Sample Report: Open Reduction and Internal Fixation of Hip Fracture
Preoperative Diagnosis: Intertrochanteric fracture, left hip.
Postoperative Diagnosis: Intertrochanteric fracture, left hip.
Procedure: Open reduction and internal fixation of intertrochanteric fracture, left hip, with DHS hip screw and four-hole sideplate.
Indications: This 96-year-old female fell at the boarding home, where she lives, on the day of admission and sustained an intertrochanteric fracture of her left hip.
Description of Procedure: Under satisfactory spinal anesthesia, the patient was placed on the Telos table, and I was able to do some traction with some manipulation and reduction. This was checked in the AP and lateral position. She was then prepped and draped in this position.
A 6-inch incision was made, beginning at the tip of the greater trochanter and going distally along the lateral thigh. Sharp dissection was used to go through the subcutaneous fat. Hemostasis was achieved with electrocoagulation. The fascia was incised in line with the incision, and the vastus lateralis muscle was split by sharp resection down to the underlying femur, and a Bennett retractor placed. Under C-arm control, I placed a guidewire up into the neck. The greater trochanter had fractured right at the place where the guidewire went, so this made placement rather easy. This was checked on the AP and lateral, and I used the 135-degree angle guide. I then measured and determined I needed a 90-mm compression hip screw. The wire was then driven in a little further, and the drill for the hip screw and sideplate barrel was run over the screw under x-ray control. This was then removed, and the 90-mm compression hip screw was placed over the guidewire and again checked in the AP and lateral. It was found to be in good position, and I had very good purchase in the head.
The 135-degree angle, four-hole sideplate was placed, the barrel of which was slipped over the shaft of the screw and fixed to the femoral shaft. It was held in place with a Jackson bone clamp. A total of four screws were put in place by drilling, measuring, and putting in four tap screws. The four tap screws consisted of one 40-mm, two 38-mm, and one 6-mm screw. Finally, all of them were tightened down. The Jackson clamp was removed, and the wound was irrigated. The vastus lateralis muscle was allowed to fall back together.
The fascia was closed with #1 Vicryl interrupted sutures. The subcutaneous fat was closed with 0 Vicryl interrupted inverted sutures, and the skin was closed with skin staples. A Betadine dressing was applied. The patient left the operating room in satisfactory condition with no drains and no complications. Prior to the procedure, the patient received 1 g IV Ancef.