PREOPERATIVE DIAGNOSIS: Complex right thumb carpometacarpal joint dislocation.
POSTOPERATIVE DIAGNOSIS: Complex right thumb carpometacarpal joint dislocation.
OPERATION PERFORMED: Open reduction of complex right thumb carpometacarpal joint dislocation.
ANESTHESIA: General.
SURGEON: John Doe, MD
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
PATHOLOGY: None.
COMPLICATIONS: None.
TOURNIQUET TIME: 30 minutes at 250 mmHg.
CLINICAL NOTE: This (XX)-year-old male injured his hand, suffered the above-described injury, and requested the above-described procedure to help facilitate his physical therapy and recovery from his pain syndrome. He understands the risks include, but are not limited to bleeding, infection, nerve damage, pain, possible blood clots, disability, death, worsened pain, no relief of pain, need for further procedures, need for hospitalization. Multiple questions were asked and answered in detail, and informed consent was obtained.
DESCRIPTION OF PROCEDURE: After consent was obtained, prophylactic IV antibiotic was administered. The patient was transported to the operating room, laid supine on the operating table, secured with leather straps. The bony prominences were well padded. The right proximal thigh was well padded. A tourniquet applied.
The right hand was sterilely prepped and draped in the normal fashion. After satisfactory anesthesia was demonstrated, the procedure was commenced. A 15 blade scalpel was used to make approximately a 4 cm longitudinal incision over the dorsal radial aspect of the thumb, centered over the metacarpophalangeal joint. Sharp Metzenbaum scissors were used to spread soft tissues down to metacarpal cortex. Subperiosteal dissection was performed to the joint and was used to extricate the head of the metacarpal from the muscle bellies of the thenar eminence. The joint was relocated, confirmed on radiographic imaging. Stressing of the radial collateral ligament and ulnar collateral ligament suggested they were intact.
The wound was copiously irrigated with sterile saline solution. Skin edges were reapproximated using 3-0 nylon as interrupted vertical mattress stitches. Bacitracin ointment was applied. Sterile non-adherent dressing applied. Light compressive dressing was applied. A thumb spica splint was applied. Tourniquet was deflated.
The patient was aroused from anesthesia and transported to the recovery room in satisfactory condition after having tolerated the procedure well. At the end of case, sponge and needle counts were correct. There were no obvious complications.
