cclarson
Guru
Hello Everyone, I'm having a tough time choosing which would better fit for the situation in the report below. Which would work for this situation, 25337 or 25420? Let me know what you guys think and thank you in advance! 
POSTOPERATIVE DIAGNOSIS:
Right extensor digiti minimi rupture with distal radial ulnar joint arthritis.
PROCEDURE PERFORMED:
1. Right extensor indicis proprius to extensor digiti minimi tendon transfer.
2. Right distal ulnar hemiarthroplasty.
Indications:
The patient presents after a work injury approximately 2 years ago that she is now been cleared for surgery. She has continued to have difficulty with elevating her small finger as well as arthritis in the DRUJ. She elects to proceed as scheduled. Risks benefits and alternatives were discussed with the patient and they elect to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An incision was made over the DRUJ and extending out to the fourth and fifth metacarpals. The extensor retinaculum was opened over the EDM in the fifth compartment. This was elevated out of the wound. The tendon appeared to have healed in a lengthened position with scar and so the retinacular and capsular flap was elevated and then the distal ulna was exposed. We initially used our opening reamer and then reamed sequentially to 4.5 mm trial. The cutting guide was applied and a provisional cut was made on the distal ulna. We initially placed the trial but felt that we needed to seat this deeper. So at this point, we removed further osteophytes off of the ulna and then we were satisfied with our position of the trial. We then placed the implant, the Integra 4.5 mm stem with the small head. At this point x-rays were taken, confirmed good position of the stem with good overall stability. The wound was then thoroughly irrigated, and the flap was repaired and imbricated to close and increase stability dorsally.
At this point we then turned our attention to the EDM tendon and given the lengthened position, and there were some tendon adhesions, I felt the patient would benefit from a tendon transfer. So, the fourth compartment was opened and the EIP tendon was identified. We then released the EIP tendon distally over the second metacarpal and this was then transferred and the scar and excess EDM tendon was excised and then a Pulver-Taft weave was performed with the fifth finger in slight extension relative to the others. We were able to get full passive flexion of the fifth finger. The tendon was fixed with multiple 4-0 FiberWire sutures. This was then placed underneath the extensor retinaculum and at this point the tourniquet was deflated. Hemostasis was obtained. The skin was then closed with buried Monocryl and nylon sutures. A sugar tong splint in supination with the fingers in extension was applied. The patient tolerated the procedure well without complication.
POSTOPERATIVE DIAGNOSIS:
Right extensor digiti minimi rupture with distal radial ulnar joint arthritis.
PROCEDURE PERFORMED:
1. Right extensor indicis proprius to extensor digiti minimi tendon transfer.
2. Right distal ulnar hemiarthroplasty.
Indications:
The patient presents after a work injury approximately 2 years ago that she is now been cleared for surgery. She has continued to have difficulty with elevating her small finger as well as arthritis in the DRUJ. She elects to proceed as scheduled. Risks benefits and alternatives were discussed with the patient and they elect to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An incision was made over the DRUJ and extending out to the fourth and fifth metacarpals. The extensor retinaculum was opened over the EDM in the fifth compartment. This was elevated out of the wound. The tendon appeared to have healed in a lengthened position with scar and so the retinacular and capsular flap was elevated and then the distal ulna was exposed. We initially used our opening reamer and then reamed sequentially to 4.5 mm trial. The cutting guide was applied and a provisional cut was made on the distal ulna. We initially placed the trial but felt that we needed to seat this deeper. So at this point, we removed further osteophytes off of the ulna and then we were satisfied with our position of the trial. We then placed the implant, the Integra 4.5 mm stem with the small head. At this point x-rays were taken, confirmed good position of the stem with good overall stability. The wound was then thoroughly irrigated, and the flap was repaired and imbricated to close and increase stability dorsally.
At this point we then turned our attention to the EDM tendon and given the lengthened position, and there were some tendon adhesions, I felt the patient would benefit from a tendon transfer. So, the fourth compartment was opened and the EIP tendon was identified. We then released the EIP tendon distally over the second metacarpal and this was then transferred and the scar and excess EDM tendon was excised and then a Pulver-Taft weave was performed with the fifth finger in slight extension relative to the others. We were able to get full passive flexion of the fifth finger. The tendon was fixed with multiple 4-0 FiberWire sutures. This was then placed underneath the extensor retinaculum and at this point the tourniquet was deflated. Hemostasis was obtained. The skin was then closed with buried Monocryl and nylon sutures. A sugar tong splint in supination with the fingers in extension was applied. The patient tolerated the procedure well without complication.