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Supracondylar Humerus Percutaneous Pinning Sample

DATE OF OPERATION:  MM/DD/YYYY

PREOPERATIVE DIAGNOSIS:
Left elbow supracondylar humerus fracture, closed, type 2.

POSTOPERATIVE DIAGNOSIS:
Left elbow supracondylar humerus fracture, closed, type 2.

OPERATION PERFORMED:
Left elbow supracondylar humerus closed fracture and percutaneous pinning.

SURGEON:  John Doe, MD

ASSISTANT:  None.

ANESTHESIA:  General.

COMPLICATIONS:  None.

TOURNIQUET TIME:  None was used.

HARDWARE UTILIZED:  K-wires x2, 0.062 size.

INDICATIONS FOR OPERATION:  The patient is a (XX)-year-old Hispanic male who fell, injuring his left elbow. The patient was diagnosed with a closed type 2 supracondylar humerus fracture. Recommendation for closed reduction and casting versus percutaneous pinning of the supracondylar humerus fracture was offered to the patient and his parents to provide adequate alignment for optimal healing and function. Risks, benefits, and alternatives of the surgery were discussed in detail. Risks including, but not limited to scar, infection, bleeding, nerve or vessel injury, need for further surgeries, malunion, loss of motion of the elbow, and pain were discussed in detail with the patient and his parents. Questions regarding surgery were answered and verbal and written consent was obtained from his parents prior to the surgery.

DESCRIPTION OF OPERATION:  After informed consent was obtained from the patient's parents, he was taken to the operating field, transferred from gurney to the operating table, placed in supine position.  General anesthesia was administered by the anesthesia staff.  He was intubated without complication or difficulty.  The patient received Ancef 500 mg IV preoperatively for infection prophylaxis.

While the patient was under general anesthesia, the left elbow was manually manipulated with traction and hyperflexion with attempted reduction of supracondylar humerus fracture.  There was a 30-degree extension deformity of the distal aspect of the humerus.  This was corrected with manual manipulation.  There was some hinging that went on with attempted range of motion of the elbow and concern for instability with closer management of the fracture would be persistently present.  It was then decided that percutaneous pinning of the fracture site would be in the best interest of the patient to provide a stable construct for healing.  The left upper extremity was then sterilely prepped and draped in the usual fashion.

Using the C-arm as a working table, the left elbow was evaluated and the supracondylar humerus fracture was held in a reduced position.  Next, 0.062 K-wire was then placed percutaneously on the lateral epicondyle, and under C-arm guidance, it was passed across the fracture sites on the lateral epicondyle to the medial cortex of the metaphysis.  C-arm images confirmed placement in AP and lateral planes of the percutaneously placed pin.  With this completed, a second pin was placed in a converging fashion and providing stable fixation of the supracondylar humerus fracture.

The elbow was taken through range of motion and the fracture appeared to be stable.  The anterior humeral line, on the lateral projection, did bisect the capitellum as per normal alignment of the elbow.  The K-wires were then cut short, bent, and pin caps were applied.  Xeroform was placed around the pin sites.  Well-padded dressing was placed over the pin sites and a long, more padded fiberglass cast was then placed on the left upper extremity with the elbow in 90 degrees of flexion in neutral forearm rotation.  Care was taken not to wrap the cast tightly to allow for any mild swelling that may occur following the procedure.

The patient did not have severe swelling at the elbow at the time of surgery but only mild swelling about the elbow.  The patient had 2+ radial pulses prior to casting and adequate capillary refill to his hand, less than 2 seconds.  General anesthesia was reversed at the completion of the case.  He was extubated and returned to the recovery room in stable condition, appearing comfortable.