OPERATION NOTE:

 Open Reduction & Internal Fixation Left Right Lateral Malleolus & syndesmosis screw(s)
(*=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 C fracture (AO 44-C1.1)

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 and sural nerves

Findings:           Fibular fracture above the level of the syndesmosis: ~cm

Procedure:          Syndesmotic injury identified & diastasis corrected and held with periarticular clamp

Confirmed reduction with image intensifier.

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

Fracture reduced and held with bone reduction clamp.

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.

The far cortex was/was not* tapped with a 3.5mm tap through protection sleeve.

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

5 6 7 8 9 10  hole contoured 1/3 Tubular plate applied with good bicortical hold above and below the fracture.

mm Syndesmosis screw(s) applied Through Below plate with image intensifier guidance =/- guide wires

Washout.

Haemostasis.

Stable fixation and reduction 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.

Will Will not  require further procedure for removal of screws in as discussed pre-operatively with patient

Signed: ______________________

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