedic consultation and preoperative clearance for surgery. She was taken for ORIF.
OPERATION IN DETAIL: After adequate preoperative evaluation, preoperative medication, and signing the informed consent, the patient was taken to the operating room and administered a general endotracheal anesthetic with prominences well padded, she underwent an uneventful reduction and was placed on traction through a well-padded boot, her left lower extremity was flexed and abducted at the hip. All boney prominences and the peroneal nerve were well padded. Fluoroscopic AP and lateral images revealed a good reduction of her intertrochanteric femoral fracture.
The right hip was then sterily prepared with Betadine scrub and solution and draped into the sterile field. She was administered IV preoperative antibiotics. A straight lateral approach to the proximal femur was made. Dissection was carried through the skin and subcutaneous tissue. Hemostasis was obtained with electrocautery. The fascia lata was divided in line with the skin incision. The fascia over the vastus lateralis was divided in line with the skin incision, and the Sikhethiwe MsimangaCase No. 2 Student Number:98827756 OPERATIVE REPORT Patient Name: Emma Parker Hospital No. : 11259.
Date of Admission: 9/26/2011 Page 2 vastus lateralis was divided in line with its fibers, revealing the lateral aspect of the proximal femur, which was retracted with the Benet and Homan retractors without complication. A guide pin was placed along the anterior neck to give the proper amount of anteversion using the 135 drill guide. A guide pin was placed though the lateral aspect of the proximal femur across the facture site and into the center of the head and neck, as demonstrated by AP and lateral fluoroscopic C-arm images. This was then measured and 85mm was found to be the appropriate length.
The core was cut for the sliding screw without complication using a preset remar set at 85mm. The tap was then used to tap the way for a proximal screw, and an 85mm sliding screw was inserted across the facture sight into the head and neck without complication. A 4-hole 135-degree side plate was then attached. We slid it over the DePuy sliding screw and attached it to the proximal femur using a Lowman turkey-claw clamp. With the fixation in place, AP and lateral fluoroscopic images throughout the fracture site and hardware position confirmed good reduction and good placement of the hardware.
At this point the side plate was then secured to the proximal femur using the 3-2 drill bit to drill a hole measuring the approximate length with depth gauge and placing 4 to 5 cortical screws of the appropriate length without complication. At this point the compression screw was inserted. All traction was left off and the compression screw was tightened impaction the fracture nicely. All screws were then tightened with the screwdriver. The Lowman was removed as was all hardware.
Multiple views in the AP and lateral places of the fracture site and hardware for placement confirmed good reduction and good hardware placement for her intertrochanteric femoral fracture. With open reduction, internal fixation complete, the wound was copiously irrigated with antibiotic solution. Hemostasis was obtained with electrocautery. The fascia over the vastus lateralis was closed with a running suture of 0 Vicryl. A Hemovac drain was left between the fascia later and the vastus lateralis connected to a separate stab wound. The fascia later was closed with a running suture of 0 Vicryl with a few interrupted sutures.
Care was taken to make sure that the drain was not sutured into the wound. The subcutaneous tissue was closed with staples. A sterile dressing was applied, and the patient was returned to the recovery room via stretcher. Sikhethiwe MsimangaCase No. 2 Student Number:98827756 OPERATIVE REPORT Patient Name: Emma Parker Hospital No. : 11259 Date of Admission: 9/26/2011 Page 3 The patient tolerated the procedure well. There were no complications. Blood loss was negligible no replacement. Lap, needle, and sponge counts were correct x2, and she returned to the recovery room in good condition, where she was neurovascularly intact.
__________________________ Carol Dodd, MD CD:sm D: 9/26/2011 T: 9/28/2011 C: Sherman Loyd, MD Sikhethiwe MsimangaCase No. 2 Student Number:98827756 HILLCREST MEDICAL CENTER HISTORY AND PHYSICAL EXAMINATION Patient Name: Emma Parker Hospital No. : 11259 Room No. : 444 Date of Admission: 9/25/2011 Admitting Physician: Sherman Loyd, MD Admitting Diagnoses: Acute intertrochanteric fracture of right hip. The history below was obtained from the patient, and physical examination was performed, with her stated verbal understanding and consent. She was alert oriented x3, with reasonable though content.
She understood questions well and was in no acute distress. CHIEF COMPLAINT: Right hip injury. HISTORY OF PRESENT ILLNESS: I was called to see this 69 year old black female patient, well known to me, who was brought to the ER after she sustained an injury of her right hip. She states she was walking when her right leg just gave out and she fell onto the right hip. She complained of mild pain in the right hip, and mild edema was noted in the ER. In addition, she had external rotation of the right leg. Initial x-ray demonstrated findings of intertrochanteric fracture, nondisplaced, of the right hip.
Consultation was obtained from Dr. Dodd, who concurred with the diagnosis, and treatment recommendations were made. She was subsequently admitted to the hospital for further evaluation and treatment, including surgical repair of the hip. PAST MEDICAL HISTORY: Usual childhood diseases. She denies previous rheumatic fever or polio. The only surgical history was an appendectomy in the past and repair of a fractured left hip in approximately 1993. SOCIAL HISTORY: She lives at home with her husband, who is rather feeble. Denies the use of tobacco or alcohol. FAMILY HISTORY: Non contributory.
REVIEW OF SYSTEMS: Otherwise unremarkable. Sikhethiwe MsimangaCase No. 2 Student Number:98827756 HISTORY AND PHYSICAL EXAMINATION Patient Name: Emma Parker Hospital No. : 11259 Room No. : 444 Date of Admission: 9/25/2011 PHYSICAL EXAMINATION: GENERAL: This is an alert black female patient appropriate for stated chronologic age who is in no acute distress. Skin: Demonstrates multiple Senile Keratotic lesions. Head, Eyes, Ears, Nose, Throat: Normocephalic. Normal hair distribution. PERRLA/EOMI sclera anicteric. Fondoscopic exam: Essentially benign other than some mild cataract formation.