OPERATION NOTE:

  Left Right Dynamic Hip Screw

Date of operation:

Patient name:      

Hospital number:

Date of Birth:       

Consultant   

Surgeon:                                                       Supervision:    Independent/Unscrubbed/Scrubbed*
Grade:           FY2/CT1/CT2 StR/SpR Fellow Consultant

Assistant:     
Grade:            FY2/CT1/CT2 StR/SpR Fellow Consultant

Anaesthetist:
Grade:            FY2/CT1/CT2 StR/SpR Fellow Consultant

Indication:  Closed inter-trochanteric neck of femur fracture

Background:    Patient consented, understanding the risks of  bleeding, infection, nerve damage, venous thrombo-embolism, non union, malunion, leg length discrepancy, shortening, further surgery, avascular necrosis and anaesthetic including mortality, hear attack and strokes.

Setup:              WHO safety checklist performed .Prepped with Betadine/Chlorhexidine* and draped

Anaesthetic:     Block / GA / Spinal *

Antibiotics:       At induction mg_ Cefuroxime Co-Amoxiclav Clindamycin Gentamicin

Equipment:    Image intensifier:

Position:            Supine. Traction table

Approach:         Direct lateral

                A straight line incision distal tothe GT Was adopted. The fascia lata was sharply incised

               The vastus lateralis was split and a Norfolk and Norwitch retractor was inserted.
 

Findings:         Intertrochanteric NOF # - reduced well closed

Procedure:    Closed reduction achieved – checked AP and Lat.
                        A 3.2 2.8 2.5 2.0 mm DHS threaded guidewire was inserted through the 145 140 135 130 125 degree guide.
                        This was checked on the AP and lateral fluroscopically.
                        This measured mm. Reamed to mm using triple reamer.
                        A bone tap was not* required.
                        A mm x 12.5 13 mm stainless steel lag screw inserted.
                        A 2 3 4 5 6 hole 145 140 135 130 125 degree standard barrel plate held with 2 3 4 5 6 bicortical screws (, , , mm).
                        Bleeding haemostasis with diathermy. Blood loss approx ml.

                        Final check x-ray images saved/printed*

Closure:           A 2-0 Vicryl tacking suture to the vastus epimysium followed by a running 1 Vicryl to the Fascia Lata.

                          2-0 Deep Dermal  and nylon 3-0 clips for skin.  Opsite Mepore Tegaderm dressing

Post-op:            Routine obs. VTE prophylaxis.

                           Check bloods (FBC & U+E) tomorrow.

                           Orhtogeriatric review with fragility fracture bone assessment

                           Follow-up with GP/in clinic in 10 12 14 days for wound review and removal of clips/sutures*.

Signed: ______________________

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