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Knee Arthrotomy Transcribed Operative Sample Report

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSES:
1.  Gunshot wound to right knee.
2.  Right patellar fracture.
3.  Right femoral lateral condyle fracture.

POSTOPERATIVE DIAGNOSES:
1.  Gunshot wound to right knee.
2.  Comminuted fracture of lateral facet of patella.
3.  Fracture of lateral condyle, femur.
4.  Retained bullet fragments in knee joint.

OPERATION PERFORMED:
1.  Right knee arthrotomy.
2.  Removal of retained bullet fragments.
3.  Open reduction and internal fixation, right lateral femoral condyle fracture.
4.  Partial patellectomy.

SURGEON:  John Doe, MD

ASSISTANT:  Jane Doe, MD

ANESTHESIA:  General endotracheal.

ESTIMATED BLOOD LOSS:  200 mL.

COMPLICATIONS:  None.

INDICATION FOR OPERATION:  The patient is a (XX)-year-old gentleman who sustained a gunshot wound to his right knee. Radiographs and CT scans showed the above fractures. Informed consent was obtained for operative fixation and irrigation and debridement of his knee joint.

DESCRIPTION OF OPERATION:  The patient was brought to the OR and laid supine on the OR table. General anesthesia was induced. A tourniquet was placed high up on his right thigh, and the right lower extremity was prepped and draped in the usual sterile fashion. An Esmarch bandage was used to exsanguinate the right lower extremity, and the tourniquet was inflated to 350 mmHg.

An anterior approach to the knee joint was performed. A lateral parapatellar arthrotomy was performed. The patellar fracture was examined, and there was noted to be a highly comminuted fracture of the lateral facet of the patella. Approximately 10-15% of the patellar articular surface was comminuted, and these bone fragments were not reconstructable. Therefore, a rongeur was used to remove these loose bone fragments. The fractured patella was smoothed out using a rongeur.

Next, attention was directed toward removing the two large bullet fragments in the knee joint. These were removed without difficulty. Attention was directed to the lateral femoral condyle. Approximately 30% of the articular surface of the lateral femoral condyle was comminuted and destroyed. There was a sagittal fracture line, as was also noted preoperatively on CT scans.

Three 3.5 mm cortical screws were used to stabilize the lateral femoral condyle fracture from lateral to medial. These screws were placed in standard AO fashion holding this fracture reduced. Again, approximately 30% of the articular surface of the lateral femoral condyle was involved and was not reconstructable.

The wound was thoroughly irrigated with 9 liters of normal saline, the middle 3 liters of which contained 100,000 units of bacitracin. C-arm fluoroscopy was used to examine the knee joint. Two more small pieces of bullet fragments were found, and these were removed under C-arm visualization.

The parapatellar arthrotomy was closed using #1 Ethibond suture in figure-of-eight fashion. The subcutaneous layer was closed with 2-0 Vicryl suture followed by staples for the skin. The bullet entrance wound was also thoroughly debrided and irrigated out. This wound was closed with a simple 2-0 nylon suture.

Of note, the tourniquet was deflated prior to closure, and hemostasis was obtained. Sterile dressings were applied. The patient was placed into a knee immobilizer. He was awakened from anesthesia and transferred to a stretcher and taken to the PACU for recovery.