Cats3
Contributor
I am at a loss on this. is there anyone that is able to help me with this? I currently have 28110, 28308, 28297, 28270, 28730, but I am not sure!!
Progressive flatfoot deformity, right foot, with midfoot arthritis, hallux valgus, clawing of the 2nd and 3rd toes, bunionette deformity.
POSTOP DIAGNOSIS:
Progressive flatfoot deformity, right foot, with midfoot arthritis, hallux valgus, clawing of the 2nd and 3rd toes, bunionette deformity.
PROCEDURE:
Right midfoot fusion, Lapidus bunionectomy, 2nd and 5th metatarsal osteotomy, excision bunionette, correction of claw toes 2 and 3.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room after preop discussion of risks and benefits of the procedure including damage to nerves and blood vessels, infection, and incomplete relief from pain; understanding there were no guarantees as well as her ongoing complaints of pain, difficulty with shoe wear, the patient consented to the outlined procedure, recognizing the extended recovery period. After adequate general anesthesia, preoperative regional anesthesia, and preoperative prophylactic antibiotics, the patient's right lower extremity was exsanguinated with an Esmarch bandage and tourniquet inflated to 250 mmHg. The limb was then prepped with an alcohol prep, followed by ChloraPrep prepping and draped in a normal sterile fashion. An incision was made between the 1st and 2nd interspace in the midfoot. Dissection was carried down through the subcutaneous tissue. Bleeding was controlled with electrocautery. The dorsal neurovascular bundle was identified and protected. Degenerative changes of the midfoot were easily exposed. There the degenerative changes of the anterior tibial tendon. The extensor tendons were then mobilized. The base of the 1st TMT joint, intertarsal joint, base of the 2nd metatarsal, base of the 3rd metatarsal were all individually isolated. Ultimately, a 2nd dorsal incision was made to improve access to the 3rd metatarsal. Each of these joints were then scarified, multiple trephined. Peripheral osteophytes were removed and because of the flatfoot deformity, the bone graft was then wedged into the 1st and 2nd metatarsals harvested from various osteotomy sites and the debrided exostosis. The forefoot was held in a corrected position with K-wires and then formally stabilized with screw fixation. The intercuneiform joints were fused with a 3.5 screw going from the 1st to the 2nd into the 3rd cuneiform. The 1st TMT joint was secured with 2 screws, 1 from the 1st to the 1st cuneiform and an oblique one into the 2nd and into the adjoining cuneiform. Two 7 screws were used to fuse the 2nd and 3rd TMT joints. Besides the bone graft, the DBX was injected into the dorsal osteotomies. An incision was made over the 5th metatarsal, capsule was incised. A prominent lateral eminence was removed, used as bone graft, and then a chevron osteotomy was made in the 5th metatarsal, pushing the head in a tibial direction. Excess bone was then removed. Capsule was repaired with 2-0 Vicryl. Skin closed with 3-0 nylon. An incision was made in the 2nd interspace, allowing exposure of the 2nd and 3rd metatarsals. Capsular release was then performed. The long extensor was lengthened in both cases. The 2nd metatarsal was then fully exposed and an oblique osteotomy was then made to shorten the metatarsal. This was also used as bone graft. The long extensors were then repaired with 4-0 Vicryl as was the capsule. An oblique incision was made over the 1st MTP joint. The dorsal sensory nerve was identified. The capsule was opened in a V-shaped fashion. The medial eminence as well as a dorsal cheilus were then removed. All this extra bone was used as bone graft. The toe was held in a corrected position, capsule repaired with 2-0 Vicryl. After screw fixation and K-wires were removed, the tourniquet was released. Bleeding was controlled with electrocautery. Skin incisions were closed with 3-0 nylon. A bulky sterile dressing was applied. The patient was returned to postanesthesia room in satisfactory condition. Intraoperative radiographs show correction of flatfoot deformity with midfoot fusion, shortening of the 2nd metatarsal, closing of the interspace of the 5th metatarsal, improved clinical alignment with acceptable screw fixation of the midfoot.
Progressive flatfoot deformity, right foot, with midfoot arthritis, hallux valgus, clawing of the 2nd and 3rd toes, bunionette deformity.
POSTOP DIAGNOSIS:
Progressive flatfoot deformity, right foot, with midfoot arthritis, hallux valgus, clawing of the 2nd and 3rd toes, bunionette deformity.
PROCEDURE:
Right midfoot fusion, Lapidus bunionectomy, 2nd and 5th metatarsal osteotomy, excision bunionette, correction of claw toes 2 and 3.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room after preop discussion of risks and benefits of the procedure including damage to nerves and blood vessels, infection, and incomplete relief from pain; understanding there were no guarantees as well as her ongoing complaints of pain, difficulty with shoe wear, the patient consented to the outlined procedure, recognizing the extended recovery period. After adequate general anesthesia, preoperative regional anesthesia, and preoperative prophylactic antibiotics, the patient's right lower extremity was exsanguinated with an Esmarch bandage and tourniquet inflated to 250 mmHg. The limb was then prepped with an alcohol prep, followed by ChloraPrep prepping and draped in a normal sterile fashion. An incision was made between the 1st and 2nd interspace in the midfoot. Dissection was carried down through the subcutaneous tissue. Bleeding was controlled with electrocautery. The dorsal neurovascular bundle was identified and protected. Degenerative changes of the midfoot were easily exposed. There the degenerative changes of the anterior tibial tendon. The extensor tendons were then mobilized. The base of the 1st TMT joint, intertarsal joint, base of the 2nd metatarsal, base of the 3rd metatarsal were all individually isolated. Ultimately, a 2nd dorsal incision was made to improve access to the 3rd metatarsal. Each of these joints were then scarified, multiple trephined. Peripheral osteophytes were removed and because of the flatfoot deformity, the bone graft was then wedged into the 1st and 2nd metatarsals harvested from various osteotomy sites and the debrided exostosis. The forefoot was held in a corrected position with K-wires and then formally stabilized with screw fixation. The intercuneiform joints were fused with a 3.5 screw going from the 1st to the 2nd into the 3rd cuneiform. The 1st TMT joint was secured with 2 screws, 1 from the 1st to the 1st cuneiform and an oblique one into the 2nd and into the adjoining cuneiform. Two 7 screws were used to fuse the 2nd and 3rd TMT joints. Besides the bone graft, the DBX was injected into the dorsal osteotomies. An incision was made over the 5th metatarsal, capsule was incised. A prominent lateral eminence was removed, used as bone graft, and then a chevron osteotomy was made in the 5th metatarsal, pushing the head in a tibial direction. Excess bone was then removed. Capsule was repaired with 2-0 Vicryl. Skin closed with 3-0 nylon. An incision was made in the 2nd interspace, allowing exposure of the 2nd and 3rd metatarsals. Capsular release was then performed. The long extensor was lengthened in both cases. The 2nd metatarsal was then fully exposed and an oblique osteotomy was then made to shorten the metatarsal. This was also used as bone graft. The long extensors were then repaired with 4-0 Vicryl as was the capsule. An oblique incision was made over the 1st MTP joint. The dorsal sensory nerve was identified. The capsule was opened in a V-shaped fashion. The medial eminence as well as a dorsal cheilus were then removed. All this extra bone was used as bone graft. The toe was held in a corrected position, capsule repaired with 2-0 Vicryl. After screw fixation and K-wires were removed, the tourniquet was released. Bleeding was controlled with electrocautery. Skin incisions were closed with 3-0 nylon. A bulky sterile dressing was applied. The patient was returned to postanesthesia room in satisfactory condition. Intraoperative radiographs show correction of flatfoot deformity with midfoot fusion, shortening of the 2nd metatarsal, closing of the interspace of the 5th metatarsal, improved clinical alignment with acceptable screw fixation of the midfoot.