adunlap23
Guru
IS this enough to assign 25337? Or is it included in the spur removal?
Post op diagnosis:
1. Distal Ulna bone spur
2. RT small finger extensor tendon rupture
3. RT ring finger extensor tendon rupture
4. RT middle finger extensor tendon rupture
5. RT distal ulna subluxation w/erosion through capsule
Procedures:
1. RT small finger extensor tendon repair
2. RT ring finger extensor tendon repair
3. RT middle finger extensor tendon repair
4. RT distal ulna excision bone spur
5. RT distal ulna imbrication of dorsal capsule
Op note:
"I made a longitudinal incision in line with the patient's previous incision. I extended this slightly proximally and distally. Dissection was carried down through the skin and subcutaneous tissues. I incised the extensor retinaculum of the fourth extensor compartment. I identified three tendon stumps. These were ruptured but not significantly displaced.
Directly over the area of the rupture there was erosion of the distal ulna through the dorsal capsule. I identified the distal ulna. With a rongeur and rasp i shaved the sharp edge done and made it smooth. I then elevated soft tissue flaps dorsally and I sewed the extensor retinaculum and dorsal capsule layer with a layered closure. I sewed this tightly. I used 4-0 moncryl on the deeper tissue and then I used a 3-0 Mersilene stitch in a figure of eight fashion to completely close the capsule over the distal ulna. this resulted in a good secure closure with imbrication of the dorsal capsule.
Attention was focused on extensor tendon repair. I identified a slip which was a separate slip going to the sall finger of the EDC tendon. I was able to mobilize this, and this did mobilize well. I felt this amendable to primary repair. After I trimmed this back to fresh healthy tissue, there was no signifigant tension on the repair. This was repaired with a 6-0 prolene running epitendinous stich followed by 4-0 fiberwire locking adelaide repair.
Attention was focused on the ring finger. Likewise, he had a slip to the ring finger which was ruptured as well. I trimmed this back to fresh healthy tissue, and I was able to also primarily repair this with minimal tension. this was repaired with 6-0 prolene running epitendinous stitch followed by 4-0 fiber wire locking adelaide repair.
The patient also had another slip which was to the middle finger which was ruptured as well. I trimmed this back to fresh healthy tissue. This was slightly tight, but i was also able to primarily repair this with a kessler stitch bringing the tendonds together followed by a 3-0 mersilene locking adelaide stitch. This resulted in excellent stability of the tendons."
He goes on to detail the closure of the surgical wound.
Post op diagnosis:
1. Distal Ulna bone spur
2. RT small finger extensor tendon rupture
3. RT ring finger extensor tendon rupture
4. RT middle finger extensor tendon rupture
5. RT distal ulna subluxation w/erosion through capsule
Procedures:
1. RT small finger extensor tendon repair
2. RT ring finger extensor tendon repair
3. RT middle finger extensor tendon repair
4. RT distal ulna excision bone spur
5. RT distal ulna imbrication of dorsal capsule
Op note:
"I made a longitudinal incision in line with the patient's previous incision. I extended this slightly proximally and distally. Dissection was carried down through the skin and subcutaneous tissues. I incised the extensor retinaculum of the fourth extensor compartment. I identified three tendon stumps. These were ruptured but not significantly displaced.
Directly over the area of the rupture there was erosion of the distal ulna through the dorsal capsule. I identified the distal ulna. With a rongeur and rasp i shaved the sharp edge done and made it smooth. I then elevated soft tissue flaps dorsally and I sewed the extensor retinaculum and dorsal capsule layer with a layered closure. I sewed this tightly. I used 4-0 moncryl on the deeper tissue and then I used a 3-0 Mersilene stitch in a figure of eight fashion to completely close the capsule over the distal ulna. this resulted in a good secure closure with imbrication of the dorsal capsule.
Attention was focused on extensor tendon repair. I identified a slip which was a separate slip going to the sall finger of the EDC tendon. I was able to mobilize this, and this did mobilize well. I felt this amendable to primary repair. After I trimmed this back to fresh healthy tissue, there was no signifigant tension on the repair. This was repaired with a 6-0 prolene running epitendinous stich followed by 4-0 fiberwire locking adelaide repair.
Attention was focused on the ring finger. Likewise, he had a slip to the ring finger which was ruptured as well. I trimmed this back to fresh healthy tissue, and I was able to also primarily repair this with minimal tension. this was repaired with 6-0 prolene running epitendinous stitch followed by 4-0 fiber wire locking adelaide repair.
The patient also had another slip which was to the middle finger which was ruptured as well. I trimmed this back to fresh healthy tissue. This was slightly tight, but i was also able to primarily repair this with a kessler stitch bringing the tendonds together followed by a 3-0 mersilene locking adelaide stitch. This resulted in excellent stability of the tendons."
He goes on to detail the closure of the surgical wound.
Last edited: