system: You are a clinical documentation assistant. Generate only the requested clinical note section using only facts from the dialogue. Do not invent information. If the section is not supported by the dialogue, return N/A.

user: Section: GENHX

Dialogue:
Doctor: Good morning, young man.
Patient: Good morning, doctor.
Doctor: Who is this young lady, is this your grandmother, or sister?
Guest_family: Oh doctor, yes, I am his grandmother.
Doctor: Good, my chart says that you're fourteen years old. Is that correct?
Patient: Yes sir.
Doctor: Good, so what seems to be the problem today?
Patient: I've been having pain in this knee for about a month now.
Doctor: Can you remember a specific injury to this knee?
Patient: Um, yeah, I was playing basketball when I jumped, and then when I landed I felt this knee pop.
Doctor: Do you remember the date of your injury, young man?
Guest_family: Um, it was on December twenty second two thousand seven.
Doctor: Good, so how have you been treated for this so far?
Patient: We went to another clinic first, and they put me in a splint.
Guest_family: Yeah, and then they referred us over to Children's.
Doctor: Have they taken x rays yet?
Patient: Yes, I got back a few minutes ago.
Doctor: Let's have a look. Well, you broke your leg.
Patient: What, where? Can you show me?
Doctor: Right here, this is a tibial tubercule avulsion fracture with patella alta.
Guest_family: What does that mean, doctor?
Doctor: Well, he's broken his leg, and pulled some bone off by doing so. We'll need to do surgery on this.
Guest_family: Oh no, what's the name of the procedure?
Doctor: It's called an O R I F. We'll go in there with some hardware to put everything back together, and he can get on the road to healing.
Guest_family: Let me call his father while we discuss this. What's the risk of infection from this surgery?
Doctor: Historically, it's less than one percent. We use antibiotics to control for infection.
Guest_family: Okay, will he be asleep for this?
Doctor: Yes, he won't feel a thing.
Guest_family: That's good too. Will he need this hardware out in the future?
Doctor: We can remove everything once he has healed up nicely. Other risks include bleeding, changes in the sensation of the leg, hardware failure, need for post op rehab, need for hardware removal, and failure to restore extensor mechanism tension. But I would not worry about these things. I have been doing these surgeries for years and things like this rarely happen.
Guest_family: Yes, his father agrees. We're going to do the surgery.

assistant: The patient is a 14-year-old male who reported having knee pain for 1 month. Apparently while he was playing basketball on 12/22/2007 when he had gone up for a jump, he felt a pop in his knee. The patient was seen at an outside facility where he was splinted and subsequently referred to Children's for definitive care. Radiographs confirmed comminuted tibial tubercle avulsion fracture with patella alta. Surgery is recommended to the grandmother and subsequently to the father by phone. Surgery would consist of open reduction and internal fixation with subsequent need for later hardware removal. Risks of surgery include the risks of anesthesia, infection, bleeding, changes on sensation in most of the extremity, hardware failure, need for later hardware removal, failure to restore extensor mechanism tension, and need for postoperative rehab. All questions were answered, and father and grandmother agreed to the above plan.