# 5th metatarsal head/bursa excision



## Jamie Dezenzo (Oct 9, 2012)

Looking at 28110 726.91 and 726.79....including the bursa excision?

OP note:


POSTOPERATIVE DIAGNOSIS:  Left 5th metatarsal head exostosis with a bursa to the lateral aspect of the 5th metatarsophalangeal joint.  

PROCEDURE PERFORMED:  Left bursa excision to the 5th metatarsophalangeal joint with a left partial 5th metatarsal head ostectomy.    


FINDINGS:  The patient had a large bursa located to the lateral aspect of the 5th metatarsophalangeal joint.  There were no signs of infection, however, to this area.  She also had a very sharp lateral eminence of the 5th metatarsal head.  

INDICATIONS:  Patient has developed a significant amount of swelling and pain to the lateral aspect of the 5th metatarsophalangeal joint.  She has developed a large lateral eminence of the 5th metatarsal bone with a soft tissue bursa to this lateral aspect.    


Attention was directed to the lateral aspect of the 5th ray where a 5.5 cm incision was made.  This incision was carefully taken through skin and soft tissue using sharp and blunt dissection.  Blunt dissection was carried down to the 5th metatarsophalangeal joint where there was a large bursa located to the lateral aspect of this 5th metatarsal head.  This large bursa was completely excised using a sharp 15 blade.  There was no purulence or any signs of infection located to this area today.  

A sharp 15 blade was then made down to the 5th metatarsal head.  She had a large sharp exostosis located to this 5th metatarsal head.  A partial ostectomy was made using a sagittal saw, and all rough edges were smoothed with a rasp.  There were no remaining sharp edges to the 5th metatarsal head.  There was no remaining bursa to this area.  So this wound was copiously irrigated with normal saline and then closed with a 2-0 Vicryl, 4-0 Vicryl and a 4-0 nylon.  The area was covered with Adaptic, 4 x 4s, Kerlix roll, Sof-Rol and a Coban dressing.  Tourniquet was deflated at this time. 

THANKS!!!


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