Lisa A
Networker
Can you please help me code the following operative report?
DETAILS OF PROCEDURE:
...the previously placed cables were identified and removed. The femoral peg was identified. Dissection was then carefully taken down superior to the tip of the greater trochanter, and the tip of the femoral rod was identified. The interference screw was loosened. The femoral peg was then removed and the proximal portion of the femoral rod was removed, as well.
At this point, attention was then turned to the fracture site. The nonunion was taken down and the end of the fracture and the proximal end of the fractured rod was identified. The attempts were made to withdraw the rod proximally. However, because of the expansion of the rod distal to the isthmus, we were unable to remove the rod. At this point, decision was made to osteotomize the femur and make a large lateral window, in order to remove the rod. The initial osteotomy and window was placed down to the level of the isthmus; however, we were unable to remove the rod at that level and so the osteotomy was then continued down to distal to the isthmus. Removing bony window, the femoral cortex was saved for later use. The rod was then able to be removed without difficulty. The ostomy to the bone and bony canal was d brided utilizing curettes. The wound was pulsatilely lavaged and dried. The osteotomized femoral cortex windows were then replaced over the lateral aspect of the femur. Then these were fixated utilizing seven Accord cables. These were subsequently tightened down and fixated.
After fixation of the osteotomy and femoral windows, attention was then turned to the fracture site. Again, the nonunion had been taken down. The guide pin was placed through the tip of the greater trochanter and across the fracture and down to the level of the knee. The intramedullary canal was measured. A 360-mm length rod, 10-mm diameter Intertan rod was then opened. The proximal femur was reamed out utilizing the appropriate reamer. The rod was then inserted through the tip of the greater trochanter across the fracture into the intramedullary canal and down to the level just proximal to the physeal scar. After ensuring appropriate position and alignment utilizing C-arm and utilizing the guide for the compression and lag screws, the appropriate guide pin was placed. After ensuring appropriate position and alignment of the guide pin was overreamed and 100-mm lag screw was selected. The drill hole for the compression screw was also reamed under C-arm guidance. When this had been completed, the 100-mm compression screw was inserted to the appropriate level and position, and then the 95-mm compression screw was inserted. Excellent fixation was obtained utilizing this. The fracture was then reduced and excellent reduction was noted. Then utilizing C-arm, a distal interlock screw was placed. Drill hold was made, and 45-mm interlock screw was then placed.
With utilization of the C-arm, excellent position and alignment was noted. The
wound was then again pulsatilely lavaged and dried. Utilizing burr, saw and
osteotome, the bone adjacent to and around the nonunion site was dovetailed and taken down to bleeding bone. When this was complete, Allograft was then utilized and packed down around the nonunion site and then along the osteotomy sites. Then utilizing the 30 ml of Plexur M, this was then also packed in around the nonunion site and down along the osteotomy sites...
DETAILS OF PROCEDURE:
...the previously placed cables were identified and removed. The femoral peg was identified. Dissection was then carefully taken down superior to the tip of the greater trochanter, and the tip of the femoral rod was identified. The interference screw was loosened. The femoral peg was then removed and the proximal portion of the femoral rod was removed, as well.
At this point, attention was then turned to the fracture site. The nonunion was taken down and the end of the fracture and the proximal end of the fractured rod was identified. The attempts were made to withdraw the rod proximally. However, because of the expansion of the rod distal to the isthmus, we were unable to remove the rod. At this point, decision was made to osteotomize the femur and make a large lateral window, in order to remove the rod. The initial osteotomy and window was placed down to the level of the isthmus; however, we were unable to remove the rod at that level and so the osteotomy was then continued down to distal to the isthmus. Removing bony window, the femoral cortex was saved for later use. The rod was then able to be removed without difficulty. The ostomy to the bone and bony canal was d brided utilizing curettes. The wound was pulsatilely lavaged and dried. The osteotomized femoral cortex windows were then replaced over the lateral aspect of the femur. Then these were fixated utilizing seven Accord cables. These were subsequently tightened down and fixated.
After fixation of the osteotomy and femoral windows, attention was then turned to the fracture site. Again, the nonunion had been taken down. The guide pin was placed through the tip of the greater trochanter and across the fracture and down to the level of the knee. The intramedullary canal was measured. A 360-mm length rod, 10-mm diameter Intertan rod was then opened. The proximal femur was reamed out utilizing the appropriate reamer. The rod was then inserted through the tip of the greater trochanter across the fracture into the intramedullary canal and down to the level just proximal to the physeal scar. After ensuring appropriate position and alignment utilizing C-arm and utilizing the guide for the compression and lag screws, the appropriate guide pin was placed. After ensuring appropriate position and alignment of the guide pin was overreamed and 100-mm lag screw was selected. The drill hole for the compression screw was also reamed under C-arm guidance. When this had been completed, the 100-mm compression screw was inserted to the appropriate level and position, and then the 95-mm compression screw was inserted. Excellent fixation was obtained utilizing this. The fracture was then reduced and excellent reduction was noted. Then utilizing C-arm, a distal interlock screw was placed. Drill hold was made, and 45-mm interlock screw was then placed.
With utilization of the C-arm, excellent position and alignment was noted. The
wound was then again pulsatilely lavaged and dried. Utilizing burr, saw and
osteotome, the bone adjacent to and around the nonunion site was dovetailed and taken down to bleeding bone. When this was complete, Allograft was then utilized and packed down around the nonunion site and then along the osteotomy sites. Then utilizing the 30 ml of Plexur M, this was then also packed in around the nonunion site and down along the osteotomy sites...