POSTOPERATIVE
DIAGNOSIS: Subcapital femoral neck fracture, right hip.
PROCEDURE:
Right
hip bipolar hemiarthroplasty with Stryker Accolade press-fit #4, 132 degree
Accolade TMZF stem, and 26 V40 head 45 mm UHR Centrax.
ANESTHESIA:
Spinal.
ESTIMATED BLOOD LOSS: 150
mL.
COMPLICATIONS: None.
DRAINS: None.
SPECIMEN: Femoral head.
PROCEDURE IN DETAIL:
Following induction of anesthesia, the patient was placed in lateral
decubitus position and prepped and draped in sterile fashion, right side
up. Prophylactic antibiotics of Ancef 1g
had been given. Longitudinal posterior
approach was utilized through the skin and subcutaneous tissue. The fascia was divided, and short external
rotators and capsule were divided in the T-fashion. The femoral head was removed from the
acetabulum with the corkscrew. The head
was sized to a 46-mm Centrax and trial
reductions of 45 and 46 mm Centrax were
performed. The femoral neck cutting
guides were then utilized to cut the femoral neck in appropriate length
followed by reaming and broaching to a # 4 stem. Trial reduction was performed. Hip was taken through a full range of motion
with +0 neck length and noted to be stable.
Components were removed. The
wound was irrigated with pulsatile lavage.
The actual stem was then implanted, and the hip was taken through a full
range of motion with the 46-mm trial head and noted to be stable with +0 neck
length. The actual head was
implanted. The hip was again reduced,
taken through a full range of motion, and it was determined that the 46-mm Centrax was slightly tight and this was
removed and trial again performed with #5, which fit well within the acetabulum
and was stable and the 45 mm UHR was then selected, implanted, and hip taken
through full range of motion with the actual component noted to be
stable throughout full range of motion with good leg lengths. The wound was irrigated copiously with
antibiotic irrigation. Thrombin spray
was utilized. The short external
rotators and capsule repaired with #1 Ethibond interrupted vertical mattress
sutures. The fascia was repaired with #1
Vicryl interrupted vertical mattress sutures.
The wound again was irrigated and subcutaneous closed with 2-0 Vicryl
interrupted vertical mattress sutures.
The skin was closed with staples.
Adaptic, 4x4s, ABD, and Micropore tape applied. The patient was sent to the recovery room in
a good condition.
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