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Navicular ORIF With Arthrodesis Operative Sample Report


PREOPERATIVE DIAGNOSIS:  Left navicular fracture and dislocation.

POSTOPERATIVE DIAGNOSIS:  Left navicular fracture and dislocation.

OPERATION PERFORMED:  Open reduction and internal fixation, left navicular, with arthrodesis of the navicular to the medial cuneiform using 3.5 cortical screw.

SURGEON:  John Doe, MD

ANESTHESIA:  General endotracheal.


TOURNIQUET:  Left upper thigh, well padded.

TOTAL TOURNIQUET TIME:  25 minutes, inflated to 350 mmHg.

INDICATION FOR OPERATION   This is a (XX)-year-old female who was involved in a motor vehicle accident about 3 weeks ago and sustained a comminuted navicular fracture and dislocation with subluxation of the talonavicular and navicular-medial cuneiform. The patient was put in a splint and on followup was still found to have subluxation of the navicular-medial cuneiform. The decision was made at this point to proceed with an ORIF.

DESCRIPTION OF OPERATION:  The patient was given 1 gram of Ancef in the preoperative area and was brought to the operating room and placed in the supine position. After satisfactory general endotracheal anesthesia was administered, the left lower extremity was prepped and draped in the usual sterile routine fashion. The mini C-arm was used as a trial of closed reduction and percutaneous pinning was tried, but we could not reduce the navicular back to its anatomic position in regards to the medial cuneiform. The decision at this point was made to proceed with open reduction. The tourniquet was inflated after exsanguination with the Esmarch. A routine incision was performed on the dorsal medial aspect of the foot centered over the navicular-medial cuneiform joint. The incision was taken down to the navicular and cuneiform. The flap was elevated medially and laterally. There was subluxation of the navicular dorsally at the navicular-medial cuneiform joint. There was a lot of comminution in the plantar part of the navicular. Debris was removed with a rongeur and curette and the fracture site irrigated with normal saline. The fracture was reduced back into position using a bone clamp and was confirmed using the C-arm, both AP and lateral, and was in good anatomical reduction. At this point, a rongeur was used to make a trough for the screw, which was placed from distal to proximal through the medial cuneiform into the dorsal piece of the navicular. A 3.5 screw was placed and was confirmed using the C-arm to be in good position with good anatomic reduction of the navicular. The wound at this point was irrigated copiously with normal saline. A dorsal x-ray was taken, which confirmed good placement of the screw and anatomic reduction of the navicular-medial cuneiform joint, which was affixed with the screw. The subcutaneous tissues were closed with 3-0 Vicryl and the skin closed with 3-0 nylon. A dressing was applied in the form of Adaptic, 4 x 4 and sterile Webril. A short leg splint was applied. The patient tolerated the procedure well and was taken to the recovery room in stable condition with no complications.