DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Anterior talofibular ligament tear, right ankle.
2. Workers' compensation injury, right ankle.
3. Joint pain, right ankle.
POSTOPERATIVE DIAGNOSES:
1. Anterior talofibular ligament tear, right ankle.
2. Workers' compensation injury, right ankle.
3. Joint pain, right ankle.
OPERATION PERFORMED:
1. Open ankle arthrotomy, right ankle, with debridement of synovitis.
2. Modified Brostrom-Gould ankle ligament repair/stabilization, right ankle.
SURGEON: John Doe, DPM
ANESTHESIA: General.
HEMOSTASIS: Pneumatic thigh tourniquet inflated to 300 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 mL.
INJECTABLES: Marcaine plain 0.5%.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: Under mild sedation, the patient was brought to the operating room and placed in the supine position. General anesthesia was achieved. The patient was put into the lateral position on the beanbag and the harnesses to the lower limb were appropriately padded. The upper extremity was also protected by Anesthesia. The leg was then scrubbed, prepped and draped in the usual aseptic manner. It was elevated and exsanguinated with an Esmarch and the tourniquet inflated to 300 mmHg. A common peroneal block was given with 0.5% Marcaine plain. Attention was directed to the patient's lateral ankle where a curvilinear incision was made along the anterior portion of the fibula, extending down to the tip of the distal fibula. This was made to the epidermis and dermis down to the subcutaneous tissue. Any bleeders were cauterized as necessary. We carried our incision down to the extensor retinaculum, which appeared to be somewhat torn with a little bit of fatty herniation to the area. This was retracted in an inferior position. We extended our incision deeper down to the level of the ankle joint capsule. There was noted to be a partial tear with some synovial tissue and coloration to the area. We made an incision through the capsule along the margin of the lateral gutter down to the distal portion of the fibula. It was noted that the patient's synovial tissue billowed to the area and that the intracapsular portion of the ligament appeared to be thickened and dystrophic and invaginated to the lateral gutter. This correlated directly to where the patient's pain had been located. We debrided the dystrophic tissue down to healthy margins and flushed the wound copiously with normal sterile saline. The ankle joint was explored and no signs of osteochondral lesion could be noted and the synovial tissue debrided out and we reflushed again with normal sterile saline. We then reapproximated the capsule and ligament with 2-0 Ethibond and figure-of-eight stitch technique with excellent reapproximation noted. There was not noted to be any further invagination to the lateral gutter. This was performed along the entire course of the ankle joint capsule. We then plicated the extensor retinaculum up over the repair to reinforce the stabilization. Subcutaneous tissue was then repaired with 3-0 Vicryl and the skin was closed with skin staples. A local periligamental block was given with 0.5% Marcaine plain. The area was then dressed with Adaptic, 4 x 4, Kling, Kerlix, ABD and then Ace wrap. We then applied a modified Jones compression type cast with the patient's foot held in a dorsiflexed and mildly everted position. Before the cast was applied, the ankle joint was tested and noted to be very secure and stable. No anterior drawer on inversion stress was noted whatsoever. Tourniquet was deflated and prompt return of good response was noted to all digits of the patient's right foot before the cast was applied. The patient tolerated the procedure well and was transferred to the recovery room with vital signs stable. Neurovascular status returned promptly following release of the tourniquet.
