# Trapezial excision and thumb metacarpal stabilization with percutaneous pinning.



## martnel (Jan 28, 2010)

I was looking at 25445, or 25210 and 20650...but I am not convinced of either option!  Any suggestions? 


POSTOPERATIVE DIAGNOSIS: Left thumb carpometacarpal joint arthritis

NAME OF OPERATION:	1.	Left trapezial excision.
                                       2.	Thumb metacarpal stabilization with percutaneous pinning.

Procedure: ......  A curvilinear incision was made near the base of the thumb at the carpometacarpal joint.  Dissection was carried down to the level of the carpometacarpal joint.  The first dorsal compartment tendons were reflected to allow access.  The trapezium was identified and noted to have no cartilage on its distal surface.  The base of the thumb metacarpal was also noted to be essentially completely denuded of cartilage.  The trapezium was then excised in its entirety.  The wound was copiously irrigated and hemostasis was obtained with electrocautery.  The joint capsule was then closed.  The skin was then approximated with a running subcuticular Vicryl stitch and Steri-Strips were applied.

Attention was then turned to stabilization of the thumb metacarpal.  Four 1.6 mm Kirschner wires were placed, holding the thumb metacarpal in a near anatomic position.  The implants were checked with their position as well as the position of the thumb metacarpal with fluoroscopy.  The implants were then cut below the level of the skin for improved hygiene and decreased chance of postoperative infection.  A sterile dressing was then applied and a thumb spica splint was fashioned.


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