INFORMED CONSENT FOR ORIF/CRIF+-K-WIRE FIXATION +- HCS SCREW,RIGHT LITTLE

FINGER,ADHESIOLYSIS OF 3,4,5 FINGERS+- SURAL NERVE GRAFTING,NERVE REPAIR+/-VEIN

I, VARUN DS,25/M Hospital no. 03983184 have been explained by my treating doctor
in aSPECIFIC
language understood by me that I need to undergo ORIF/CRIF+-K-WIRE
COMPLICATIONS
FIXATION +- HCS SCREW,RIGHT LITTLE
Post operatively prolonged FINGER,ADHESIOLYSIS
immobilization may be required. OF
3,4,5 FINGERS+- SURAL Risk ofNERVE GRAFTING,NERVE
infection in the wound and/or bone.REPAIR +/-VEIN
This may require further
GRAFT surgery
for RIGHT MIDDLE,RING,LITTLE
and/or antibiotics FINGER EXTENSOR TENDON
ADHESION,NEUROMANerve OF MIDDDLE AND
Injury can occur- RING
Loss FINGERS,NON-UNION
of sensations/ OF the
altered sensation over
PROXIMAL PHALANX
nerve distribution HEAD OF LITTLE FINGER.
may occur.
I have been explained about Painthe
mayoperation
persist in great detail in the language I understand.
The following complications that could
Deformity result from the surgery are as follows:
may persist
Chances of k-wire breakage, inability to achieve reduction, persistent pain.
GENERAL COMPLICATIONS
Stiffness may persist
The nerve may beStiffness in the joints may occur at the joints.
repaired, grafted
Sural nerve donorThe bone mayhas
site morbidity notbeen
unite properly. This may
explained
require further surgery
Risk of and/or bone has
malunion,non-union graft.
been explained.
Damage to nerves and/or vessels resulting in
Wound problems: Such as superficial dehiscence
numbness /Persistence
weakness/problem
of neuromainpain
circulation of the limb. This may
temporary or permanent.
Admission Another at
for mobilization operation may
a later date hasbe required
been to correct
explained
the situation.
Scar tenderness and Scar adherence
Buildup of pressure in the muscle
Vein graft might be required, has been explained
compartment, which can require re-operation
Risk of infection in wound and/or bone. This
I also give consent for any additional procedure which deemed necessary by the surgeon on the
may require further surgeries and/or antibiotics.
table during my operation.
Abnormal pain response to surgery with
I hereby giveworsening
my consentofinpain
full consciousness
and disability.for the above mentioned surgery and to deal with
any unforeseen complications as they mayThe arise.surgical cut may cause changes to the
sensation
I also give consent anddoctor
to the colourfor
of use
the of
limb.
photos and videos related to my condition and its
In some
treatment for educational and research purposes. The people, healing
following of has
consent the been
wound may beto the
explained
abnormal
patient and his relativesand the
in the woundthey
language canunderstand
be thickened andundersigned
by the red and the scar may
treating be
doctor.
painful.
Increased risk in smokers of wound and chest
infections, heart and lung complications and thrombosis.
Signature of the patient

Witness: Signature: Signature of the Doctor