Johnsondeb1102
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NEW to orthopaedic coding...I am not sure how to properly code this...
OP Report....
Post op diag..Right foot Lisfranc fracture dislocation, 1st through 5th tarsometatarsal joint.
Procedure:
1. Open reduction and internal fixation with fusion of the RT Lisfranc interval/joint 2nd tarsometatarsal joint.
2. Open reduction and internal fixation with fusion 1st tarsometatarsal joint.
3. Closed reduction, percutaneous pinning, 3rd through 4th tarsometatarsal joint.
Indications:
Patient is a 31 yr old female with an unknown injury to her right foot, presented to the clinic with swelling. x-ray showing dislocation of the 1st through 5th TMT joint. We had to wait for swelling to improve before surgical treatment. Due to the chronicity of the injury recommended a fusion of the 1st and 2nd TMT joint, possible fusion of the 3rd with a closed reduction and percuntaneous pinning 3rd, 4th and 5th potentially.
Procedure in detail:
The right lower extremity examined under fluroscopy. Again, fracture dislocation of the 1st through 5th tarsometatarsal joints. An incision between the 1st joint and the Lisfranc interval was made through skin and subcutaneous tissue. Care was taken not to injure the dorsalis pedis artery. A 2nd incision was made laterally between 4th and 5th metatarsals. Quite a bit of work was required at the 1st TMT joint, as well as the 2nd TMT joint, as well as the Lisfranc interval as there was significant fibrinous tissue there, as well deformity of the joints due to the chronicity of the injury. Using a lamina spreader, I was able to mobilize these joints, and using a rongeur remove ant significant fibrinous tissue. A power bur was used to debride the cartilage of the metatarsal and medial cuneiform, as well as the 2nd metatarsal and middle cuneiform. Once debridement had been completed because of the significant injury to the 1st TMT joint it was shortened , the saw was used to resect a portion of the 2nd metatarsal base. With this done it did align much better than previous. With the 1st TMT joint held reduced, a K-wire was placed. The 2nd metatarsal was reduced to the middle cuneiform and Lisfranc interval. The point of reduction forceps were used to hold it reduced. The K-wires were then used to hold that reduced as well. The staple gun was placed over the 1st TMT joint using a 4 poly staple. The guide was using and drill holes placed. The staple was then placed, malleted into position. The bur had to be used prior to this dorsally to help flatten the bone so the staple would not be significantly prominent. The staple was placed and the guide was removed causing nice compression over the 1st TMT joint, and the K-wire was removed from the medial cuneiform into the base of the 2nd metatarsal. Guidewire for the 4.0 cannulated screw was placed. Once in good position near cortex was reamed with a depth gauge and appropriate length cannulated screw short thread was placed holding good compression on that 2nd metatarsal base of the Lisfranc interval. With that done, attention was turned to the lateral would with the 1st and 2nd reduced nicely. The 3rd, 4th and 5th were east to reduce. The 3rd and 4th were held reduced and a K-wire was placed obliquely through the 4th into the base of the 3rd, and into the cunneiform. This held this reduced nicely, as well the 5th did not require any K-wire fixation. With that done, AP, lateral and oblique x-rays showed the 1st through 5th TMT joint nicely reduced. The wounds were irrigated with surge irrigation and then subcu was closed with 2-0 Vicryl, skin with 4-0 nylon. Pin was bent, cut, dressed with steril Xeroform, 4x4's ABD, cast padding, short-leg posterior splint.
OP Report....
Post op diag..Right foot Lisfranc fracture dislocation, 1st through 5th tarsometatarsal joint.
Procedure:
1. Open reduction and internal fixation with fusion of the RT Lisfranc interval/joint 2nd tarsometatarsal joint.
2. Open reduction and internal fixation with fusion 1st tarsometatarsal joint.
3. Closed reduction, percutaneous pinning, 3rd through 4th tarsometatarsal joint.
Indications:
Patient is a 31 yr old female with an unknown injury to her right foot, presented to the clinic with swelling. x-ray showing dislocation of the 1st through 5th TMT joint. We had to wait for swelling to improve before surgical treatment. Due to the chronicity of the injury recommended a fusion of the 1st and 2nd TMT joint, possible fusion of the 3rd with a closed reduction and percuntaneous pinning 3rd, 4th and 5th potentially.
Procedure in detail:
The right lower extremity examined under fluroscopy. Again, fracture dislocation of the 1st through 5th tarsometatarsal joints. An incision between the 1st joint and the Lisfranc interval was made through skin and subcutaneous tissue. Care was taken not to injure the dorsalis pedis artery. A 2nd incision was made laterally between 4th and 5th metatarsals. Quite a bit of work was required at the 1st TMT joint, as well as the 2nd TMT joint, as well as the Lisfranc interval as there was significant fibrinous tissue there, as well deformity of the joints due to the chronicity of the injury. Using a lamina spreader, I was able to mobilize these joints, and using a rongeur remove ant significant fibrinous tissue. A power bur was used to debride the cartilage of the metatarsal and medial cuneiform, as well as the 2nd metatarsal and middle cuneiform. Once debridement had been completed because of the significant injury to the 1st TMT joint it was shortened , the saw was used to resect a portion of the 2nd metatarsal base. With this done it did align much better than previous. With the 1st TMT joint held reduced, a K-wire was placed. The 2nd metatarsal was reduced to the middle cuneiform and Lisfranc interval. The point of reduction forceps were used to hold it reduced. The K-wires were then used to hold that reduced as well. The staple gun was placed over the 1st TMT joint using a 4 poly staple. The guide was using and drill holes placed. The staple was then placed, malleted into position. The bur had to be used prior to this dorsally to help flatten the bone so the staple would not be significantly prominent. The staple was placed and the guide was removed causing nice compression over the 1st TMT joint, and the K-wire was removed from the medial cuneiform into the base of the 2nd metatarsal. Guidewire for the 4.0 cannulated screw was placed. Once in good position near cortex was reamed with a depth gauge and appropriate length cannulated screw short thread was placed holding good compression on that 2nd metatarsal base of the Lisfranc interval. With that done, attention was turned to the lateral would with the 1st and 2nd reduced nicely. The 3rd, 4th and 5th were east to reduce. The 3rd and 4th were held reduced and a K-wire was placed obliquely through the 4th into the base of the 3rd, and into the cunneiform. This held this reduced nicely, as well the 5th did not require any K-wire fixation. With that done, AP, lateral and oblique x-rays showed the 1st through 5th TMT joint nicely reduced. The wounds were irrigated with surge irrigation and then subcu was closed with 2-0 Vicryl, skin with 4-0 nylon. Pin was bent, cut, dressed with steril Xeroform, 4x4's ABD, cast padding, short-leg posterior splint.