intra-op complications

[sinustarsi]

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what are some of your hard intra-op problems you ran into and how did you solve them?

 

[347932]

what are some of your hard intra-op problems you ran into and how did you solve them?

Anytime you cut something you shouldn't have (nerve, artery) or crack a bone you are trying to fix (poorly planned osteotomy or poor bone stock in general) you're in trouble.

Hardware failure is never fun. Generally you can't plan for that, so its especially frustrating.

Poor workup of patient is also completely avoidable, but lots fall into this trap. Not preparing an RA patient properly is a big no no.

Interestingly, if you are a careful surgeon with good pre-operative planning and preparation, most intra-op issues can all but be avoided. There will always be issues that crop up, but if your training was good and you prepare for your cases, you should be able to anticipate problems before they come up and have the necessary skill and equipment set up to get yourself out of a jam.

Unless of course you do a lot of trauma which is sometimes rather hair raising. In those situations though, particularly in very severe trauma, sometimes a good outcome is not really expected, so your margin of error can be much wider.

 

[newankle]

Last week I had a neglected achilles rupture. Patient was initially treated by PCD and sent for PT and never immobilized. 7 weeks later he still has weakness of course and some pain/swelling. MRI showed retraction with gap reported 4cm however intraop it was more like 6-7cm. I did the following in order: V to Y advancement of the proximal portion (musculotendinous junction, reinforce ends of both sides of the remaining tendon, detach and reroute the plantaris tendon across both sides of the rupture (detached proximally, not distally, and routed lateral to medial across the inferior portion then up and across the proximal portion medial to lateral and sutured to itself under tension), modified bunnell stitch to further approximate and tighten then wrapped the repair/interface with allograft (graft jacket 5x5cm piece). At the end of the procedure he was at neutral to maybe 3 degress of plantarflexion).