Bobby A
Guru
I just have the hardest time with these DX and CPT needed. Any great explaining much appreciated. thank you
Pre-op diagnosis: Right foot medial sesamoiditis, stress fracture base of second met
Post-op diagnosis: same
Procedure:
1) Right foot medial sesamoidectomy
2) Right foot base of second metatarsal closed reduction with percutaneous fixation utilizing calcium phosphate
3) Right foot medial cuneiform closed reduction with percutaneous fixation utilizing calcium phosphate
4) Right foot middle cuneiform closed reduction with percutaneous fixation utilizing calcium phosphate
Operation performed: Patient was taken to the operating room and identified as correct patient. The correct extremity was identified. IV antibiotics were given within 30 minutes prior to incision. Patient was prepped and draped in the usual, sterile orthopedic fashion. Surgical timeout completed. Right foot identifies the correct extremity. Calf tourniquet inflated to 50 mmHg.
The medial sesamoidectomy and I made a plantar based incision underneath the first metatarsal head. Skin was incised subcutaneous tissues dissected. Capsulotomy was made medial sesamoid was identified. I then dissected this utilizing a knife and carefully protected with nerve. Successful resection of the medial sesamoid utilizing a rongeur was accomplished. X-rays confirmed successful medial sesamoidectomy.
I then addressed the medial cuneiform stress fracture and identified the medial cuneiform on x-ray guidance. Percutaneous incision was then made overlying the medial cuneiform with blunt dissection down to the bone. I then inserted a guidewire and injected a total of 0.3 mL of calcium phosphate. I then made a second percutaneous incision overlying the middle cuneiform and also bluntly dissected the bone. On x-ray guidance and inserted the guidewire and then injected a total of 0.4 mL of calcium phosphate.
Finally, I made a percutaneous incision at the base of the second metatarsal and blunt dissection to bone. Guidewire was inserted under x-ray guidance into the base of the second metatarsal and injected 0.3 mL of calcium phosphate.
x-ray showed excellent alignment without complications. Thorough irrigation completed. Percutaneous incisions closed with 4 nylon. Medial sesamoidectomy incision closed with 3-0 Vicryl and 3-0 Monocryl. Sterile dressings were applied. Patient was placed in the postoperative boot and brought to PACU in stable fashion. No complications to report
Pre-op diagnosis: Right foot medial sesamoiditis, stress fracture base of second met
Post-op diagnosis: same
Procedure:
1) Right foot medial sesamoidectomy
2) Right foot base of second metatarsal closed reduction with percutaneous fixation utilizing calcium phosphate
3) Right foot medial cuneiform closed reduction with percutaneous fixation utilizing calcium phosphate
4) Right foot middle cuneiform closed reduction with percutaneous fixation utilizing calcium phosphate
Operation performed: Patient was taken to the operating room and identified as correct patient. The correct extremity was identified. IV antibiotics were given within 30 minutes prior to incision. Patient was prepped and draped in the usual, sterile orthopedic fashion. Surgical timeout completed. Right foot identifies the correct extremity. Calf tourniquet inflated to 50 mmHg.
The medial sesamoidectomy and I made a plantar based incision underneath the first metatarsal head. Skin was incised subcutaneous tissues dissected. Capsulotomy was made medial sesamoid was identified. I then dissected this utilizing a knife and carefully protected with nerve. Successful resection of the medial sesamoid utilizing a rongeur was accomplished. X-rays confirmed successful medial sesamoidectomy.
I then addressed the medial cuneiform stress fracture and identified the medial cuneiform on x-ray guidance. Percutaneous incision was then made overlying the medial cuneiform with blunt dissection down to the bone. I then inserted a guidewire and injected a total of 0.3 mL of calcium phosphate. I then made a second percutaneous incision overlying the middle cuneiform and also bluntly dissected the bone. On x-ray guidance and inserted the guidewire and then injected a total of 0.4 mL of calcium phosphate.
Finally, I made a percutaneous incision at the base of the second metatarsal and blunt dissection to bone. Guidewire was inserted under x-ray guidance into the base of the second metatarsal and injected 0.3 mL of calcium phosphate.
x-ray showed excellent alignment without complications. Thorough irrigation completed. Percutaneous incisions closed with 4 nylon. Medial sesamoidectomy incision closed with 3-0 Vicryl and 3-0 Monocryl. Sterile dressings were applied. Patient was placed in the postoperative boot and brought to PACU in stable fashion. No complications to report
