PINES CITY COLLEGES

College of Nursing Magsaysay Avenue, Baguio City

OR Write Up

Submitted to: Mrs. Tello Clinical Instructor Submitted by: Cerbito, may-Jean Eugenio, Dianne Uy, Mary Princess D. BSN IV-5 Group 4

PATIENTS PROFILE Name Age Address : Labi, Ivan Cairu Postino :6 : 003 Trinville Subdivision Tomay LTB

Case Number : 033264-SD Pre-0perative Diagnosis : Fracture Closed Lateral Condyle Left Humerus Post operative Diagnosis: Fracture Closed Lateral Condyle Left Humerus Surgeon : Dr. Lee Buasen Anesthesiologist : Dr. Henry Jason Daz A.S O.S A.F O.F : 8:14 a.m : 8:40 a.m : 8:25 a.m : 9:54 a.m

ANATOMY & PHYSIOLOGY OF THE SYSTEM INVOLVE

Lateral radiograph of a distal humerus fracture of the left elbow. Only the intra-articular portion of the lateral condyle is involved. One of the most important constituent in human anatomy, the arm plays a vital role in various body functions. The term 'arm' is more often used to refer to the entire limb, starting from the shoulder to the wrist. However, in the medical field, the term 'arm' is technically used to refer to the upper limb, from the shoulder to the elbow joint. The remaining part, from the elbow joint to the wrist, is referred to as the 'forearm'. Referring to the commonly used meaning of the term arm, let's have a look at the various arm bones and muscles in our body. Read more on human body systems. Arm Bones Anatomy The arm bones anatomy consists of three bones that make up the upper arm and the lower arm. The upper arm is made up of the humerus and the lower arm consists of the radius and the ulna. Let us go into the details of arm bones anatomy by describing these bones in detail.

Humerus The upper arm bone that extends from the shoulder to the elbow is called the humerus. This is a long bone that helps in supporting and movement of the upper arm. The humerus is present in both the arms, thus, there is a total of two arms in the human body. The anatomy of the humerus is divided into 3 parts. The first part consists of the round head, then the narrow neck and lastly the processes called the tubercules. There are many muscles and ligaments attached to the humerus. The muscles of the humerus include the following:
y y y y y y y y y y y y

Deltoid Supraspinatus Pectoralis major Teres major Latissimus dorsi Infraspinatus Biceps brachii Brachialis Coracobrachialis Brachioradialis Triceps brachii Anconeus

Open Reduction Internal Fixation

O.R.I.F. is an abbreviation for Open Reduction Internal Fixation. An open reduction internal fixation refers to a surgical procedure to fix a severe bone fracture, or break. "Open reduction" means surgery is needed to realign the bone fracture into the normal position. "Internal fixation" refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection. Open reduction internal fixation can also refer to the surgical repair of a joint, such as a hip or knee replacement. The surgical procedure is performed by a doctor who specializes in orthopedics, which is a branch of medicine concerning the musculoskeletal structure of the body. Under general anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or stitches. The steel rods, screws, or plates can be permanent or temporary and removed when healing takes place. Once the open reduction internal fixation is performed, a cast is usually applied. In the case of an ankle fracture, for instance, the first cast is a non-weight bearing cast, and crutches can be used to help keep weight off the healing bones. Later, when the healing has progressed, this cast will be replaced with one that can bear weight. Eventually, after a period of some weeks, the cast will be removed entirely. Also Known As: Operative Treatment, Open Treatment

Reasons for Procedure

This surgery is done to repair fractures that would not heal correctly with casting or splinting alone.

Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have this procedure, your doctor will review a list of possible complications which may include:

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Infection Bleeding

Reaction to anesthesia Blood clots

Factors that may increase the risk of complications include:

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Heart or lung disease History of blood clots Obesity Infection Diabetes

Prior to Procedure
y

y y y y

Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an emergency procedure. Before your surgery, you may have: o Physical exam to check your blood circulation and nerves affected by the broken bone o X-ray, CT scan, or MRI scan tests that take a picture of your broken bone and surrounding areas o Blood tests o Tetanus shot depending on the type of fracture and if your immunization is current o Questions your doctor may ask include: How did you break your bone? How much pain do you feel? Do you take any blood-thinning medicines? o Questions you should ask include: Will I need rehabilitation after surgery? What will I need to assist in my recovery (eg, wheelchair , crutches )? An anesthesiologist will talk to you about anesthesia for your surgery. Arrange for a ride home from surgery. If your surgery is urgent, you may not have time to fast beforehand; make sure to tell your doctor and the anesthesiologist when you last ate and drank. If your surgery is scheduled, you may be asked to stop taking medicines that thin the blood, like warfarin (Coumadin), clopidogrel (Plavix), or aspirin . If surgery is urgent, make sure to let your doctor know if you take any blood-thinners or other medicines.

Anesthesia
General anesthesia may be used. It will block any pain and keep you asleep during the surgery. It is given through an IV (needle in your vein) in your hand or arm. In some instances, a spinal anesthetic, or more rarely a local block, may be used to numb only the area where the surgery will be done. This will depend on where the fracture is located and the time it will take to perform the procedure.

Description of Procedure
Each ORIF surgery differs based on the location and type of fracture. In general, a breathing tube may be placed to help you breathe while you are asleep. Then, the surgeon will wash your skin with an antiseptic and make an incision. Next, the broken bone will be put back into place. Next, a plate with screws, a pin, or a rod that goes through the bone will be attached to the bone to hold the broken parts together. The incision will be closed with staples or stitches. A dressing and/or cast will then be applied.

Lateral radiograph after open reduction and pinning of a type III supracondylar humerus fracture.

Pathophysiology
A humerus fracture is an injury to the bone of the upper arm. The upper arm bone, the humerus, connects the shoulder to the elbow. Humerus fractures are generally divided into three types of injuries. Distal Humerus Fractures Distal humerus fractures are uncommon injuries in adults. These fractures occur near the elbow joint. These fractures most often require surgical treatment unless the bones are held in proper position. This type of fracture is much more common in children, but the treatment is very different in this age group. How do humerus fractures occur? Humerus fractures can occur by many different mechanisms, but are most commonly caused by falls. What is the treatment for a humerus fracture? The good news is that most humerus fractures will heal without surgery. The majority of patients can be treated with a sling or brace, and with time the fracture will heal. Casting is not possible with most types of humerus fractures. Surgery may be required when the bone fragments are far out of position. Determining when the alignment is acceptable depends on a number of factors. Fractures close to the shoulder and elbow joints, especially fractures that extend into the joint, are more likely to require

surgery. Conversely, fractures in the center of the shaft of the bone rarely require surgery, even with the bone fragments appear not perfectly aligned.