Southern Luzon State University

College of Allied Medicine

Lucban, Quezon

OPEN REDUCTION INTERNAL FIXATION

In Completion to the Requirements of the CATCH-UP Plan of the

Operating Room Area

Submitted to:

Mrs. Thelma Babia RN, MAN

Submitted by:

ESTANGCO, Christine Jane

TENORIO, Daryl Joyce

Group 1
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

I. SCRIPT OF ROLE-PLAYING

OPEN REDUCTION INTERNAL FIXATION (ORIF)

DEFINITION
Internal fixation is the surgical implantation of mechanical devices inside the human
body for the purpose of repairing a bone after fracture.
Open Reduction Internal Fixation (ORIF), Involves surgical placement of implants
(mainly plates and screws) to guide the healing process of a bone, after the open reduction
procedure. Open reduction refers to open surgery to set bones, as is necessary for displaced
fractures.
Internal fixation refers to fixation of screws and / or plates, or intramedullary bone nails
(femur, tibia, and humerus) to enable or facilitate healing. The former type (plates and screws)
provides rigid fixation which prevents micro-motion across the lines of fracture, enabling direct
bone healing (or primary bone union).
Open Reduction Internal Fixation techniques are often used in cases where the fractures
are at or close to the joints, such as displaced articular fractures and forearm fractures, cases
where the bone would otherwise not heal correctly with casting or splinting alone. This type of
surgery should be done with great discretion under MSF settings because of the risk of
introducing infection in a closed fracture.

RISKS AND COMPLICATIONS OF INTERNAL FIXATION

Risks and complications in performing Internal fixation can include bacterial colonization
of the bone, infection, stiffness, and loss of range of motion, non-union, mal-union, damage to
the muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates,
screws, and pins, compartment syndrome, deformity, audible popping and snapping, and possible
future surgeries to remove the hardware.
Metal devices (and indeed all foreign bodies inside the human body) invite bacterial
colonization if there is contamination. Because of the high risk of osteomyelitis when infection
occurs after performing internal fixation, MSF will only allow the performance of internal
fixation once the minimal requirements for performing it are met and maintained. Constant
supervision and checking is done during the program that the conditions are met at all times.
Sterile conditions and meticulous surgical techniques can reduce, but do not remove, the risk of
infection when internal fixation is used. The severity of the fracture, its location, and the medical
status of the patient must all be considered. In addition, no technique is fool proof. The fracture
may not heal properly, the plate or rod may break or deform, or the patient may have an allergic
reaction to the implant.
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

INDICATIONS FOR INTERNAL FIXATION

Not all fractures require internal fixation. Indeed most fractures can heal without it, only
that it takes longer and in a bad position in case of displaced fractures. Therefore, MSF
recommends that it is only performed in the following fractures with the following conditions:
Displaced intra-articular fracture.
Axial or angular instability which cannot be controlled by closed methods.
Mal-reduction / failure of reduction (e.g. interposed soft tissue).
Multiple traumas.
Early mobilization and functional recovery is desirable and possible.
DIAGNOSTIC IMAGING
X-ray for pre and post-surgery imaging.
X-ray image available in the Operating room – hard copy in the chart or digital image. If
use of film: to provide X-ray viewing box in OR.
C-arm for intra-operative fluoroscopic guidance.
Radiation protective equipment.
LABORATORY
Blood bank
Antibiotic: culture and sensitivity available
POSSIBLE NURSING DIAGNOSES:
Acute Pain
Risk for Peripheral Neurovascular Dysfunction
Risk for Impaired Gas Exchange
Impaired Physical Mobility
Impaired Skin Integrity
Risk for Infection
Deficient Knowledge

CASE SCENARIO
This 27-year-old fell down some stairs at school yesterday, landing on his outstretched right
hand. His GP arranged an X-ray the same day, which showed no fracture. He had significant arm
pain overnight and was referred for an MRI this morning. It showed an open fracture of his arm.

SCENES:
--------------------------------------PREOPERATIVE------------------------------------------
1st scene: Endorsement
Ward Nurse: Good morning, ma’am! Endorsing patient Fluffy 27-year-old. He has been
admitted to the hospital because of a comminuted fracture on his right humeral shaft. The patient
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

fell on the stairs and had his arm fractured. The patient is awake and coherent, oriented to time
and place, afebrile, hooked with Lactated Ringer's Solution at 800 ml level inserted on his left
cephalic vein without swelling on insertion site, infusing well, his latest VS are temp is 37.4,
pulse 102 bpm, respirations 21 bpm, blood pressure 120/82 mmHg, Pain Scale of 9/10; On
physical examination, with arm pain, deformity, swelling, and ecchymosis on his right arm.
CN: Ano po kaya yung latest laboratory test results ni patient?
Ward Nurse: Blood cultures were obtained. Labs show that his white blood cell count was
above average, specifically 12000 units, PTT, PT INR are within normal range. Ordered a
(humerus) x-ray on his right arm, and the results showed a comminuted fracture. CT scan also
revealed fragments of bone. The provider ordered two antibiotics and pain medications.
CN: Kailan po kaya yung huling nagbigay ng pain meds and other medications?
Ward Nurse: The patient is currently receiving Ceftriaxone 2 grams intravenous every 24 hours
combined with Metronidazole 500 mg intravenous every 8 hours to get rid of the infection.
Acetaminophen 1000 mg was given intravenously combined with Ibuprofen 600 mg every 6
hours for his pain. It was last given at 6 am in the morning. Ativan 2 mg was also given
intravenously.
CN: Ano pong ordered na diet ni patient?
Ward Nurse: Patient was advised NPO after midnight.
CN: Nakapagbigay po ba ng health teaching sa patient and signed na po ba yung informed
consent?
Ward Nurse: Pre-opeartion teaching is done, including cast care, pain relief measures. Consent
for operation is obtained and verified with the signature of the patient attached to the waiver.
CN: Naifollow up na po kaya yung mga hard copy ng imaging test results ni patient?
Ward Nurse: Nakuha ko na po kanina and nakaattach na din sa chart.
CN: Anong blood type po ni patient? Nakapag crossmatch na ba and available na po ba yung
blood?
Ward Nurse: Type B po si patient and nakapag undergo na po ng cross matching. Available na
din po yung reserved blood para kay patient.
CN: Meron na po kayang marking na ginawa sa operation site?
Ward Nurse: Meron, sa right humerus and with signature nadin po ni Doc Valdez.

2nd Scene: Interview and verification of patient

CN: Magandang umaga po, ako si Student Nurse Christine ang mag-aassist po sa inyo sa inyong
surgery.
CN: Ano pong inyong pangalan tsaka po birthday?
PT: Ako si Fluffy at ang birthday ko ay May 1, 1994
CN: Pwede ko po bang tingnan yung inyong Identification band? Kamusta po?
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

PT: Eto ako ay ninenerbyos sa gagawin sa akin mamaya pero ito naman ay nabanggit nasa akin
sa ward.
CN: Ganon po ba, kailangan po ng operation para po maging mas maging mabilis at mapaganda
ang healing ng iyong buto. Kukunan ko po muna kayo ng vital signs.
-Initial VS are as follows:
T: 36.9 degrees C RR: 21 bpm PR: 95 bpm BP: 120/80 O2 Sat: 98%
CN: Kailan po kayo huling kumain?
PT: Kagabi pa siguro mga bandang 11 pm siguro yung huli kong kain.
CN: Kayo po ba ang ay may allergies sa medication, o sa latex?
PT: Wala naman po
CN: Meron po ba kayong pustiso, contact lenses, o mga hikaw sa inyong katawan?
Kinakailangan po nating tanggalin ang mga iyan para po mas maging ligtas ang operasyon.
PT: Wala naman dahil tinanggal ko na kahapon.
CN: Meron po ba kayong make-up sa inyong mukha, or nail polish sa inyong daliri?
PT: Wala po.
CN: Nasaan po kaya ang inyong kasama or family member?
PT: Ah sandali lang po, meron lang pong inaasikaso sa billing sa baba. Pero nakausap na po sya
ng nurse kanina.
CN: Sige po, kakausapin ko nalang po ulit siya pagbalik ko mamaya. Nasa kanya po ba yung
inyong mga personal na gamit?
PT: Oo.
CN: Meron po bang mga ipinaalala po yung nurse niyo kahapon sa ward abt sa gagawin after ng
operation?
PT: Oo napaalalahanan naman ako kahapon tungkol sa deep breathing kapag masakit, tsaka
yung paggalaw, at pagtataas ng kamay upang maiwasan ang pamamaga.
CN: Okay po, kayo po ba ay nakapagligo bago dalahin po dito?
PT: Oo kahapon, tsaka nakadumi din ako kahapon.
CN: Sige po, babalikan ko po ulit kayo mamaya para po i-assist ko po kayo sa pagpasok sa OR.

3rd Scene: Prepares OR

CN: Turns on OR light and AC
CN: Turns on and checks the machines, and equipment to be used. Ensures the safety of the
environment of the theatre and checks the electrical wirings of the machine. The wirings should
be untangled and keep from being tripped by other team members.
SCRUB NURSE: Ensures that the theater has been cleaned, together with the CN.
● Medical Hand Washing/Scrubbing/Drying
● Gowning/Gloving
● Draping and preparing mayo table.
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

● Scrub nurse receives help from circulating nurse in unpacking the set.
*After scrubbing, gowning, gloving
CN: Checks the availability of materials, blood, plates and screws to be used, hard copy of
imaging test results.
TOGETHER: Performs instrument count as the scrub nurse arranges the instruments on the
mayo table.
● 6 Allis
● 6 Mosquito
● 6 Kelly
● 6 Straight
● 1 Suction tip
● 1 Tourniquet
● 2 Blades
● 4 Sutures
● 3 Sponges
● 2 Drill bits
● 2 Retractors
● 10 Screws

CN: Counter checks the count and records in the logbook. Then asks the scrub that the patient
will be brought into the theater. Brings a patient into the operating table with the assistance of
a nursing assistant.

---------------------------------------INTRAOPERATIVE PHASE------------------------------------
CN: Assists the patient in transfer and positions the patient on the operating table. Ensures the
safety of the patient upon transferring the patient.
Anesthesiologist: Induction of anesthesia (Regional Anesthesia; Peripheral Nerve Block)
CN: Checks VS and contraptions.
CN: Monitors patient status and vital signs with regards to induction of anesthesia (checks if
the area is numbed).
*Skin prep
CN: The circulating nurse prepares the antiseptic solutions to be used in painting on the
operation site. Prepares gauze pads, a towel for drying, a surgipad to avoid splashing and
wetting other parts of the patient’s body.
CN: Initiates skin prep by using a 7.5% antiseptic solution for the first paint, 3 times using
circular motion starting at the incision site towards outward direction and then pat dry. And a
10% antiseptic solution for the second paint 3 times, focusing on the operative site mark.
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

*Draping Patient
Scrub Nurse: Prepares to drape the patient, using 4 towels and secured with towel clips.

OPERATION BEGINS
Time out of OR Team (5 Members) Introduction ng members

CN: THIS IS PATIENT FLUFFY, 27 YEARS OLD, please introduce yourselves.

SCRUB NURSE: I AM DARYL TENORIO, THE SCRUB NURSE

CN: I AM CHRISTINE ESTANGCO, THE CIRCULATING NURSE
ASSISTANT SURGEON (BRECELLE): I AM BRECELLE DELVO, THE ASSISTANT
SURGEON
SURGEON (CHESKA): I AM, SURGEON
ANESTHESIOLOGST: Good morning everyone, I AM, KAREN ALGANES, THE
ANESTHESIOLOGIST.

Surgeon: This is Mr. Fluffy, a 27-year-old male. We are doing an open reduction internal
fixation, having a diagnosis of right humeral fracture. He is in supine position with a supporting
hand table.
Surgeon: List ng hihingin
● Blades
● Suction
● Tourniquet
● Sponge
● Sutures
● allis
● Drill bits
● Retractors
● Screws
● Compression set
● Power drill

END OF OPERATION
CN AND SN: Undertake the last count of sponges and instruments with the circulating nurse.
● 6 allis
● 6 Mosquito
● 6 kelly
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

● 6 straight
● 1 Suction Tip
● 1 Tourniquet
● 1 #10 Blade
● 1 #11 Blade
● 4 Sutures
● 3 Sponges
● 2 Drill bits
● 2 Retractors
● 10 Screws

SN: Informs the surgeon of the count result, and the surgeon verifies the count.
SN: Clears away instruments and equipment.
CN: Helps in applying the dressing and casting of the patient.
SN: Removes and disposes of drapes.
SN: De-gown with help of CN (assuming).
CN: Prepares the patient for the recovery room. Checks vital signs and compares with the
baseline, informs anesthesiologist if vs is unstable. Monitors and assesses the patient for
anesthesia side effects. Completes documentation.
CN: Hands the patient over to the recovery room and endorses to the PACU nurse.
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

PRE-OPERATIVE CHECKLIST

1. Patient’s Name: Patient Fluffy Bear Date: 07/12/21

Height: 189 cm Weight: 60 kg
Identification Band Present: Patient Fluffy, May 1, 1994
2. Informed Consent signed: Yes
3. Surgical Site: Right Arm Mid Humerus
4. History & Physical Examination report present:
Patient Fluffy Bear, a 27-year-old, fell down some stairs at school yesterday, landing on
his outstretched right hand. His GP arranged an X-ray the same day, which showed no fracture.
He had significant arm pain overnight and was referred for an MRI this morning. It showed an
open fracture of his arm.
Physical examination reveals that he was conscious and oriented to time and place,
afebrile, has an arm pain, skin is smooth and with ecchymosis noted on the right arm, with
swelling and erythema, with crepitus noted upon moving the affected arm, with a visible
deformity noted on the right arm.
Date: 07/13/21
5. Laboratory records present:
CBC:
● WBC: 12,000
● RBC: 4.9 mcl
● PTT: 28
● PT: 12 sec.
● INR: 0.9%
Hgb: 16 g/dL
UA: Negative
Hct: 46%

6. Item Present Removed

a. Natural teeth /
Dentures: upper, /
lower, partial
bridge, fixed;
crown

b. Contact lenses /

c. Other Prosthesis /
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

d. Jewelry: /
Wedding ring
Earrings: Pierced,
Clipped-on
Neck chains /
Any other body
piercings

e. Make up /
Nail polish
7. Clothing:
a. Clean patient /
gown
b. Cap /
c. Sanitary pad etc.

8. Family instructed where to wait? Waiting Area outside OR complex

9. Valuables secured? Yes within wife of patient
10. Blood Available? Yes
11. Pre-anesthesia medications given: Ativan
Type: intravenously Time: 8:20 am
12. Voided: 5 times Amount: 154 ml Time: 7:15 am Catheter: Foley
Catheter
13. Vital signs:
Temperature: 36.9 degrees C PR: 95 bpm RR: 21 bpm BP: 110/70 mmHg
14. Special problems/precautions (Allergies, deafness, etc): None
15. Area of skin prep: Right anterior mid humerus

16. Christine Jane C. Estangco 07/13/21 9:00 am

Signature: Nurse releasing patient Date Time
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

SURGICAL MEMO FORM

Name: Fluffy A. Bear DOB: January 19, 1994

Phone: 09162427912 Email: fluffy@gmail.com

Address: Ibabang Iyam Lucena City, Quezon Province

Pre - Op Date: 07/07/21 Surgery Date: 07/07/21

Diagnosis: Right Humeral Fracture

Surgery Rec: Right Arm

Anesthesia: Regional Nerve Block Anesthesia Dosage: 4.5mg

PATIENT HISTORY

Medical History: Patient Fluffy fell down some stairs at school yesterday, landing on his
outstretched right hand. His GP arranged an X-ray the same day, which showed fracture. He had
significant arm pain overnight and was referred for an MRI this morning. It showed a fracture of
his arm.

Surgery 1: Open Reduction Internal Fixation Date: 07/07/21

Surgery 2:

Surgery 3:

Medication 1: Acetaminophen Dosage: 650 mg

Medication 2: Ativan Dosage: 2 mg

Medication 3: Dosage:

Allergies: None
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

Other Medical Conditions: NONE

EXAMINATIONS

Height: 5’6’’ Weight: 63 kg BMI: 24.2 Normal

Temp: 36.9 Pulse: 175 BP: 120/80 RR: 22

HEENT: Atraumatic Neck: No Jugular Vein distension, No Mass

Heart: Regular, No Murmur Lungs: Clear Breath Sound

Abdomen: Non - Tender Extremities: Fracture on Right Upper Arm

Labs: Normal X-Rays: Humeral Fracture

EKG: U/A: Within normal range

RESULTS

 The patient is cleared for surgery

□ The patient is not cleared for surgery
□ Further test required

07/07/21
Signature Date
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

INSTRUMENT COUNT SHEET

PATIENT NO: #153

ID #153 TRAY BASIC CIRC Christine Jane Estangco

ORTHOPEDI
C TRAY
DAT 07/07/2 ASSEMBLE Daryl Joyce S. SCRU Daryl Joyce S. Tenorio
E 1 D BY: Tenorio B
QTY INSTRUMENT DESCRIPTION 1ST ADDE 2ND FINAL
COUN D COUN COUN
T T T
4 RAKE RETRACTORS 4 - 4 4
2 WEITLANER 2 - 2 2
2 ARMY NAVY RETRACTOR 2 - 2 2
2 TOOTHEDTISSUE FORCEPS 2 - 2 2
2 TOOTHEDADSON FORCEPS 2 - 2 2
2 STRAIGHT MAYO SCISSOR 2 - 2 2
2 CURVED MAYO SCISSOR 2 - 2 2
2 METZENBAUM 2 - 2 2
1 BANDAGE SCISSOR 1 - 1 1
1 WIRE CUTTER 1 - 1 1
1 PIN CUTTER 1 - 1 1
2 CURVED PEAN CLAMP 2 - 2 2
2 KOCHER LOVE LACE 2 - 2 2
5 CURVED CRILE 5 - 5 5
2 NEEDLE HOLDERS 2 - 2 2
8 TOWEL CLIPS PIERCING 8 - 8 8
8 TOWEL CLIPS NON-PIERCING 8 - 8 8
1 SPONGE FORCEP 1 - 1 1
1 YAUNKER SUCTIONTIP 1 - 1 1
3 KNIFE HANDLE 3 - 3 3
2 PLIER 2 - 2 2
2 SCREW DRIVER 2 - 2 2
1 MALLET 1 - 1 1
1 RULER 1 - 1 1
1 DEPTH GAUGE 1 - 1 1
3 GUIDE WIRE 3 - 3 3
1 RASP 1 - 1 1
1 HANDLE DRILL WITH CHUCK 1 - 1 1
3 LISTON BONE CUTTER 3 - 3 3
2 PERIOSTEAL ELEVATOR 2 - 2 2
1 JOKER CUSHING ELEVATOR 1 - 1 1
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

1 FREER DISSECTOR 1 - 1 1
6 CURETTE 6 - 6 6
1 BLUNT NERVE HOOK 1 - 1 1
1 GIGLI SAW 1 - 1 1
6 OSTEOTOMES 6 - 6 6
10 SCREWS 10 - 10 10
3 SHEET WADDING 3 - 3 3
2 BLADES 2 - 2 2
4 SUTURES 4 - 4 4
6 ALLIS FORCEP 6 - 6 6
6 KELLY FORCEP 6 - 6 6
6 STRAIGHT KELLY FORCEP 6 - 6 6
6 MOSQUITO 6 - 6 6
129 TOTAL INSTRUMENT COUNT 129 0 129 129

FINAL COUNT: 129 Total Instruments Count - COMPLETE

CIRCULATOR: Christine Jane Estangco
SCRUB: Daryl Joyce S. Tenorio
DATE/TIME: 07/07/21 – 9:00 – 11:30 am
PROBLEM: None
COMMENT:
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

FDAR SAMPLE CHARTING IN OR

Time Focus 6-2 pm

7:30 am Open D> Received into the operating room per stretcher accompanied by
Reduction NOD and nursing assistant with ongoing IVF Lactating Ringer’s
Internal Solution 1L inserted at left cephalic vein at 800 cc level, infusing
Fixation of the well, conscious, and coherent, with informed consent signed for
right mid ORIF, operative site marked by Dr. Valdez, pre-anesthetic meds
humerus given, Ativan 2 mg intravenously, Acetaminophen 650 mg IV, with
8:00 am fracture NPO diet ------------------------------------------------------------------------
A> Preoperative interview done, preoperative and post-operative
instructions given such as pain relief measures, verified patients’
identity, and given psychological support, preoperative checklist
completed, prepared, and follow up blood bag and hard copy of CT
scan imaging results, secured availability of plates and pins to be used
8:30 am during the operation.----------------------------------------------------------
>Ushered to the OR table in supine position, with preoperative vital
signs BP: 110/70 mmHg, PR: 95 bpm, RR: 21 bpm, T: 36.9 C, O2
8:45 am Sat: 98%, O2 inhalation administered @ 2 LPM per nasal cannula
>Given regional nerve block 4.5 mg anesthesia by Dr. Valdez, no
adverse reactions were noted during the induction of anesthesia.
9:12 am >Skin prepped in the right arm, then draped by Scrub Nurse Daryl.
>Time out was initiated, Dr. Valdez as surgeon, Nurse Daryl as scrub
nurse, Nurse Christine as circulating nurse, Dr. Karen as
anesthesiologist, initial count of instruments were done, verification
9:15 am of patient, operation and operative site was done.------------------------
>Time of operation started where an incision was done by Dr. Valdez,
9:55 am assisted by Nurse Daryl.-----------------------------------------------------
10:03 am >Plates were placed and screwed in place.-------------------------------
>Final counting of instruments was initiated before closing, and
informed the surgeon about the results, sponges, needles, and
10:12 am instruments count were complete.------------------------------------------
10:20 am >Operation was finished.----------------------------------------------------
>Application of dressing and cast was done, post-op care was done,
post operative vital signs were recorded, BP: 100/70 mmHg, PR: 91
10:40 am bpm, RR: 23 bpm, T: 37.3 C, O2 Sat: 99%-------------------------------
>Into recovery room per stretcher with IVF of LRS @ 400 cc
level.----------

Christine Jane C. Estangco

BSN III-SLSU CAM
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

NARRATIVE REPORT

OPERATION: ORIF

DESCRIPTION: 
□ Open reduction internal fixation (ORIF) with irrigation and debridement of open
fracture.

PREOP DIAGNOSIS:

□ Right open humeral fracture

POSTOP DIAGNOSIS:
□ Right open humeral fracture.

INTRAVENOUS FLUIDS: 

□ 650 packed red blood cells.

TOURNIQUET TIME: 
□ 2 hours.

URINE OUTPUT: 
□ 1600 cubic centimeters.

ESTIMATED BLOOD LOSS: 

□ 250 cubic centimeters.

COMPLICATIONS: 
□ None.

PLAN:
□ Non-weightbearing right lower extremity, clindamycin x 48 hours.

OPERATIVE NARRATIVE:
 Southern Luzon State University
College of Allied Medicine
Lucban, Quezon

 The patient is a 27-year-old female who fell down some stairs at school yesterday,
landing on his outstretched right hand. She sustained a right open humeral fracture. Given the
emergent nature of the right humeral fracture and her young age as well as the open fracture, it
was decided to proceed with an urgent operative intervention. The risks of surgery were
discussed in detail and the consents were signed. The operative site was marked. The patient
was taken to the operating room where she was given preoperative clindamycin. The patient had
then general anesthetic performed by anesthesia.
A well-padded side tourniquet was placed. Attention was turned to the right humerus.
The large medical laceration was extended, and the tissues were debrided. All dirty of the all-
injured bone, muscle, and tissues were debrided. Wound was then copiously irrigated with 8
liters of normal saline. At this point, the medial malleolus fracture was identified and was
reduced. This was then fixed in with two 4.5 mm cannulated Synthes screws.
Next, the patient was then placed in the fracture table and all extremities were well
padded. All prominences were padded. The right arm was then prepped and draped in usual
sterile fashion. A 2-cm incision was made just distal to the greater trochanter. This was carried
down sharply through the skin to the fascia. The femur was identified. The guidewire for a
striker Asnis 6.5 mm screw was placed in the appropriate position. The triangle guide was then
used to ensure appropriate triangular formation of the remainder of the screws. A reduction of
the fracture was performed prior to placing all the guide wires. A single 8 mm Asnis screw was
placed inferiorly followed by two 6.5 mm screws superiorly.
Next, the abrasions on the right elbow were copiously irrigated. The necrotic and dead
tissue was removed. The abrasions did not appear to enter the joints. They were wrapped with
Xeroform 4 x 4 x 4 Kerlix and Ace wrap.
The patient was placed in the AO splints for the right arm. The wounds were dressed in
Xeroform 4 x 4 x 4s and IO band. The care was then transferred for the patient to Halstead
Service.
The plan will be non-weightbearing right upper extremity and antibiotics for 48 hours.
Dr. Valdez was present and scrubbed for the entirety of the procedure.