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Sample Orthopedics Operative Reports

TITLE OF OPERATION:
Left knee arthroscopy with partial medial meniscectomy.

PREOPERATIVE DIAGNOSIS:
Left knee medial meniscal tear and chondromalacia of the patella.

POSTOPERATIVE DIAGNOSIS:
1. Posterior horn tear around medial meniscus in the white-white to white-red zone, which was irreparable.
2. Chondromalacia changes of grade 2 of the patellofemoral compartment.

NAME OF OPERATION:
Left knee arthroscopy with partial medial meniscectomy.

ANESTHESIA:
Spinal.

TOURNIQUET TIME:
32 minutes.

BLOOD LOSS:
Minimal.

FLUIDS:
900 cc Crystalloid.

SPECIMEN:
None.

PROCEDURE:
The patient was brought down to the operating room and transferred from a hospital stretcher to the operating table. She was then induced under a spinal anesthetic by Dr. ______.

The patient was placed into the supine position and the lower extremity was then prepped and draped in normal sterile fashion for knee arthroscopy. A proximal thigh tourniquet was placed and an Esmarch bandage was used to exsanguinate the limb. The tourniquet was then inflated to approximately 100 to 150 mm of mmHg above systolic pressure. The knee was examined for range of motion and laxity.

An 11-blade stab incision was made along the anterolateral aspect for the anterolateral portal. A Dell trocar was then inserted and the arthroscope was then introduced. Once it was confirmed to be within the joint proper, the knee was distended with sterile saline solution, a pump lavage system at 55 mm of mmHg, and medium flow.

A systematic tour about the knee was performed beginning in the suprapatellar pouch, followed by the patellofemoral region, lateral gutter, posterolateral corner, and then the lateral compartment. Next, the intracondylar notch region was examined and finally, the medial compartment and medial gutter. Any abnormal findings in these regions would be found in the postoperative or findings section of this operative description.

With the arthroscope visualizing in the medial compartment, the determination of the anteromedial portal was made by inserting a spinal needle so that it would be in the proper orientation above the anterior horn of the medial meniscus directed back toward the posterior horn. Once this orientation was determined, an 11-blade stab incision was made at that site, again, followed by the insertion of a Dell trocar. An arthroscopy probe was then inserted and a subsequent systematic tour in the reverse direction utilizing the probe was then made. All menisci were probed. All articular cartilage surfaces of the tibial, femoral, and patella were probed. The cruciate ligaments also were probed. Again, any abnormal findings would be found in the top of this operative report.

THERAPEUTIC ARTHROSCOPY:
A posterior horn tear of the medial meniscus in the white-white zone to white-red zone, which was complex in nature and was irreparable, was debrided back to a stable margins using an arthroscopy meniscal biter and a 4.0 shaver.

The chondromalacia changes were all stable and did not require any chondroplasty.

The arthroscope was removed from the lateral compartment and was placed into the medial portal, and again, a tour of the knee was made this time visualizing it from the medial side and with the arthroscopy probe placed at the lateral portal. There was no further pathology identified. There was no evidence of remaining loose body or other abnormality.

All instruments were eventually able to be removed with no evidence of any breakage. The arthroscopy portals were reapproximated using 4-0 nylon in interrupted fashion. Prior to the removal of the arthroscope, 0.5% Marcaine and Astramorph were distilled into the knee joint before closure.

The tourniquet was released. There was no significant bleeding. The wounds were dressed with sterile bandages and a compression wrap from the toes to the mid thigh was placed.

The patient was transferred off of the operating table back to a hospital stretcher and taken to the recovery room in fair condition. There was no evidence of any vascular deficit. As the spinal was still in place, we could not fully assess the neurologic status.

POSTOPERATIVE PLAN:
The patient will be permitted weightbearing as tolerated and is encouraged to frequently flex and extend the knee as well as her ankle. Crutches will be provided for her if she is unable to ambulate without the use of these assistive devices.

Appropriate oral analgesics and oral antiinflammatory medications will be provided for the patient.

The patient was instructed on ice and elevation to the limb.

She will follow up in my office in approximately 6-10 days for postoperative consultation, wound examination, suture removal, and institution of more formalized physical therapy.


TITLE OF OPERATION:
Reduction osteoplasty of craniofacial bones with contouring bur.
Revision of scar, 17 cm of scalp, unusual, extended.

PREOPERATIVE DIAGNOSIS:
Cranial deformity secondary to previous reconstruction and cranial growth abnormality.

POSTOPERATIVE DIAGNOSIS:
Cranial deformity secondary to previous reconstruction and cranial growth abnormality.

ANESTHESIA:
General endotracheal anesthesia.

DESCRIPTION: The patient was placed on the operating table in the supine position. After adequate induction of general anesthesia, the patient was prepared and draped in the usual sterile fashion. This was accomplished after an appropriate removal of hair and prescrubbing. Dr. X then reopened the vertical portion of the incision and repaired the defect with a piece of titanium mesh. Once this was complete, the secondary procedure was begun.

Attention was directed to the segments. We extended the vertical incision transversely to the left side in order to allow exposure of the prominent right frontal or right parietal thickened bone. This was contoured with a pineapple bur. This was reduced in sized down to the minimal amount in view of the thickness of the bone. This gave a smoother overall contour. Other areas were difficult to reach to correct any more extensive irregularity. I discussed the case with Dr. X regarding the extension of the temporal region. He agreed that since there was extensive tension on the wound repair that extending down into the frontal region with the associated swelling could compromise the skin closure which was extraordinarily difficult, and would not have otherwise allowed for the scar revision. Therefore we elected to proceed with the scar revision. This was discussed with the family.

The old scar was removed down to the area where there appeared to be hair growth. This was trimmed appropriately and hemostasis was achieved with electrocautery. Closure was then accomplished with 2-0 Vicryl interrupted sutures followed by 3-0 Vicryl on the periphery, followed by a running 3-0 nylon. A sterile dressing was applied. The patient tolerated the procedure well, anesthesia was reversed and the patient was transferred to the recovery room in good condition.


TITLE OF OPERATION:
Removal of varied irritating plates and screws.
Reduction osteoplasty of craniofacial bones.
Scar revision (bicoronal).

INDICATIONS FOR SURGERY:
This patient underwent a craniofacial reconstruction in the past. This resulted in a good overall extension of the skull. He had a smooth forehead but with some irregularity in the temporal parietal region. He had some irregularities of the overlying bone with a slight temporal hollow. It was elected to proceed with revision of the scar, removal of the prominent hardware and contouring of the bone, possibly reconstructing a temporal fossa.

PREOPERATIVE DIAGNOSIS:
Loosening of plate and screws following craniofacial reconstruction.
Prominent hypertrophic scar.
Prominent reconstructive craniofacial bones.

POSTOPERATIVE DIAGNOSIS:
Loosening of plate and screws following craniofacial reconstruction.
Prominent hypertrophic scar.
Prominent reconstructive craniofacial bones.

ANESTHESIA:
General endotracheal anesthesia.

DESCRIPTION: The patient was placed in the supine position. After adequate induction of general anesthesia, a small episode. We then proceeded with preparation and draping in the usual sterile fashion. The old incision was excised. Old scar was excised and the incision opened. Subperiosteal dissection with some supraperiosteal dissection proceeded without difficulty. We then extended all the way down to the forehead where the plates, screws and wires were all removed.

Attention was directed to the frontotemporal orbital region where some of the excess bone was contoured down. This was also accomplished in the upper sagittal and parietal region. This appeared to decrease the prominence of this area and diminished the temporal hollow. This allowed for a good overall shape, and therefore the area was copiously irrigated with saline. Closure was accomplished with 3-0 Vicryl and a running 4-0 nylon. The patient tolerated the procedure well and was reversed from anesthesia and transferred to the recovery room in good condition.


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