vmounce
Guru
Not sure how to code. I appreciate any help.
Vickie
I made a lateral curved incision over his left elbow, dissection of soft tissue. Then, immediately, the muscle is completely ruptured and I can put my finger right into the joint. A huge hematoma came out. I aspirate the joint, and I clean it with normal saline, and I could see that the elbow is dislocated medially. The forearm is dislocated medially, with all of the lateral condyle, starting in the middle of the trochlea, going up vertically and then through the growth plate,and then again up in the lateral metaphysis. There are a few little fragments that I remove with a pickup and then, after I clean everything, I reduce it anatomically. I place first a kwire transversely from the lateral condyle into the medial epicondyle to reduce the articular surface anatomically. Then, I place 2 other kwires, going from the lateral condyle to proximal portion of the humerous obliquely, and through the opposite proximal cortex. That provides an excellent fixation and good reduction. I can move the elbow and the fracture is stable. I then close the capsule with vicryl 0. I close the muscle aponeurosis with vicryl 0. We close the subcutaneous with for pain management postop. We left 3 pins coming out of the skin. The procedure well tolerated. We padded, with the elbow at 90' and the forearm in supination. Tourniquet down. Good capillary refill. The procedure well tolerated.
Vickie
I made a lateral curved incision over his left elbow, dissection of soft tissue. Then, immediately, the muscle is completely ruptured and I can put my finger right into the joint. A huge hematoma came out. I aspirate the joint, and I clean it with normal saline, and I could see that the elbow is dislocated medially. The forearm is dislocated medially, with all of the lateral condyle, starting in the middle of the trochlea, going up vertically and then through the growth plate,and then again up in the lateral metaphysis. There are a few little fragments that I remove with a pickup and then, after I clean everything, I reduce it anatomically. I place first a kwire transversely from the lateral condyle into the medial epicondyle to reduce the articular surface anatomically. Then, I place 2 other kwires, going from the lateral condyle to proximal portion of the humerous obliquely, and through the opposite proximal cortex. That provides an excellent fixation and good reduction. I can move the elbow and the fracture is stable. I then close the capsule with vicryl 0. I close the muscle aponeurosis with vicryl 0. We close the subcutaneous with for pain management postop. We left 3 pins coming out of the skin. The procedure well tolerated. We padded, with the elbow at 90' and the forearm in supination. Tourniquet down. Good capillary refill. The procedure well tolerated.