Description of Event or Problem · 1
THE PATIENT FELL ON HER RIGHT ARM AT HOME IN LATE (B)(6), WAS SEEN IN ER AND FOUND ON X-RAY TO HAVE COMPLETE FRACTURE THROUGH THE SURGICAL NECKS OF THE PROXIMAL HUMERUS WITH SIGNIFICANT DISLOCATION, MULTIPART HUMERAL HEAD FRACTURE; IMMOBILIZER PLACED, REFERRED TO ORTHO SURGERY. THREE DAYS AFTER THE FALL, THE PATIENT HAD OUTPATIENT SURGERY: RIGHT PROXIMAL HUMERUS EXTERNAL FIXATOR APPLICATION WITH CLOSED REDUCTION UNDER GENERAL ANESTHESIA WITH AN INTERSCALENE BLOCK; IMPLANTS USED: NBX PROXIMAL HUMERUS EXTERNAL FIXATOR WITH QUANTITY OF SIX 3MM STEINMANN PINS AND QUANTITY OF TWO 4MM STEINMANN PINS. IN MID-(B)(6), THE PATIENT HAD OUTPATIENT SURGERY: RIGHT PROXIMAL HUMERUS EXTERNAL FIXATOR REMOVAL. IN MID-(B)(6), THE PATIENT WAS ADMITTED TO THE HOSPITAL FOR RIGHT SHOULDER PAIN, SYMPTOMS CONSISTENT WITH SEPTIC ARTHRITIS AND OSTEOMYELITIS IN THE RIGHT SHOULDER AFTER EXTERNAL FIXATOR REMOVAL. THE FOLLOWING DAY, THE PATIENT HAD SURGERY: RIGHT SHOULDER ARTHROSCOPY WITH IRRIGATION AND DEBRIDEMENT, EXTENSIVE SYNOVECTOMY OF THE GLENOHUMERAL JOINT AND SUBACROMIAL SPACE; RIGHT SHOULDER SYNOVECTOMY AND CHONDROPLASTY; OPEN RIGHT HUMERUS IRRIGATION AND DEBRIDEMENT WITH BONE BIOPSY. TWO DAYS AFTER ADMISSION, INFECTIOUS DISEASE (I.D.) CONSULTATION: APPEARS TO BE A POSTOPERATIVE SEPTIC ARTHRITIS OF THE RIGHT SHOULDER, STATUS POST FRACTURE AND EXTERNAL FIXATION WITH OSTEOMYELITIS AND PRESUMED STAPHYLOCOCCAL INFECTION; RECOMMENDATIONS FOR PICC LINE AND 6 WEEKS ANTIBIOTIC THERAPY. FOUR DAYS AFTER ADMISSION, THE PATHOLOGY REPORT SIGNED FOR THE BONE BIOPSY: NEGATIVE FOR ACUTE OSTEOMYELITIS. THE FOLLOWING DAY, THE PATIENT DISCHARGED HOME WITH HOME HEALTH. PER I.D. PHYSICIAN IMPRESSION: (B)(6) OSTEO; GROWING (B)(6) FROM OP CULTURE; CHANGE FROM VANCO TO CEFAZOLIN THROUGH THE NEW YEAR.