# arthroplasty with MTP procedure help?



## BFAITHFUL (Apr 11, 2010)

need help with the following, i know hammer toe repair is 28285 but not sure about the procedure done the MTP?

DX:   subluxed/dislocated second metatarsophalangeal joint with hammertoe of the PIPJ second toe of right foot.

Procedure:  Tenotomy, capsulotomy, and plantar plate release of the second metatarsophalangeal joint of right foot.
Hammertoe arthroplasty of the proximal interphalangeal joint of the second toe
K-wire fixation of distal, middle, proximal and metatarsal head

An elliptical in cision was made over the proximal interphalangeal joint extending from about the distal interphalangeal joint to about the metatarsophalangeal joint  This incision was carred past the metatarsophalangeal joint in a linear fashion.l  ZThe llipse of skin that was raised was removed in totol  The incisio was deepened down through the superficial and deep fascia layers to the head of the second metatarsal.  Along the way, the extensive digitorum longus and brevis tendons were found isolated and tenotomized.

The capsule overlying the second metatarsophalangeal joint was incsied on its dorsal medial, and lateral aspects.  All bleeders were clamped and bovied along the way and all other vital structures were retracted.  With a McGlamry elevator, the metatarsophalangeal joint was entered and the McGlamry elevator waqs used to free the plantar plate and the medial and lateral collateral ligaments around the head of the second metatarsal.  Withi this done, it was noted that the toe reduced well and the need for a partial metatarsal head resection was obviated.  There was still however, a hammer digit noted on the second toe of the right foot.  The ellipse of skin that was raised over the second proximal interphalangeal joint was removed in toto.  Through a sweries of sharp and blunt dissections, this incision was carred down to the capsule tendon apparatus over the proximal interphalagneal joint to the second toe.  With sharp dissection, the tendon and capusle were incised on the dorsal medial and lateral aspects.  The tendon was reflected proximally and the head of the proximal phalanx was then able to be delivered into the wound

With this being done, a Hall oscillating saw was used to remove the head of the proximal phalanx at approximately the head and neck of the proximal phalanx of the second toe, right foot.  ZWit the head of the second metatarsal being removed, a rasp was used to remove any sharp edges.  A lavage was used to flush out the area, both in the second toe and second metatarsophalangeal joint area.  With this being done, the wound was inspected for any other abnormalities; none were seen.  3-o Dexon simple interrupted sutures were used to close. coapt and hold the tendon over the proximal interphalangeal joint.3-0 Dexon sutures were used to close the skin and to provide closure over the metatarsophalangeal joint.  With this being done, prolene was used to close, coapt and hold the skin.  The area was lavaged again.  A dry sterile dressing was applied.  Marcaine, approximately 4cc, was used postoperatively.


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