OPERATION NOTE:

 Open Reduction & Internal Fixation Left Right Lateral Malleolus : Tension band wire
(*=delete as appropriate)
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: Weber A fracture (AO 44-A1.3)

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, anaesthetic and need for further procedure (eg removal of metalwork).

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 with pillow under ipsilateral buttock Lateral

Approach:         Direct lateral

                Dissection down to bone, with care to avoid injury to deep peroneal nerve

Findings:           Fibular fracture below the level of the syndesmosis

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

Fracture reduced and held with bone reduction clamp

Two 1.6mm 2.0mm K-wires were inserted in the fibula, parallel to its axis

A tension band construct was added using a 0.8mm 0.9mm 1.0mm 1.1mm wire passed behind the K wires and through the fibula proximal to the syndesmosis

This was tightened with from two sides in parallel under fracture site was well reduced and held - blood extruded from fracture site.

The K wires were cut and bent, then tamped into distal tip fibula, holding tension band wire

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. Jelonet

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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