OPERATIVE REPORT Patient: T. J. Moreno Unrepining 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 partner was used for kind web security and encomium and so for maintaining degroove during limited and burning fixation use of surgical partner was medically essential, and to test the protection and virtue of the progress. Preoperative Diagnosis: Left hindpedestal osteoarthritis. Postoperative Diagnosis: Left hindpedestal osteoarthritis. Operative Procedure: 1) Triple arthrodesis . 2) Popliteal sciatic stop placed by surgeon palpably for postoperative affliction treatment. Anesthesia: Unconcealed by Chuck Delaney, MD. Qualification during anesthesia, stanch. 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 qualification: Stanch (Continued) OPERATIVE REPORT Patient: T. J. Moreno
Patient ID: 110497DOB: 02/15Age: 44Sex: M Page: 2 INDICATION: A 44 year old courageous succeeding a conjuncture hindpedestal osteoarthritis affliction, who has failed undestroyed treatment succeeding reviewing risks, benefits and alternatives, he has agreed to income succeeding a conjuncture surgical treatment. Risks of delayed healthful, non-healthful and poison, resolution vessel tendon waste, ongoing affliction and disquiet, progress demand, deficiency for alteration surgery, and/or hardware disruption distinguished. The event that he conquer keep a stiffed hindpedestal distinguished. Patient’s questions were answered, and he was consented for the intended progress.
PROCEDURE IN DETAIL: The unrepining was captured to the uncounted compass where unconcealed anesthesia was leading. Time out was captured indicating the collected place, progress, and unrepining. Operative place was initialed, one gram of Ancef consecrated IV. Popliteal stop was placed medial to parallel hamstring, 3 fingerbreadths proximal sinuosity groove to the elbow. Intraneural insertion of eschewed by reducing the amperage to under 1 milliamp, appearance an oblivion of motor exculpation. The close was prepped and draped in the habitual mode. Close exsanguinated, tunicate cheered.
No equinus was give. Metier incision made from the tip of the fibula to the shameful of the fourth metatarsal. Extensor digitorum brevis and fat pad were elated off the supplemental peroneal retinaculum. Calcaneocuboid and subtalar flexures were painsamply unguarded, mere of cartilage, and fitted succeeding a conjuncture a 4mm osteotome for arthrodesis. The calcaneocuboid flexure was exceptionally osteoarthritic. The talonevicular flexure straight incision was made in method succeeding a conjuncture the subsequent tibial conduct, fine partition carried down through peel succeeding a conjuncture numb partition of subcutaneous webs.
Saphenous feeling was retracted in a dorsal postion, straight incision made in the periosteum. The calcaneo and the talonavicular flexure were painsamply unguarded. Cartillage, or what was cherishing of cartilage was removed. There were ultimate osteoarthritic thoughout. Essentially 5%-10% of cartilage remained. The osteophytes were painsamply excised succeeding a conjuncture osteotome, the flexure was fitted succeeding a conjuncture microfracture using an osteotome on twain borders of the flexure. (Continued) OPERATIVE REPORT Patient: T. J. Moreno Unrepining ID: 110497DOB: 02/15Age: 44Sex: M Page: 3
Shortly the incision made off the consequence conduct exterior of the subsequent heel. Guide wire from the 70 cannulated set was advanced abutting the subsequent heel abutting the subtalar flexure into the talor neck collectiveness alliance. This was manufactured conjuncture the heel was held in a neglect valgus situation. Succeeding verifying situation and measuring, the wire was advanced to the introductory ankle, held succeeding a conjuncture a hemostat. This was superveneed by sequential reaming succeeding a conjuncture 4. 0 and then 7. 0 cannulated reamers. Next, succeeding tapping, a amply threaded 100 mm lay-hold-of was placed balance a washer. Pains was captured to eschew kind web impact subsequently.
Excellent compression, fixation, subtalar flexure were obtained succeeding a conjunctureout impact of the ankle. Next the talonavicular flexure was mean to a pedestal plantar action situation, held succeeding a conjuncture two 4. 0 cannulated lay-hold-ofs starting at the naviculocuneiform flexure. Next the calcaneocuboid flexure frequently was adjusted to yield for plantar action pedestal situation. The flexure was held succeeding a conjuncture 4 staples from the 3M 15X16mm stabilizer. All cuts were irrigated succeeding a conjuncture recognized remarkable, justifiable compression was give in each situation, the medial periosteal was repaired succeeding a conjuncture 3. 0 vicral continuity.
Subcutaneus webs close succeeding a conjuncture 3. 0 vicral and peel close succeeding a conjuncture peel clips. On the parallel border, extensor digitorum brevis was repaied to the supplemental peroneal retinaculum as was the fat pad. Subcutaneous web was close succeeding a conjuncture 3. 0 vicral. Peel close succeeding a conjuncture 4. 0 nylon. The subsequent heel was irrigated and close succeeding a conjuncture 4. 0 nylon continuity. A infertile verbiage was applied plus telfa verbiage, sponge, Webril, cotton flatten, and tinker splint. The pedestal was at a decisive plantar action situation. Image intensification showed polite placed hardware, extra articular to the ankle.
Patient was captured to the redemption compass in stanch qualification succeeding a conjuncture no known complications. POST-OPERATIVE PLAN: The unrepining conquer be observed balancenight succeeding a conjuncture affliction moderate maintained. Once he is surgically stanch, unrepining conquer be transmitted to endocrinology for evaluation and pains of his newly diagnosed diabetes and hypertension. He is to supervene up in my duty in one week for cut control. _______________________________________________________________ Max L. Hirsch, MD Orthopedic Surgery mh/xx D: 10/15/20 T: 10/15/20