OPERATION NOTE:

 Open Reduction & Internal Fixation Left Right Medial Malleolus

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: Medial malleolus fracture

Background:    Patient consented, understanding the risks of  bleeding, infection, nerve damage, venous thrombo-embolism, non union, malunion, prominent metalwork, further surgery, complex regional pain syndrome and anaesthetic.

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

Anaesthetic:     Block / GA*

Antibiotics:       At induction mg_ Cefuroxime Co-Amoxiclav Clindamycin

Equipment:      Tourniquet:                         Tourniquet pressure: 200 225 250 275 300 325 mmHg      Tourniquet time:mins

Inflated after Exsanguination Elevation

Image intensifier:

Position:            Supine Lateral Prone with leg elevated on cushion with pillow under contralateral buttock

Approach:         Direct medial, curving anteriorly at tip of medial malleolus

                Careful dissection down to bone

Findings:           Medial malleolar fracture

Procedure:        Fracture identified, haematoma and any interposing periosteum cleared out. Fracture site refreshed.

Fracture reduced and held with bone reduction clamp K-wire(s)

Standard small fragment (3.5mm) x    mm lag screw applied as per AO technique with hole drilled perpendicular to the fracture line, proximal segment drilled to nominal screw diameter (gliding hole) and distal to core screw diameter (2.5mm) and countersink drilled for screw head using cancellous screws a cancellous screw with washers with a washer with image intensifier guidance and guide wire(s)

Fracture well reduced and held - blood extruded from fracture site with reduction.

Washout.

Haemostasis.

Stable fixation confirmed with image intensifier and stress test with no talar tilt or shift. Final check x-ray images saved/printed*

Closure:           Deep tissue: vicryl, deep dermal vicryl 2-0 to deep and nylon 3-0 staples for skin.

Backslab at 90degrees flexion/Wool & Crepe*

LA infiltrated at wound:

Post-op:            Routine obs. VTE prophylaxis. NWB with crutches. Home when safe.

Follow-up with GP/in clinic in two weeks for wound review and removal of sutures.

Follow-up in clinic in six weeks with removal of Backslab Dressings and x-ray on arrival.

Signed: ______________________

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