Skeletal System

Using the words below fill in the operative report:

• chondromalacia
• x-rays
• arthritis
• Orthopedic
• arthroscopy
• total hip arthroplasty
• femoral
• tendinitis

PATIENT NAME: Mrs. Karen SMITH
AGE: 72 Sex: Female
DATE OF SURGERY: February 24
PREOPERATIVE DIAGNOSIS: Degenerative arthritis of both hips; more severe on the right side.
POSTOPERATIVE DIAGNOSIS: Severe degenerative arthritis and severe _________[Blank 1] of the right hip.

NAME OF PROCEDURE: Total hip arthroplasty.

HISTORY: Mrs. Karen Smith is a 72-year-old widow who has been living alone and independently since her husband’s premature death 15 years ago. Mrs. Smith has worked for 30 years at the production line in a factory and is now retired.

Mrs. Smith has been experiencing discomfort in her hips, especially the right one, over the parts twenty years or so. However, what started as a mild discomfort over time turned into severe pain. Now the pain is so bad that she is afraid that it might soon rob her of her independence. She first sought help for her hip pain many years ago. After physical examination, her family physician ordered _________[Blank 2] for both hip joints. Based on the results, it was concluded that the pain was due to severe _______[Blank 3] mainly due to wear and tear. She was advised to lose weight and to take over-the-counter painkillers as needed. She was also referred to a physiotherapist. However, despite the fact that she has lost 10% of her original body weight of 170 pounds and has been adhering to the exercise regimen recommended by her physiotherapist, the pain has grown worse over the years and now is almost unbearable. She was last visited by an orthopedic surgeon and subsequently was admitted to the General Hospital Outpatient _________[Blank 4] Clinic for ___________[Blank 5] of both hips.

OPERATIVE REPORT: The patient was brought to the operating room by anesthesia personnel. She was placed on the operating table. A Foley catheter was inserted. The patient was then placed into the lateral decubitus position with her right side up. The right lower extremity was prepped and draped in standard fashion for a ___________[Blank 6]. Dissection was carried sharply down through the soft tissue to the greater trochanter. The greater trochanter was used as a landmark to orient the remainder of the dissection which was continued posteriorly and proximally to expose the iliofemoral joint.

The acetabulum was reamed. A 50 mm acetabular shell was used. Femur was debrided using a _________[Blank 7] canal curette. The length of the femoral stem was then checked with the canal curette in place. Appropriate femoral stem and head were selected and implanted. Intraoperative radiographs were obtained to ensure proper component position.

The hip was then checked for range of motion. The patient reached 90 degrees of flexion and full extension with no instability. No abnormality was detected in the surrounding soft tissue. There was no indication of __________[Blank 8].

The area was then closed in a layered fashion. The subcutaneous tissues were closed using surgical Vicryl 5-0 sutures. An incisional VAC was placed over the wound as well. Sponge and needle counts were correct at the end of the operation. The patient tolerated the procedure well and was returned to the recovery room in good condition.

__________________________________
Michael Porter, MD, Orthopedic Surgery

Check your answers: ^[2]

Use the words below to fill in the operative report:

• orthopedic
• supination
• colles
• carpal
• tenomyoplasty
• sterilized
• aligned
• fluoroscopy
• tenorrhaphy
• sutured
• splint
• arthralgia
• akinesia
• atrophy

PATIENT NAME: Liam PALMER
AGE: 22
SEX: Male
DOB: December 4
DATE OF ADMISSION: May 5
DATE OF PROCEDURE: May 5
ATTENDING PHYSICIAN: Michael Porter, MD, Orthopedic Surgery
PREOPERATIVE DIAGNOSIS: Fx of the distal end of radius.
POSTOPERATIVE DIAGNOSIS: Fx of the distal end of radius.
ANESTHESIA: General.

INDICATION: This 22-year-old male had been skating earlier today when he lost his balance and fell. Trying to break the fall with an outstretched arm, he landed on his right arm, breaking his wrist. Mr. Palmer was brought to the ________[Blank 1] clinic in Toronto General Hospital. The wrist has been kept in a neutral position since even a slight movement was painful. The injured area is edematous and any attempt for active or passive flexion, extension, _______[Blank 2], or pronation caused a sharp pain that shoots all the way to the right shoulder. Posterior-Anterior and lateral x-rays of the wrist and forearm confirmed ________[Blank 3] fracture of the distal end of radius with the broken piece displaced posteriorly. The _______[Blank 4] bones were intact. The patient required surgery to fix the broken bone. Although not certain at that point, there was a possibility that the patient also required __________[Blank 5].

PROCEDURE: The surgery was done under general anesthesia. The patient’s arm was placed in a proper position to allow for an easy and unobstructed access to the surgical area. The surgical area was _________[Blank 6]. A longitudinal incision was made to access the fracture. The fractured bone was realigned, and a metal plate was used to secure the _______[Blank 7] bone and restore stability. Throughout the surgery _________[Blank 8] was used to ensure proper reduction of the bone. The surrounding muscles, tendons, and ligaments were examined to ensure their integrity. There was no need for tenomyoplasty or ________[Blank 9]. Once the surgery was completed, the surgical incision was _________[Blank 10], the wrist was bandaged, and the arm was placed in a long cast to immobilize the wrist and elbow joints. The patient left the operation room in good and stable condition.

The patient was discharged from the hospital on the following day. He was scheduled for his first follow up visit in 3 weeks. At that time, the cast will be replaced with a removable wrist ________[Blank 11] and the patient will be referred to a physiotherapy clinic. Timely rehabilitation is extremely important in these types of fractures to reduce _______[Blank 12] and prevent from _______[Blank 13] and muscle _______[Blank 14].

_________________________________________
Michael Porter, MD, Orthopedic Surgery

Check your answers: ^[3]