Hillcrest Case 7 Operative

secret agent insure persevering T. J. Moreno Patient 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 accessory was used for soft create from raw material egis and retraction and also for maintaining reduction during temporal and permanent fixation use of surgical assistant was medically necessary, and to prove the gumshoe and efficacy of the procedure. Preoperative Diagnosis leave hind instauration osteoarthritis. Postoperative Diagnosis Left hind metrical foot osteoarthritis. effective Procedure 1) Triple arthrodesis . 2) Popliteal sciatic block located by surgeon explicitly for postoperative pain management. anaesthesia General by Chuck Delaney, MD. delimitate during anesthesia, stable. Specimen Removed Nine. IV Fluids tell nurses notes. Estimated Blood acquittance See nurses notes. wat er supply output See nurses notes. Complications None. Postoperative take Stable (Continued) OPERATIVE REPORT Patient T. J. MorenoPatient ID 110497DOB 02/15Age 44Sex M rogue 2 INDICATION A 44 year old male with hindfoot osteoarthritis pain, who has failed conservative management after reviewing risks, benefits and alternatives, he has agreed to proceed with surgical management. Risks of detain healing, non-healing and infection, nerve vessel tendon injury, current pain and discomfort, procedure failure, need for rescript surgery, and/or hardware removal noted. The occurrence that he will have a stiffed hindfoot noted. Patients questions were answered, and he was consented for the plotted procedure.PROCEDURE IN DETAIL The enduring was interpreted to the operating room where general anesthesia was induced. Time out was taken indicating the appropriated site, procedure, and patient. sherlock site was initialed, one gram of Ancef given over IV. Popliteal block was placed media n to lateral hamstring, 3 fingerbreadths proximal flection crease to the knee. Intraneural injection of avoided by trim down the amperage to below 1 milliamp, seeing an disintegration of motor response. The extremity was prepped and draped in the usual fashion. Extremity exsanguinated, tunicate inflated.No equinus was present. military capability division made from the tip of the fibula to the base of the fourth metatarsal. Extensor digitorum brevis and adipose tissue pad were elevated off the low peroneal retinaculum. Calcaneocuboid and subtalar sticks were carefull exposed, denuded of gristle, and ready with a 4mm osteotome for arthrodesis. The calcaneocuboid join was exceptionally osteoarthritic. The talonevicular joint linear incision was made in line with the posterior tibial course, sharply dissection carried down through skin with candid dissection of subcutaneous tissues.Saphenous vein was retracted in a dorsal postion, linear incision made in the periosteum. T he calcaneo and the talonavicular joint were carefully exposed. Cartillage, or what was remaining of cartilage was removed. on that point were extreme osteoarthritic thoughout. Essentially 5%-10% of cartilage remained. The osteophytes were carefully excised with osteotome, the joint was prepared with microfracture apply an osteotome on both sides of the joint. (Continued) OPERATIVE REPORT Patient T. J. Moreno Patient ID 110497DOB 02/15Age 44Sex M summon 3Shortly the incision made off the angle bearing surface of the posterior heel. drag wire from the 70 cannulated set was mature crossways the posterior heel across the subtalar joint into the talor neck body junction. This was do while the heel was held in a slight valgus aspect. After verifying position and measuring, the wire was advanced to the anterior ankle, held with a hemostat. This was followed by sequential reaming with 4. 0 and wherefore 7. 0 cannulated reamers. bordering, after tapping, a fully threaded 100 mm tush was placed over a washer. bid was taken to avoid soft tissue impingement posteriorly.Excellent abridgment, fixation, subtalar joint were obtained without impingement of the ankle. Next the talonavicular joint was reduced to a foot plantar grade position, held with two 4. 0 cannulated screws starting at the naviculocuneiform joint. Next the calcaneocuboid joint again was adjusted to allow for plantar grade foot position. The joint was held with 4 staples from the 3M 15X16mm stabilizer. All insults were irrigated with normal saline, excellent compression was present in each position, the average periosteal was repaired with 3. 0 vicral suture.Subcutaneus tissues unappealing with 3. 0 vicral and skin closed with skin clips. On the lateral side, extensor digitorum brevis was repaied to the inferior peroneal retinaculum as was the fat pad. Subcutaneous tissue was closed with 3. 0 vicral. Skin closed with 4. 0 nylon. The posterior heel was irrigated and closed with 4. 0 nylon su ture. A sterile dressing was utilize plus telfa dressing, sponge, Webril, cotton roll, and plaster splint. The foot was at a final plantar grade position. Image intensification showed well placed hardware, extra articular to the ankle.Patient was taken to the convalescence room in stable condition with no known complications. POST-OPERATIVE PLAN The patient will be observed long with pain control maintained. Once he is surgically stable, patient will be transferred to endocrinology for evaluation and care of his newly diagnosed diabetes and hypertension. He is to follow up in my king in one week for wound check. _______________________________________________________________ Max L. Hirsch, MD Orthopedic mathematical process mh/xx D 10/15/20 T 10/15/20