What follows is the text of the Operation Report from December 17th, 2009, the day on which my ankles were fixed. I just received this after asking for a copy of it during a follow-up appointment I had on Tuesday. Certain portions have been omitted to keep swarms of lawyers from descending on my family. Also, a few reformats have been done here and there to make it more readable, and I've added a few explanations of some of the more technical terms, trying to limit those so that I don't defeat the goal of improving readability.
Here we go:
OPERATION: 12/17/09
PREOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.
POSTOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.
OPERATION:
1. Open reduction internal fixation (a.k.a. ORIF - fixing a fracture after incision into the break site - ed.), left bimalleolar ankle fracture.
2. Open reduction internal fixation, right bimalleolar ankle fracture.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
50.
COMPLICATIONS:
None.
DRAINS:
None.
TOURNIQUET TIME:
Left 25 minutes and right 27 minutes.
INDICATIONS FOR PROCEDURE:
The patient is a 46-year-old male who suffered significant bilateral ankle fractures after a fall 5 days prior. He was eventually medically cleared and due to the displaced subluxed (dislocated - ed.) ankle fractures bilaterally was indicated for ORIF. He understands risks and benefits of surgery and consents for the procedure.
SUMMARY OF OPERATION:
Following successful induction of general anesthetic, both ankles were prepped simultaneously. Ancef 1 g (an antibiotic - ed.) was administered prior to start. Calf tourniquets were applied. The left side was done first.
Following exsanguination (I assume this means either free bleeding or some removal of blood from the site - ed.), toruniquet was inflated on the left. Lateral incision was made through skin and subcutaneous tissue. The fibula was dissected down to and underwent reduction. There was minimal comminution (breakage into a number of pieces - ed.) but somewhat softened bone.
Fracture site was irrigated of hematoma and a curette was used to remove any loose bony fragments. It was then reduced anatomically with a bone-holding clamp, and a single compession screw AP (anterior/posterior - ed.) was placed to hold the reduction. A 6-hole 1/3 tubular locking plate was bent to conform and placed along the lateral aspect. Initially, 2 compression screws, cancellous (i.e., into spongy bone material - ed.) was placed distally (at the far point - ed.) and cortical (dense bone - ed.) placed proximally, followed by 3 locking screws of appropriate length.
We then moved to the medial side and made a small curvilinear incision over the medial malleolus. Opened the deltoid ligament to identify the fracture, irrigated it, and reduced it anatomically and held in place with a bone clamp. Two 50 mm 3.5 partially threaded screws were then placed in parallel through the medial malleolus obtaining good compresion and good derotation (stability - ed.).
X-rays confirmed good hardware placement and anatomic ankle mortise reduction on AP and lateral images. The limb was then wrapped snugly with an Ace wrap and the tourniquet deflated.
We moved to the right side and performed a similar procedure after tourniquet inflation; first the fibula and then the medial malleolus in similar fashion. We used a 7-hole 1/3 tubular locking plate laterally with a single AP compression screw for this similar short oblique fracture. Anatomic reduction was achieved on both sides. Final X-rays confirmed good hardware placement, screw length, and mortise reduction.
Both ankles were then irrigated thoroughly and closed with 0 Vicryl (absorbable sutures - ed.) for the deeper tissues including the deltoid ligaments medially followed by 2-0 Vicryl for the subcutaneous tissue. The wounds were then dried, Mastisol (an adhesive - ed.) and Steri-Strips were applied to all 4 incisions, Xeroform (gauze - ed.) and sterile dressings followed by a soft roll and boots placed bilaterally.
The patient was then reversed from general anesthesia and taken to recovery in stable condition.
The aforementioned nightmare happened either during the operation or during recovery. I'll never be sure which, but from what my wife tells me I'm guessing it happened in recovery.
I promise it'll be up soon. It scared me, but it might give you a good laugh once you've read it. Go ahead, if you can't laugh at the walking wounded, who can you laugh at? (Hawkeye Pierce, M.A.S.H., if memory serves.)
