PREOPERATIVE DIAGNOSES:
1. Right hallux limitus
2. Degenerative joint disease of the 1st MTPJ
POSTOPERATIVE DIAGNOSES:
1. Right hallux limitus
2. Degenerative joint disease of the 1st MTPJ
PROCEDURE:
1. Right 1st MPJ cheilectomy
2. Right hallux proximal phalanx hemi joint implant arthroplasty 1st MPJ
ANESTHESIA:
General
HEMOSTASIS:
A well padded tourniquet was placed about the right ankle set at 250 mmHg for a total duration of 48 minutes.
INJECTABLES:
20 mL of 0.5% marcaine plain was infiltrated proximal to the incision site.
FLUIDS:
800 mL of Lactated Ringer
ESTIMATED BLOOD LOSS:
Less than 5 mL
SPECIMENS:
None
COMPLICATIONS:
None.
DISPOSITION:
Stable.
MATERIALS:
1. Dressing Supplies
2. 3-0 Vicryl or 4-0 Nylon
3. Osteomed Hemi Base Great Toe Implant, Medium size. Lot 1065384. Exp 2018-02
SUMMARY:
The patient was brought to the operating room, placed in the supine position on the operative table. Time-out was performed reconfirming the patient's identity, planned procedure, and procedure site. All team members identified themselves. After adequate induction of anesthesia, the tourniquet was placed and the lower extremity was prepped and draped in the usual aseptic manner.
Procedure # 1: Hallux Rigidus correction with cheilectomy and proximal phalanx hemi joint implant arthroplasty 1st MPJ
Attention was directed to the dorsum of the foot overlying the 1st MPjoint, where an incision was made in the skin and deepened into the subcutaneous tissue plane, taking care to retract and avoid neurovascular structures and Bovie bleeders as necessary. A linear incision was made in the underlying joint capsule and sharp dissection was used to reflect capsule and periosteum from the head of the metatarsal and base of the proximal phalanx. There was notable osteophyte formation on the dorsal, medial and lateral aspects of the joint, and there was 75% total cartilage loss. A MaGlamry elevator was inserted into the joint and used to free the sesamoids and soft tissue attenuation plantarly. A power saw was then used to remove any osteophytic bone, and the bone was smoothed using back-blade technique, thus accomplishing the cheilectomy.
Attention was then directed to the base of the proximal phalanx. A sagittal saw was used to resect bone at the base of the proximal phalanx to allow space for the implant. An Osteomed hemi base implant was placed in the base of the proximal phalanx according to manufacturer's recommendations. The joint was noted to have excellent range of motion, with no catching or clicking throughout motion. The incision was flushed with normal saline and closed in a layered fashion with the above suture. A dry sterile dressing was placed.
Tourniquet was released, noting immediate capillary refill time to all digits of the lower extremity. The patient was then transferred to the postanesthesia care unit with vital signs stable and vascular status intact.
1. Right hallux limitus
2. Degenerative joint disease of the 1st MTPJ
POSTOPERATIVE DIAGNOSES:
1. Right hallux limitus
2. Degenerative joint disease of the 1st MTPJ
PROCEDURE:
1. Right 1st MPJ cheilectomy
2. Right hallux proximal phalanx hemi joint implant arthroplasty 1st MPJ
ANESTHESIA:
General
HEMOSTASIS:
A well padded tourniquet was placed about the right ankle set at 250 mmHg for a total duration of 48 minutes.
INJECTABLES:
20 mL of 0.5% marcaine plain was infiltrated proximal to the incision site.
FLUIDS:
800 mL of Lactated Ringer
ESTIMATED BLOOD LOSS:
Less than 5 mL
SPECIMENS:
None
COMPLICATIONS:
None.
DISPOSITION:
Stable.
MATERIALS:
1. Dressing Supplies
2. 3-0 Vicryl or 4-0 Nylon
3. Osteomed Hemi Base Great Toe Implant, Medium size. Lot 1065384. Exp 2018-02
SUMMARY:
The patient was brought to the operating room, placed in the supine position on the operative table. Time-out was performed reconfirming the patient's identity, planned procedure, and procedure site. All team members identified themselves. After adequate induction of anesthesia, the tourniquet was placed and the lower extremity was prepped and draped in the usual aseptic manner.
Procedure # 1: Hallux Rigidus correction with cheilectomy and proximal phalanx hemi joint implant arthroplasty 1st MPJ
Attention was directed to the dorsum of the foot overlying the 1st MPjoint, where an incision was made in the skin and deepened into the subcutaneous tissue plane, taking care to retract and avoid neurovascular structures and Bovie bleeders as necessary. A linear incision was made in the underlying joint capsule and sharp dissection was used to reflect capsule and periosteum from the head of the metatarsal and base of the proximal phalanx. There was notable osteophyte formation on the dorsal, medial and lateral aspects of the joint, and there was 75% total cartilage loss. A MaGlamry elevator was inserted into the joint and used to free the sesamoids and soft tissue attenuation plantarly. A power saw was then used to remove any osteophytic bone, and the bone was smoothed using back-blade technique, thus accomplishing the cheilectomy.
Attention was then directed to the base of the proximal phalanx. A sagittal saw was used to resect bone at the base of the proximal phalanx to allow space for the implant. An Osteomed hemi base implant was placed in the base of the proximal phalanx according to manufacturer's recommendations. The joint was noted to have excellent range of motion, with no catching or clicking throughout motion. The incision was flushed with normal saline and closed in a layered fashion with the above suture. A dry sterile dressing was placed.
Tourniquet was released, noting immediate capillary refill time to all digits of the lower extremity. The patient was then transferred to the postanesthesia care unit with vital signs stable and vascular status intact.